Drugs

, Volume 71, Issue 12, pp 1551–1559

Management of Recurrent Head and Neck Cancer

Recent Progress and Future Directions
Therapy in Practice

Abstract

The incidence of squamous cell carcinoma of the head and neck (SCCHN) is on the rise in the US despite a drop in cigarette smoking rates. Much of this rise is due to the increasing incidence of SCCHN attributable to human papillomavirus (HPV). HPV-related SCCHN has a high cure rate, which contributes to the stable death rates despite the increased incidence. Up to half of patients with SCCHN will develop recurrence. For these patients, the first clinical decision is whether the recurrence is potentially treatable for cure, or is incurable. For those deemed potentially curable, surgical or radiation-based therapies, or both, are undertaken. For those who have incurable recurrences, the goals are palliation and possibly prolongation of life — average survivals are in the range of 6–12 months depending on the type of recurrence and other factors.

Several chemotherapy drugs are active in SCCHN, most notably the platinum compounds, taxanes, fluorouracil (5-FU), methotrexate and cetuximab. Approximately 10–25% of patients will respond to treatment with one of these drugs. The response rate is higher for combinations such as a platinum plus a taxane, a platinum plus 5-FU, a combination of the three, or one of more of these drugs plus cetuximab. Combination chemotherapy has not been shown to prolong survival over single-agent therapy, with the exception of the addition of cetuximab to a platinum and 5-FU combination. A number of orally bioavailable tyrosine kinase inhibitors have been tested or are undergoing trials in SCCHN. None of these has as yet been shown to be more effective than the currently available drugs. For patients with recurrences who are undergoing active therapy, and especially for those for whom further therapy is no longer appropriate or is declined, strict attention is necessary to palliation of pain, oral and airway issues, and to nutrition, speech, and social and psychological issues.

