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Revisiting Induction Chemotherapy for Head and Neck Cancer

Revisiting Induction Chemotherapy for Head and Neck Cancer

ABSTRACT: Squamous cell carcinomas of the head and neck are highly responsive to induction chemotherapy. However, randomized trials have failed to demonstrate a survival advantage with the addition of induction chemotherapy to locoregional therapy consisting of surgery and/or radiation therapy. Currently, concomitant radiation and chemotherapy has emerged as a standard and has optimized locoregional control in head and neck cancer. In this setting, the addition of induction chemotherapy may further improve outcome by enhancing both locoregional and distant control. As interest in induction regimens is renewed, we elected to conduct a systematic review of trials of induction chemotherapy for locoregionally advanced head and neck cancer. The most studied combination— cisplatin plus fluorouracil (5-FU)—achieves objective response rates of about 80%. In a meta-analysis, induction with platinum/ 5-FU resulted in a small survival advantage over locoregional therapy alone. The introduction of a taxane into induction chemotherapy regimens has produced promising results. Induction chemotherapy should be the subject of further clinical research in head and neck cancer. Randomized clinical trials in which the control arm is concurrent chemoradiotherapy and the experimental arm is induction chemotherapy followed by concurrent chemoradiotherapy are planned. Platinum/taxane combinations are the preferred regimens for further study in the induction setting and a suitable platform with which to investigate the addition of novel targeted agents.

The full text of this article, which is abstracted at right, appeared in last month's issue of ONCOLOGY (19:759-770, 2005). Herewith, we present the complete reference list for the article, as well as a trio of commentaries: one by Drs. Michael Gibson and Arlene Forastiere; another by Drs. Su Hsien Lim, Yungpo Bernard Su, and David Pfister; and a third by Drs. Bruce Brockstein and Everett Vokes. A complete version, incorporating both published parts, has been posted online at www.cancernetwork.com/journals/ oncology/200505/Argiris.pdf.

Disclosures

The author(s) have no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.

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