Abstract
Induction chemotherapy (ICT) is an attractive option for advanced head and neck squamous cell carcinoma (HNSCC) patients which has been prospectively evaluated in the context of a multimodality treatment approach. The theoretical benefit is the ability to suppress distant metastases and shrink the tumor while chemotherapy is better tolerated when given sequentially than concurrently. However, clinical trials have failed to show consistent benefit of ICT over concurrent radio-chemotherapy and due to so far lacking level 1 evidence ICT outside larynx organ preservation remains rather investigational. Immune modulation by inhibition of immune checkpoints is an exciting recent development in HNSCC which has mainly been investigated as second line treatment after progression on platinum-based chemotherapy in patients with recurrent/metastatic HNSCC. Due to the promising results in these trials and even more in the first-line trial KEYNOTE-048 and encouraging first preliminary results of preoperative Anti-PD1-application, the role of neoadjuvant immunotherapy is currently under investigation in HNSCC.
Highlights
Reviewed by: Markus Brunner, Medical University of Vienna, Austria Thorsten Fuereder, Medical University of Vienna, Austria
The idea of Induction chemotherapy (ICT) followed by radiotherapy (RT) in head and neck squamous cell carcinoma (HNSCC) is that chemotherapy is most effective in previously untreated patients and should promote tumor shrinkage, improve localregional therapy and eliminate micrometastases to reduce the risk of distant metastasis and prolong overall survival (OS)
Two randomized clinical trials (RCT) showed that ICT with docetaxel (T), cisplatin, and 5-fluorouracil (TPF) is superior to plus 5-FU (PF) regarding locoregional control and OS in patients with HNSCC when given before either radiation alone (TAX323) or CRT with carboplatin (TAX324) [12, 13]
Summary
This review gives a general overview of induction chemotherapy (ICT) in squamous cell carcinoma of head and neck (HNSCC). Two RCT showed that ICT with docetaxel (T), cisplatin, and 5-fluorouracil (TPF) is superior to PF regarding locoregional control and OS in patients with HNSCC when given before either radiation alone (TAX323) or CRT with carboplatin (TAX324) [12, 13]. Neither of these trials had a control arm with standard CRT. The identification of chemotherapy responders before the start of systemic therapy would be a very helpful clinical asset
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