References

  1. 1.
    Jemal A, Siegel R, Xu J, et al. Cancer statistics, 2010 CA. Cancer J Clin 2010; 60: 277–300CrossRefGoogle Scholar
  2. 2.
    Greenlee RT, Murray T, Bolden S, et al. Cancer statistics, 2000 CA. Cancer J Clin 2000; 50: 7–33CrossRefGoogle Scholar
  3. 3.
    Ryerson AB, Peters ES, Coughlin SS, et al. Burden of potentially human papillomavirus-associated cancers of the oropharynx and oral cavity in the US, 1998–2003. Cancer 2008; 113 (10 Suppl.): 2901–9PubMedCrossRefGoogle Scholar
  4. 4.
    Auluck A, Hislop G, Bajdik C, et al. Trends in oropharyngeal and oral cavity cancer incidence of human papillomavirus (HPV)-related and HPV-unrelated sites in a multicultural population: the British Columbia experience. Cancer 2010 Jun 1; 116(11): 2635–44PubMedGoogle Scholar
  5. 5.
    Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study Group. N Engl J Med 1991; 324: 1685–90CrossRefGoogle Scholar
  6. 6.
    Janot F, de Raucourt D, Benhamou E, et al. Randomized trial of postoperative reirradiation combined with chemotherapy after salvage surgery compared with salvage surgery alone in head and neck carcinoma. J Clin Oncol 2008; 34: 5518–23CrossRefGoogle Scholar
  7. 7.
    Shiono S, Kawamura M, Sato T, et al., Metastatic Lung Tumor Study Group of Japan. Pulmonary metastasectomy for pulmonary metastases of head and neck squamous cell carcinomas. Ann Thorac Surg 2009; 88: 856–60PubMedCrossRefGoogle Scholar
  8. 8.
    Lee N, Chan K, Bekelman JE, et al. Salvage re-irradiation for recurrent head and neck cancer. Int J Radiat Oncol Biol Phys 2007; 68: 731–40PubMedCrossRefGoogle Scholar
  9. 9.
    Salama JK, Vokes EE, Chmura SJ, et al. Long-term outcome of concurrent chemotherapy and reirradiation for recurrent and second primary head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2006; 64: 382–91PubMedCrossRefGoogle Scholar
  10. 10.
    Tanvetyanon T, Padhya T, McCafffrey J, et al. Prognostic factors for survival after salvage reirradiation of head and neck cancer. J Clin Oncol 2009; 27: 1983–91PubMedCrossRefGoogle Scholar
  11. 11.
    Morton RP, Rugman F, Dorman EB, et al. Cisplatinum and bleomycin for advanced or recurrent squamous cell carcinoma of the head and neck: A randomized factorial phase III controlled trial. Cancer Chemother Pharmacol 1985; 15: 283–9PubMedCrossRefGoogle Scholar
  12. 12.
    Forastiere AA, Metch B, Schuller DE, et al. Randomized comparison of cisplatin plus fluorouracil and carboplatin plus fluorouracil versus methotrexate in advanced squamous-cell carcinoma of the head and neck. A Southwest Oncology Group Study. J Clin Oncol 1992; 10: 1245–51Google Scholar
  13. 13.
    Jacobs C, Lyman G, Velez-Garcia E, et al. A phase III randomized study comparing cisplatin and fluorouracil as single agents and in combination for advanced squamous cell carcinoma of the head and neck. J Clin Oncol 1992; 10: 257–63PubMedGoogle Scholar
  14. 14.
    A phase III randomized trial of cisplatinum, methotrexate, cisplatinum + methotrexate and cisplatinum + 5-FU in end stage squamous carcinoma of the head and neck. Liverpool Head and Neck Oncology Group. Br JCancer 1990;61: 311–5CrossRefGoogle Scholar
  15. 15.
    Clavel M, Vermorken JB, Cognetti F, et al. Randomized comparison of cisplatin, methotrexate, bleomycin and vincristine (CABO) versus cisplatin and 5-fluorouracil (CF) versus cisplatin (C) in recurrent or metastatic squamous cell carcinoma of the head and neck: a phase III study of the EORTC Head and Neck Cancer Cooperative Group. Ann Oncol 1994; 5: 521–6PubMedGoogle Scholar
  16. 16.
    Williams SD, Velez-Garcia E, Essessee I, et al. Chemotherapy for head and neck cancer: comparison of cisplatin + vinblastine + bleomycin versus methotrexate. Cancer 1986; 57: 18–23PubMedCrossRefGoogle Scholar
  17. 17.
    Vogl SE, Schoenfeld DA, Kaplan BH, et al. A randomized prospective comparison of methotrexate with a combination of methotrexate, bleomycin, and cisplatin in head and neck cancer. Cancer 1985; 56: 432–42PubMedCrossRefGoogle Scholar
  18. 18.
    Gibson MK, Li Y, Murphy B, et al. Randomized phase III evaluation of cisplatin plus fluorouracil versus cisplatin plus paclitaxel in advanced head and neck cancer (E1395): an intergroup trial of the Eastern Cooperative Oncology Group. J Clin Oncol 2005; 23: 3562–7PubMedCrossRefGoogle Scholar
  19. 19.
    Schöffski P, Catimel G, Planting AS, et al. Docetaxel and cisplatin: an active regimen in patients with locally advanced, recurrent or metastatic squamous cell carcinoma of the head and neck — results of a phase II study of the EORTC Early Clinical Studies Group. Ann Oncol 1999; 10: 119–22PubMedCrossRefGoogle Scholar
  20. 20.
    Shin DM, Glisson BS, Khuri FR, et al. Phase II trial of paclitaxel, ifosfamide, and cisplatin in patients with recurrent head and neck squamous cell carcinoma. J Clin Oncol 1998; 16: 1325–30PubMedGoogle Scholar
  21. 21.
    Worden FP, Moon J, Samlowski W, et al., Southwest Oncology Group, Head and Neck Working Group. A phase II evaluation of a 3-hour infusion of paclitaxel, cisplatin, and 5-fluorouracil in patients with advanced or recurrent squamous cell carcinoma of the head and neck: Southwest Oncology Group study 0007. Cancer 2006; 107: 319–27PubMedCrossRefGoogle Scholar
  22. 22.
    Janinis J, Papadakou M, Xidakis E, et al. Combination chemotherapy with docetaxel, cisplatin, and 5-fluorouracil in previously treated patients with advanced/recurrent head and neck cancer: a phase II feasibility study. Am J Clin Oncol 2000; 23: 128–31PubMedCrossRefGoogle Scholar
