Recurrent head and neck cancer: current treatment and future prospects

Abstract

Recurrent and metastatic squamous cell carcinoma of the head and neck still carries a poor prognosis. Response rates with combination chemotherapy regimens are generally higher than those observed with single-agent chemotherapy. However, this did not translate into an overall survival benefit, not in even a single randomized trial. As none of the combination chemotherapy regimens demonstrated an overall survival benefit when compared with single-agent methotrexate, cisplatin or 5-fluorouracil, the use of combination chemotherapy outside clinical trials is usually restricted to younger patients with a good performance status and with symptomatic disease who require prompt symptom relief. After decades without real progress, a recent randomized trial showed that adding cetuximab, the first clinically available EGF receptor-directed monoclonal antibody, to a standard chemotherapy regimen (platinum/5-fluorouracil), led to an important survival benefit. In addition, the response rate nearly doubled with this approach, which has great promise for the treatment of symptomatic disease. There is now a plethora of targeted therapies in various stages of preclinical and clinical development. The next challenge will be to sort out which of them have a clinically meaningful activity and find out how to incorporate them into existing treatment regimens.

Keywords::

• chemotherapy
• head and neck cancer
• recurrent disease
• metastatic disease
• palliative treatment
• targeted therapies
• EGFR

Financial & competing interests disclosure

Jan B Vermorken participated in Advisory Boards on Head and Neck Cancer of Merck-Serono, Amgen, Sanofi-Aventis, Lilly, Boehringer-Ingelheim and Genmab and received honoraria from Merck-Serono and Sanofi-Aventis for scientific presentations. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.