Consensus recommendations for management of head and neck cancer in Asian countries: A review of international guidelines

Abstract

Head and neck cancer (HNC) is a disease of the upper aerodigestive tract and is one of the most frequently diagnosed cancers worldwide. A high rate of cancers involving the head and neck are reported across the Asian region, with notable variations between countries. Disease prognosis is largely dependent on tumor stage and site. Patients with early stage disease have a 60-95% chance of cure with local therapy. Early diagnosis and appropriate treatment are important to increase the likelihood of cure and survival. However, the majority of patients present with locally advanced disease and require multimodality treatment. This necessitates, a multidisciplinary approach which is essential to make appropriate treatment decisions, particularly with regards to tolerability, costs, available infrastructure and quality of life issues. Unfortunately, majority of the studies that dictate current practice have been developed in the west where diseases biology, patient population and available infrastructure are very different from those in the Asian continent. With this in mind an expert panel of Head and Neck Oncologists was convened in May 2012 to review the National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO) clinical practice guidelines and develop practical recommendations on the applicability of these guidelines on the management of head and neck cancer for Asian patients. The objective of this review and consensus meeting was to suggest revisions, to account for potential differences in demographics and resources, to the NCCN and ESMO guidelines, to better reflect current clinical management of head and neck cancer within the Asian region for health care providers. These recommendations, which reflect best clinical practice within Asia, are expected to benefit practitioners when making decisions regarding optimal treatment strategies for their patients.

A randomized phase 3 trial comparing nimotuzumab plus cisplatin chemoradiotherapy versus cisplatin chemoradiotherapy alone in locally advanced head and neck cancer

“…Seventy percent of patients in that study had primary tumors in the oropharynx, and only 27% of these were HPV-negative. [33][34][35][36][37] This use as routine practice is reflected in Asian guidelines, 38 Indian Council of Medical Research (ICMR) guidelines, 39 the evidence-based guidelines of TMC, 40 and in multiple randomized studies from this region. Compared with those findings, in our study, these characteristics were present in the majority of patients (Table 1).…”

Pembrolizumab in Asia‐Pacific patients with advanced head and neck squamous cell carcinoma: Analyses from KEYNOTE‐012

“…[6][7][8] In Asia, a multimodal approach that combines platinum-based chemotherapy, radiotherapy, and another agent (preferably cetuximab), is recommended for the treatment of patients with recurrent/ metastatic HNSCC. 9 However, the concomitant use of cisplatin and cetuximab in advanced HNSCC is associated with substantial toxicity, 10 and therefore its use is limited in vulnerable populations, such as the elderly. 9 Although there are no standard alternatives, other commonly used second-line treatments (eg, methotrexate or taxanes) are often plagued by low response rates (ranging from 3% to 13%).…”

“…9 However, the concomitant use of cisplatin and cetuximab in advanced HNSCC is associated with substantial toxicity, 10 and therefore its use is limited in vulnerable populations, such as the elderly. 9 Although there are no standard alternatives, other commonly used second-line treatments (eg, methotrexate or taxanes) are often plagued by low response rates (ranging from 3% to 13%). 5,11 Thus, there is an unmet need in recurrent/metastatic HNSCC for treatment options that are both well tolerated and effective.…”

Asian and non‐Asian disparities in outcomes of non‐nasopharyngeal head and neck cancer

“…Racial disparities in cancer have been previously described in the setting of NPC, where the superior prognosis among the Asian population was attributed at least in part to regional differences in screening strategies as well as earlier and more aggressive management approaches . Likewise, a number of studies of non‐nasopharyngeal HNC have also documented worse outcomes in blacks when compared to whites, but the poorer survival was felt to be secondary to socioeconomic barriers that lead to suboptimal access to health care and less timely treatments …”