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Marur S, Forastiere AA. Update on role of chemotherapy in head and neck squamous cell cancer. Indian J Surg Oncol 2010; 1:85-95. [PMID: 22930623 PMCID: PMC3421005 DOI: 10.1007/s13193-010-0021-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 06/07/2010] [Indexed: 12/31/2022] Open
Abstract
Head and neck squamous cell cancer (HNSCC) is most commonly a tobacco-related disease, affecting nearly 600,000 people worldwide each year. For decades, HNSCC has been treated successfully with multimodality treatments including, surgery, radiation, and chemotherapy, though the 'perfect' treatment paradigm remains elusive. This review will discuss a number of clinical trials, comparing various combinations of chemotherapy and the settings in which they are most successful. Promising research and recent data on the combination of cytotoxic chemotherapy with new biological agents indicate chemotherapy plays a critical role in treatment of HNSCC and will only continue to improve.
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Affiliation(s)
- S. Marur
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Bunting-Blaustein CRB1 G92 1650 Orleans Street, Baltimore, MD 21231-1000 USA
| | - A. A. Forastiere
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Bunting-Blaustein CRB1 G92 1650 Orleans Street, Baltimore, MD 21231-1000 USA
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Evolution of clinical trials in head and neck cancer. Crit Rev Oncol Hematol 2009; 71:29-42. [DOI: 10.1016/j.critrevonc.2008.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 08/18/2008] [Accepted: 09/17/2008] [Indexed: 12/14/2022] Open
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Wu FY, Yang ES, Willey CD, Ely K, Garrett G, Cmelak AJ. Refractory lympho-epithelial carcinoma of the nasopharynx: a case report illustrating a protracted clinical course. HEAD & NECK ONCOLOGY 2009; 1:18. [PMID: 19527509 PMCID: PMC2704192 DOI: 10.1186/1758-3284-1-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 06/15/2009] [Indexed: 12/13/2022]
Abstract
Nasopharyngeal carcinoma is an uncommon cancer in North America. Its clinical course is typified by locally advanced disease at diagnosis and has a high propensity for both regional and distant spread. It is, therefore, typically treated with a combination of radiation and chemotherapy. This report describes our 10-year clinical and radiological findings in a 48-year-old Vietnamese male patient with locally-advanced T4N1M0 lympho-epithelial carcinoma of the nasopharynx. Despite a long remission period after his initial course of aggressive chemoradiation, his tumor recurred locally after 4 years. Thereafter, throughout a period of over 10 years, he has been treated with multiple courses of re-irradiation and three different trials of chemotherapy. He was ultimately provided with over 30 months of progression-free tumor control with the epidermal growth factor receptor (EGFR)-inhibitor cetuximab. This case illustrates the commonly protracted course of this disease and its responsiveness to multiple treatment modalities.
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Affiliation(s)
- Frederick Y Wu
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA, USA
| | - Eddy S Yang
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Christopher D Willey
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kim Ely
- Department of Pathology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Gaelyn Garrett
- Department of Otolaryngology, Voice Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Anthony J Cmelak
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN, USA
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Le QT, Raben D. Integrating biologically targeted therapy in head and neck squamous cell carcinomas. Semin Radiat Oncol 2009; 19:53-62. [PMID: 19028346 DOI: 10.1016/j.semradonc.2008.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The integration of targeted therapies such as cetuximab to radiation therapy has revolutionized the management of head and neck cancers in the last decade. However, the use of targeted therapies raised several clinically relevant questions that have yet to be answered. These questions include the optimal patient and tumor profile for biologically targeted therapy, the optimal radiation fractionation to use with targeted therapies, how to integrate them into standard or new chemoradiation regimens, their schedule and duration of administration, their toxicity, and which direction to consider for novel targeted treatment. In this review, we highlight several of these important issues, discuss the clinical trials that are designed to address these issues, and introduce some novel targeted therapies that may contribute to the improvement of the therapeutic ratio for head and neck cancer therapy.
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Affiliation(s)
- Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305-5847, USA.
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Kim S, Grandis JR, Rinaldo A, Takes RP, Ferlito A. Emerging perspectives in epidermal growth factor receptor targeting in head and neck cancer. Head Neck 2008; 30:667-74. [PMID: 18383530 DOI: 10.1002/hed.20859] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The epidermal growth factor receptor (EGFR) has been shown to be a promising therapeutic target in head and neck cancer. Cetuximab, a monoclonal antibody against EGFR, has been approved in the United States for use with radiotherapy for head and neck squamous cell carcinoma. However, the role of EGFR targeting agents in other therapeutic modalities, such as combined chemoradiotherapy or induction chemotherapy, remains to be defined. Although results from several clinical trials have demonstrated the therapeutic potentials of EGFR targeting agents in these settings, further studies are necessary before definitive conclusions can be made. The concurrent targeting of EGFR along with other pathways important in carcinogenesis may hold significant therapeutic potential. In particular, several clinical trials are studying the effects of combining agents that target the vascular endothelial growth factor with EGFR inhibitors. Last, studies are ongoing to elucidate the predictive and correlative biomarkers in anti-EGFR therapy to allow for proper patient selection. In the case of cetuximab, these correlative biomarkers may include elements of the immune system in addition to the signal transduction proteins involved in EGFR pathway.
