Cetuximab-Taxanes-Platinum-Fluorouracil/Capecitabine (C-TPF/C-TPX) – a Feasible Option for Recurrent HNSCC with Negative Prognostic Factors. Literature Review with a Case Presentation

Abstract

Concurrent chemo-radiotherapy with Cisplatin is the standard treatment for locally advanced non-metastatic squamous cell carcinoma of the head and neck (HNSCC), but induction chemotherapy (IC) followed by chemo-irradiation, even controversial is a widely accepted option, especially in high-risk cases. A regimen including triple association (platinum-taxanes-fluorouracil) is generally considered superior in efficacy, but may be associated with severe toxicity. In the case of recurrence, the options are limited and the prognosis is generally unfavorable. Chemotherapy alone or in combination with an anti-EGFR monoclonal antibody (Cetuximab), immunotherapy or re-irradiation for selected cases are feasible options in loco-regional or metastatic repalapse. We present a case of nasopharyngeal cancer (NPC), with negative prognostic and predictive factors multimodally treated with an intensive chemotherapy regimen associating Cetuximab with a median survival higher than the median value reported in most studies. Replacing 5-Floururacil with Capecitabine and Cisplatin with Carboplatin may be an option to increase treatment tolerance and should be evaluated in randomized trials. The use of induction chemotherapy as a “new standard” before radio-chemotherapy for cases with negative prognostic factors should also be the subject of future studies. Re-challenge with platinum is also an option that needs to be re-evaluated.