Paradigm Shift in the Treatment of Head and Neck Cancer: The Role of Neoadjuvant Chemotherapy

Abstract

Abstract Learning Objectives After completing this course, the reader will be able to: Explain the need for chemotherapeutic treatment for patients with squamous cell carcinoma of the head and neck.Identify the role of neoadjuvant chemotherapy in the treatment of locally advanced squamous cell carcinoma of the head and neck.Discuss results of randomized trials evaluating taxane-based neoadjuvant chemotherapy for patients with unresectable locally advanced squamous cell carcinoma of the head and neck. Access and take the CME test online and receive 1 AMA PRA category 1 credit at CME.TheOncologist.com Chemotherapy is an integral component of the management of patients with locally advanced head and neck cancer, though the optimal use of chemotherapy remains to be defined. The combination of a platinum agent and 5-fluorouracil has been used as the standard neoadjuvant treatment and has been shown to permit organ preservation in operable patients and improve long-term survival outcomes in operable and inoperable patients. Recently, the addition of a taxane, docetaxel or paclitaxel, to standard platinum plus 5-fluorouracil induction chemotherapy has been shown to further improve response rates and survival outcomes. Phase III data are emerging to support combinations of docetaxel or paclitaxel with a platinum plus 5-fluorouracil as a new, more effective and less toxic standard for neoadjuvant chemotherapy. Sequential treatment regimens, incorporating a combination of induction chemotherapy and chemoradiation, are also under study in efforts to further improve long-term survival outcomes. Induction regimens incorporating docetaxel or paclitaxel with a platinum plus 5-fluorouracil are under evaluation in this setting. Randomized trials comparing a sequential treatment approach with standard therapies are also being undertaken and will likely define a new treatment paradigm for patients with locally advanced head and neck cancer.