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Affiliation(s)
- Seungwon Kim
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Multidisciplinary Management of Locally Advanced SCCHN: Optimizing Treatment Outcomes. Oncologist 2008; 13:899-910. [DOI: 10.1634/theoncologist.2007-0157] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Specenier PM, Vermorken JB. Neoadjuvant chemotherapy in head and neck cancer: Should it be revisited? Cancer Lett 2007; 256:166-77. [PMID: 17673364 DOI: 10.1016/j.canlet.2007.06.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 06/16/2007] [Accepted: 06/20/2007] [Indexed: 11/23/2022]
Abstract
Locally advanced SCCHN (LA-SCCHN) is generally treated by a combination of chemotherapy, irradiation and/or surgery. Timing of the chemotherapy has for long been a matter of debate but concurrent chemoradiation was widely adopted as standard of care for locally advanced squamous cell carcinoma of the head and neck after the publication of a large meta-analysis which demonstrated that concurrent chemoradiation confers an absolute survival benefit of 8% at 2 and 5 years. Induction chemotherapy has some appealing advantages including the opportunity of assessing tumor response and selecting the patients who are candidates for organ preservation. The cisplatin-fluorouracil combination has been the induction regimen of choice for two decades but has recently been superseded by a combination of cisplatin, fluorouracil and a taxane which can be considered the standard regimen when induction chemotherapy is appropriate. Multiple large randomized trials designed to compare sequential induction, i.e., chemotherapy followed by CRT to CRT alone are currently underway. New challenges are the integration of targeted therapies into the current treatment strategies and the identification of prognostic biomarkers and of factors predicting the response to treatment which would help to select patients who are likely to benefit most from induction chemotherapy.
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Affiliation(s)
- Pol M Specenier
- Department of Medical Oncology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
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Gebbia V, Giuliani F, Valori VM, Agueli R, Colucci G, Maiello E. Cetuximab in squamous cell head and neck carcinomas. Ann Oncol 2007; 18 Suppl 6:vi5-7. [PMID: 17591832 DOI: 10.1093/annonc/mdm215] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The epidermal growth factor receptor (EGFR) antagonist, cetuximab, has recently been shown to enhance the effects of radiotherapy, and reports to date indicate that this effect occurs without any change in the pattern and severity of toxicity usually associated with head and neck radiation and/or chemotherapy (CT) administration. Moreover, several studies have reported that the expression of EGFR is strongly linked to poor outcome in patients undergoing therapy. Therefore, the presence of the EGFR in almost all cases of head and neck carcinoma offers a new therapeutic opportunity to most patients. In this paper, we report a review of the major studies dealing with the use of cetuximab in advanced head and neck cancer.
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Affiliation(s)
- V Gebbia
- Medical Oncology Unit, La Maddalena Hospital, Palermo, Italy.
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Specenier P, Vermorken JB. The role of taxanes and targeted therapies in locally advanced head and neck cancer. Curr Opin Oncol 2007; 19:195-201. [PMID: 17414636 DOI: 10.1097/cco.0b013e3280f00fe7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW This review presents new data on the role of taxanes and targeted therapies in the management of squamous cell carcinoma of the head and neck. RECENT FINDINGS Taxane-containing triplets are clearly superior as an induction regimen in locally advanced squamous cell carcinoma of the head and neck when compared with cisplatin/5 fluorouracil which has been the standard for two decades. Preliminary data suggest that the addition of a taxane to cisplatin/5 fluorouracil as induction regimen followed by chemoradiation may be superior to chemoradiation alone. The addition of cetuximab to radiation prolongs locoregional control and survival without increasing mucositis. Areas of active investigation are the search for epidermal growth factor receptor mutations and the optimal way of integrating epidermal growth factor receptor-directed therapies into standard management. Meanwhile new targets are explored. SUMMARY Taxane/cisplatin/5 fluorouracil induction chemotherapy is clearly superior to cisplatin/5 fluorouracil. Epidermal growth factor receptor directed therapies can safely be combined with radiation and the combination shows encouraging results.
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Affiliation(s)
- Pol Specenier
- Department of Medical Oncology, University Hospital Antwerp, Edegem, Belgium.
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Abstract
Approaches to the treatment of locally advanced and recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN) have been limited by their toxicity. Effective, better tolerated approaches are urgently required. Cetuximab is an immunoglobulin G(1) monoclonal antibody that specifically targets the epidermal growth factor receptor (EGFR), which is commonly expressed in a number of solid tumors, including SCCHN, where it is associated with poor prognosis. Cetuximab is approved in 56 countries for use in the treatment of EGFR-expressing metastatic colorectal cancer that has progressed on irinotecan-containing therapy and has recently received approval in Europe and the USA for use in the treatment of SCCHN. A randomized Phase III study has demonstrated that cetuximab plus radiotherapy can significantly improve locoregional control and prolong overall survival compared with radiotherapy alone. Cetuximab has also been confirmed to be effective as monotherapy in recurrent and/or metastatic SCCHN that has progressed on platinum-containing therapy. Clinical studies have demonstrated that cetuximab is well tolerated and does not significantly increase the side effects associated with radiotherapy or chemotherapy. This article presents the rationale for EGFR inhibition in the management of head and neck cancers, and the preclinical and clinical evidence for the use of cetuximab in the treatment of SCCHN.
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Affiliation(s)
- Jacques Bernier
- Genolier Swiss Medical Network, Department of Radiation Oncology, CH-1272 Genolier, Switzerland.
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