Editor: Marshall R. Posner
Publisher: CMPMedica, 2006
Chemotherapy, as part of a multi-disciplinary and multi-modality approach, has become the standard of care for the treatment of locally advanced squamous cell cancer of the head and neck.
Until recently, chemotherapy has been delivered as either induction chemotherapy, also known as neoadjuvant therapy, or in combination with radiotherapy as chemoradiotherapy (CRT). Although induction chemotherapy with cisplatinum and 5-fluorouracil (PF) is effective in improving survival, patients treated with induction chemotherapy have a high rate of local-regional failure despite a reduced rate of distant failure. CRT has improved survival by reducing local-regional failure, with no improvement in control of distant disease.
To optimize therapy, sequential therapy approaches, combining induction chemotherapy, CRT, and surgery have been developed. In addition, recent advances in induction chemotherapy, namely the demonstration that a three drug induction chemotherapy regimen with docetaxel, cisplatinum, and 5-fluorouracil (TPF) is significantly more effective than PF, has increased interest and optimism regarding the potential gains of induction chemotherapy, as a sequential therapy approach.
Preliminary data support the use of sequential therapy in patients with poor-prognosis head and neck, and a phase III trial with this schedule shows highly encouraging improvements in survival, lessened toxicity, and a significant advantage to TPF in this setting. The different treatment paradigms of sequential therapy and CRT are being compared in phase III studies. TPF has replaced PF as the standard for induction chemotherapy, and sequential therapy represents an acceptable standard of care for patients with curable, locally advanced head and neck cancer.
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