Systemic therapy in the curative treatment of head and neck squamous cell cancer: a systematic review
Abstract Objective To review the available evidence and make recommendations regarding use of systemically administered drugs in combination or in sequence with radiation (RT) and/or surgery for cure and/or organ preservation in patients with locally advanced nonmetastatic (Stage III to IVB) squamou...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2017-04-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
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| Online Access: | http://link.springer.com/article/10.1186/s40463-017-0199-x |
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| author | Eric Winquist Chika Agbassi Brandon M. Meyers John Yoo Kelvin K. W. Chan the Head and Neck Disease Site Group |
| author_facet | Eric Winquist Chika Agbassi Brandon M. Meyers John Yoo Kelvin K. W. Chan the Head and Neck Disease Site Group |
| author_sort | Eric Winquist |
| collection | DOAJ |
| description | Abstract Objective To review the available evidence and make recommendations regarding use of systemically administered drugs in combination or in sequence with radiation (RT) and/or surgery for cure and/or organ preservation in patients with locally advanced nonmetastatic (Stage III to IVB) squamous cell carcinoma of the head and neck (LASCCHN). Method Recognizing the Meta-analysis of Chemotherapy in Head and Neck Cancer (MACH-NC) group reports have de facto guided practice since 2000, we searched for systematic reviews in the MEDLINE, EMBASE and Cochrane Database of Systematic Reviews published from January 2000 to February 2015 in reference to 4 research questions. A search was also conducted for randomized trials (RCTs) up to February 2015 not included in the meta-analyses. Result The MACH-NC reports, 5 additional meta-analyses, and 30 RCTs not included by MACH-NC were identified. For chemotherapy, MACH-NC findings showing improved overall survival with concomitant chemoRT did not require modification. High-dose cisplatin was most commonly studied. We confirmed this benefit with cisplatin monotherapy in patients treated with with postoperative concurrent chemoRT. Other than cetuximab, no targeted agents and radiosensitizers studied in RCTs were shown effective. TPF induction chemotherapy was superior to PF for tumor response and larynx preservation but not survival. Larynx preservation was reported with both CRT and induction chemotherapy approaches. Conclusion ChemoRT with cisplatin at least 40 mg/m2 per week given as radical or postoperative adjuvant remains a standard treatment approach for LASCCHN that improves overall survival but increases toxicity. 5-FU plus platinum is supported by less data but may be a reasonable alternative for patients unsuitable for cisplatin. Of note, stratification of outcomes by HPV-status was not available but outcomes for oropharynx cancer appeared similar to other subsites in chemoRT RCTs. No RCTs have yet demonstrated superiority or non-inferiority of cetuximab-RT to CRT. In view of this, cetuximab-RT is suggested only for patients not candidates for CRT. Taxane-based triplet induction chemotherapy is superior to doublets for rapid tumour downsizing and for larynx preservation, but does not improve overall survival and should be used with primary G-CSF prophylaxis. Further investigation of induction approaches for larynx preservation may be warranted. |
| format | Article |
| id | doaj-art-719d47d1c4af4030a5d3ce0f5d90c07e |
| institution | Kabale University |
| issn | 1916-0216 |
| language | English |
| publishDate | 2017-04-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj-art-719d47d1c4af4030a5d3ce0f5d90c07e2025-01-02T04:59:12ZengSAGE PublishingJournal of Otolaryngology - Head and Neck Surgery1916-02162017-04-0146111110.1186/s40463-017-0199-xSystemic therapy in the curative treatment of head and neck squamous cell cancer: a systematic reviewEric Winquist0Chika Agbassi1Brandon M. Meyers2John Yoo3Kelvin K. W. Chan4the Head and Neck Disease Site GroupDepartment of Oncology, Western University and London Health Science CentreDepartment of Oncology, McMaster University (Juravinski Hospital Site)Department of Oncology, McMaster University, Juravinski Cancer CentreDepartment of Otolaryngology-Head and Neck Surgery, Western University and London Health Sciences CentreSunnybrook Odette Cancer CentreAbstract Objective To review the available evidence and make recommendations regarding use of systemically administered drugs in combination or in sequence with radiation (RT) and/or surgery for cure and/or organ preservation in patients with locally advanced nonmetastatic (Stage III to IVB) squamous cell carcinoma of the head and neck (LASCCHN). Method Recognizing the Meta-analysis of Chemotherapy in Head and Neck Cancer (MACH-NC) group reports have de facto guided practice since 2000, we searched for systematic reviews in the MEDLINE, EMBASE and Cochrane Database of Systematic Reviews published from January 2000 to February 2015 in reference to 4 research questions. A search was also conducted for randomized trials (RCTs) up to February 2015 not included in the meta-analyses. Result The MACH-NC reports, 5 additional meta-analyses, and 30 RCTs not included by MACH-NC were identified. For chemotherapy, MACH-NC findings showing improved overall survival with concomitant chemoRT did not require modification. High-dose cisplatin was most commonly studied. We confirmed this benefit with cisplatin monotherapy in patients treated with with postoperative concurrent chemoRT. Other than cetuximab, no targeted agents and radiosensitizers studied in RCTs were shown effective. TPF induction chemotherapy was superior to PF for tumor response and larynx preservation but not survival. Larynx preservation was reported with both CRT and induction chemotherapy approaches. Conclusion ChemoRT with cisplatin at least 40 mg/m2 per week given as radical or postoperative adjuvant remains a standard treatment approach for LASCCHN that improves overall survival but increases toxicity. 5-FU plus platinum is supported by less data but may be a reasonable alternative for patients unsuitable for cisplatin. Of note, stratification of outcomes by HPV-status was not available but outcomes for oropharynx cancer appeared similar to other subsites in chemoRT RCTs. No RCTs have yet demonstrated superiority or non-inferiority of cetuximab-RT to CRT. In view of this, cetuximab-RT is suggested only for patients not candidates for CRT. Taxane-based triplet induction chemotherapy is superior to doublets for rapid tumour downsizing and for larynx preservation, but does not improve overall survival and should be used with primary G-CSF prophylaxis. Further investigation of induction approaches for larynx preservation may be warranted.http://link.springer.com/article/10.1186/s40463-017-0199-xSystematic reviewSquamous cell carcinomaHead and NeckHuman papilloma VirusLocally advancedSystemic chemotherapy |
| spellingShingle | Eric Winquist Chika Agbassi Brandon M. Meyers John Yoo Kelvin K. W. Chan the Head and Neck Disease Site Group Systemic therapy in the curative treatment of head and neck squamous cell cancer: a systematic review Journal of Otolaryngology - Head and Neck Surgery Systematic review Squamous cell carcinoma Head and Neck Human papilloma Virus Locally advanced Systemic chemotherapy |
| title | Systemic therapy in the curative treatment of head and neck squamous cell cancer: a systematic review |
| title_full | Systemic therapy in the curative treatment of head and neck squamous cell cancer: a systematic review |
| title_fullStr | Systemic therapy in the curative treatment of head and neck squamous cell cancer: a systematic review |
| title_full_unstemmed | Systemic therapy in the curative treatment of head and neck squamous cell cancer: a systematic review |
| title_short | Systemic therapy in the curative treatment of head and neck squamous cell cancer: a systematic review |
| title_sort | systemic therapy in the curative treatment of head and neck squamous cell cancer a systematic review |
| topic | Systematic review Squamous cell carcinoma Head and Neck Human papilloma Virus Locally advanced Systemic chemotherapy |
| url | http://link.springer.com/article/10.1186/s40463-017-0199-x |
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