Induction chemotherapy for advanced head and neck cancers: A literature review

Abstract

Induction chemotherapy before surgery and/or radiotherapy for previously untreated head and neck carcinoma results in greater response rates than chemotherapy for recurrent head and neck carcinomas. Its theoretical advantages are presented. Most studies using induction chemotherapy are nonrandomized, uncontrolled pilot efforts. Multiple-drug regimens result in greater response rates than single agents, and multiple courses result in greater response rates than single courses. Prognostic factors are discussed. Toxicities are tolerable, except for several reported regimens combining cisplatin, bleomycin, and methotrexate. Induction chemotherapy for head and neck cancer is promising and needs further studies with controlled, randomized trials with long-term follow-up.

Predictive factors of a complete response to and adverse effects of a CDDP-5FU combination as primary therapy for head and neck aquamous carcinomas

“…Recent advances in combination chemotherapy for the treatment of recurrent or metastatic carcinoma of the head and neck, as well as the low survival rates and substantial anatomical and functional defects obtained with the standard management of surgery plus radiation therapy, have sparked interest in protocols using induction chemotherapy (IC) for large-volume tumours (Al-Sarraf, 1988;Chan, 1988). Among various protocols studied, the combination regimen of cf's-diamminedichloroplatin and 5-fluorouracil (CDDP-5FU) developed at Wayne State University has shown promising results, with complete response rates in the range of 25-50 per cent (Al-Sarraf, 1988).…”

Recent Advances of Curative Chemotherapeutic Management of Head and Neck Cancer

“…The main reasons for this concept are: -The better response rates in previously untreated patients probably caused by the better vascularization of unaltered tumor tissue, -the hope to make primary unresectablc tumors resectable or to facilitate the resection of primary resectable tumors by tumor down-staging, -the hope of increasing the tumor sensitivity to radiotherapy by decreasing tumor size and the number of hypoxic cells, and -the possibility of eradicating subclinical metastases. Concerning the best form of induction chemotherapy one can say following: -Multi-drug regimens produce higher response rates than single agents [3], -The clinical complete response rates as well as the histologi cal complete response rates of cisplatin and 5-fluorouracil are higher than with all other combinations [4], -Recent results show that additional folinic acid can increase the efficacy of cisplatin/5-FU, especially the complete response rate [5,6]. -Carboplatin, a second generation platinum analog, shows in combination with 5-FU an activity comparable to cisplatin/ 5-FU in previously untreated patients, but less toxicity [7], However, the success of induction chemotherapy, should also be measured by increased disease-free survival rates and not only by response rates and toxicity.…”

Editorial. Induction chemotherapy for advanced head and neck cancer

“…'.2 In this issue of Head & Neck Surgery, Chang presents a comprehensive review of the literature on induction chemotherapy for advanced head and neck ~a n c e r .~ The selection of chemotherapeutic agents for induction regimens has primarily evolved from experience with single-agent (methotrexate, bleomycin, or cisplatin) and combination regimens (cisplatin plus bleomycin, cisplatin plus bleomycin plus methotrexate, cisplatin plus bleomycin plus vinca alkaloid, a noncisplatin-containing regimen, or cisplatin plus 5-Auorouracil infusion). '- 3 Chang's review clearly shows that previously untreated patients respond much more frequently to chemotherapy, and more often achieve complete responses, than do patients with recurrent tumor treated with surgery and/or r a d i~t h e r a p y .~ Furthermore, combination regimens proved to be superior to single agents in induction protocols. Complete and partial responses of 60 to 90%, respectively, were obtained with a variety of combination regimens.…”