The Role of Chemotherapy in the Management of Patients with Head and Neck Cancer

Abstract

Recent advances in the management of patients with head and neck cancer point to an expanding role of chemotherapy, resulting in an increased involvement of the medical oncologist in the multidisciplinary care of these patients. This review focuses on patients with squamous cell carcinoma of the oral cavity, pharynx, and larynx. A comprehensive review of the clinical trial data that have defined new standards of care and a detailed presentation of widely used chemotherapeutic regimens, including both cytotoxic and molecularly targeted agents, are presented. Information on human papilloma virusassociated squamous cell cancer of the head and neck is presented, and implications in the clinical management of this subgroup of patients based on the epidemiologic and pathologic characteristics are discussed.KEYWORDS: Cancer of the head and neck, chemotherapy, squamous cell carcinoma Approximately 48,000 new cases of head and neck cancer were expected in the United States in 2009 alone, 1 and more than 600,000 new cases will be diagnosed worldwide. Head and neck cancer accounts for 3 to 4% of all cancer diagnoses in Western countries, 2,3 and its incidence is higher in southeast Asia and in Africa where it accounts for 8 to 10% of all cancers. 4 Overall, head and neck cancer represents the eighth most common cause of cancer death.Historically, treatment of patients with squamous cell carcinoma of the head and neck (SSCHN) has primarily been driven by surgical interventions and continued advances in radiation therapy (RT) treatment planning and delivery. In this setting of complex treatment algorithms, recent advances in the management of patients with head and neck cancer point to an expanding role of chemotherapy and therefore an increased involvement of the medical oncologist in the multidisciplinary care of these patients.The scope of this review is to provide a comprehensive description of expanding chemotherapeutic options, including both cytotoxic and molecularly targeted agents, that are applicable to patients diagnosed with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx. Data on patients diagnosed with cancer of the nasopharynx will be presented separately because of its distinct etiology, pathology, and response to treatment modalities.Chemotherapy alone does not have curative potential. As a result, it does not have a defined role

The clinical significance of HOXA9 promoter hypermethylation in head and neck squamous cell carcinoma

“…Therapeutic procedures and prognosis differ substantially between early‐ and late‐stage HNSCC. Early‐stage HNSCC patients receive minimally invasive surgery or irradiation alone, with good outcomes, while late‐stage patients receive aggressive therapy, such as expanded surgery and/or concomitant chemoradiotherapy, resulting in dismal survival rates and poor quality of life . Screening for HNSCC depends on clinical symptoms and imaging examinations (laryngoscopy, computed tomography, magnetic resonance imaging, and positron emission tomography) and histopathological examination; however, owing to the non‐specificity of symptoms in early‐stage disease and ineffective conventional cancer‐related biomarkers, the early detection of HNSCC remains unsatisfactory.…”

Therapeutic strategies for systemic therapies of human papillomavirus‐related oropharyngeal cancer

“…For locoregionally advanced-stage disease (T3-4, N1-3, or fixed/matted nodes), systemic therapies are often integrated as part of a multimodality approach to potentiate the effect of definitive local/regional treatments. [10][11][12] In the incurable recurrent or metastatic setting, drug therapies are utilized to palliate symptoms, optimize disease control, and prolong survival.…”

The mechanisms of action of metformin on head and neck cancer in the pre-clinical setting: a scoping review

“…HNSCC and its treatment(s) have significant consequences on patients’ daily functions and quality of life. Despite recent advances in modern medicine, there remains a high risk of local recurrence and distant metastases ( 5 ). Treatment options for local recurrences are generally limited to salvage surgery with minimal improvement in overall survival rates ( 6 , 7 ).…”