Pharmacotherapy of head and neck squamous cell carcinoma

Background: The clinical management of locally advanced head and neck squamous cell carcinoma (HNSCC) is a challenging problem and requires a multidisciplinary approach. Historically, locally advanced HNSCC has been primarily managed with surgery and radiation (RT). The integration of pharmacotherapy has rapidly expanded over the years into the multimodality treatment paradigm of locally advanced HNSCC. Objective: The studies leading to the adoption of the current standard of care for locally advanced HNSCC are discussed. In addition, the limitations of these various treatment approaches are presented. Methods: An extensive literature search was conducted using the PubMed database for studies published before January 2009. The keywords used for this search were: head and neck neoplasms, chemoradiation, adjuvant chemotherapy, induction chemotherapy, EGFR inhibitor, cisplatin, carboplatin, paclitaxel, docetaxel, 5-fluorouracil, and cetuximab. Publications of randomized clinical trials and other supporting references leading to the current standard of care were particularly selected and discussed in this review. Conclusions: Various single-agent and multi-agent chemotherapeutic regimens have been examined in the context of randomized clinical trials in locally advanced HNSCC for definitive, induction and adjuvant settings. Results from these clinical trials support the use of cisplatin-based chemoradiation as the standard of care for the definitive and adjuvant settings. Recent evidence indicates that cetuximab, an epidermal growth factor receptor (EGFR) inhibitor, is highly active as a single agent and in combination with standard chemotherapy and/or RT. Future studies should focus to determine the optimal pharmacotherapeutic regimens for use in locally advanced HNSCC.