  23. 23.
    Vermorken JB, Mesia R, Rivera F, et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med 2008; 359: 1116–27PubMedCrossRefGoogle Scholar
  24. 24.
    Drelichman A, Cummings G, Al-Sarraf M. A randomized trial of the combination of cis-platinum, oncovin and bleomycin (COB) versus methotrexate in patients with advanced squamous cell carcinoma of the head and neck. Cancer 1983; 52: 399–403PubMedCrossRefGoogle Scholar
  25. 25.
    Posner MR, Hershock DM, Blajman CR, et al., for the TAX 324 Study Group. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med 2007; 357: 1705–15PubMedCrossRefGoogle Scholar
  26. 26.
    Vermorken JB, Remenar E, van Herpen C, et al., for the EORTC 2497 1/TAX 323 Study Group. Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med 2007; 357: 1695–704PubMedCrossRefGoogle Scholar
  27. 27.
    Burtness B, Goldwasser MA, Flood W, et al., Eastern Cooperative Oncology Group. Phase III randomized trial of cisplatin plus placebo compared with cisplatin plus cetuximab in metastatic/recurrent head and neck cancer an Eastern Cooperative Oncology Group study. J Clin Oncol 2005; 23: 8646–54PubMedCrossRefGoogle Scholar
  28. 28.
    Herbst RS, Arquette M, Shin DM, et al. Phase II multicenter study of the epidermal growth factor receptor antibody cetuximab and cisplatin for recurrent and refractory squamous cell carcinoma of the head and neck. J Clin Oncol 2005; 23: 5578–87PubMedCrossRefGoogle Scholar
  29. 29.
    Baselga M, Trigo JM, Bourhis J, et al. Phase II multicenter study of the antiepidermal growth factor receptor monoclonal antibody cetuximab in combination with platinum-based chemotherapy in patients with platinum-refractory metastatic and/or recurrent squamous cell carcinoma of the head and neck. J Clin Oncol 2005; 23: 5568–77PubMedCrossRefGoogle Scholar
  30. 30.
    Vermorken JB, Trigo J, Hitt R, et al. Open-label, uncontrolled, multicenter phase II study to evaluate the efficacy and toxicity of cetuximab as a single agent in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck who failed to respond to platinum-based therapy. J Clin Oncol 2007; 25: 2171–7PubMedCrossRefGoogle Scholar
  31. 31.
    Cohen EE, Rosen F, Stadler WM, et al. Phase II trial of ZD1839 in recurrent or metastatic squamous cell carcinoma of the head and neck. J Clin Oncol 2003; 21: 1980–7PubMedCrossRefGoogle Scholar
  32. 32.
    Cohen EE, Kane MA, List MA, et al. Phase II trial of gefitinib 250 mg daily in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck. Clin Cancer Res 2005; 11: 8418–24PubMedCrossRefGoogle Scholar
  33. 33.
    Soulieres D, Senzer NN, Vokes EE, et al. Multicenter phase II study of erlotinib, an oral epidermal growth factor receptor tyrosine kinase inhibitor, in patients with recurrent or metastatic squamous cell cancer of the head and neck. J Clin Oncol 2004; 22: 77–85PubMedCrossRefGoogle Scholar
  34. 34.
    Choong NW, Kozloff M, Taber D, et al. Phase II study of sunitinib malate in head and neck squamous cell carcinoma. Invest New Drugs 2010; 28: 677–83PubMedCrossRefGoogle Scholar
  35. 35.
    Machiels JP, Henry S, Zanetta S, et al. Phase II study of sunitinib in recurrent or metastatic squamous cell carcinoma of the head and neck: GORTEC 2006-01. J Clin Oncol 2010; 28: 21–8PubMedCrossRefGoogle Scholar
  36. 36.
    Fountzilas G, Fragkoulidi A, Kalogera-Fountzila A, et al. A phase II study of sunitinib in patients with recurrent and/or metastatic non-nasopharyngeal head and neck cancer. Cancer Chemother Pharmacol 2010; 65: 649–60PubMedCrossRefGoogle Scholar
  37. 37.
    Williamson SK, Moon J, Huang CH, et al. Phase II evaluation of sorafenib in advanced and metastatic squamous cell carcinoma of the head and neck: Southwest Oncology Group Study S0420. J Clin Oncol 2010; 28: 3330–5PubMedCrossRefGoogle Scholar
  38. 38.
    Elser C, Siu LL, Winquist E, et al. Phase II trial of sorafenib in patients with recurrent or metastatic squamous cell carcinoma of the head and neck or nasopharyngeal carcinoma. J Clin Oncol 2007; 25: 3766–73PubMedCrossRefGoogle Scholar
  39. 39.
    Abidoye OO, Cohen EE, Wong SJ, et al. A phase II study of lapatinib (GW572016) in recurrent/metastatic squamous cell carcinoma of the head and neck [abstract]. Proc ASCO 2006; 24(18S): 5568Google Scholar
  40. 40.
    Burris 3rd HA, Taylor CW, Jones SF, et al. A phase I and pharmacokinetic study of oral lapatinib administered once or twice daily in patients with solid malignancies. Clin Cancer Res 2009; 15:6702PubMedCrossRefGoogle Scholar
  41. 41.
    Seiwert TY, Clement PM, Cupissol D, et al. BIBW 2992 versus cetuximab in patients with metastatic or recurrent head and neck cancer (SCCHN) after failure of platinum-containing therapy with a cross-over period for progressing patients: preliminary results of a randomized, open-label phase II study [abstract]. J Clin Oncol 2010; 28 Suppl. 15s: 5501Google Scholar
  42. 42.
    Fury MG, Zahalsky A, Wong R, et al. A phase II study of SU5416 in patients with advanced or recurrent head and neck cancers. Invest New Drugs 2007; 25: 165–72PubMedCrossRefGoogle Scholar
  43. 43.
    Hanrahan EO, Kies MS, Glisson BS, et al. A phase II study of lonafarnib (SCH66336) in patients with chemore-fractory, advanced squamous cell carcinoma of the head and neck. Am J Clin Oncol 2009; 32: 274–9PubMedCrossRefGoogle Scholar
  44. 44.
    Cohen EE, Davis DW, Karrison TG, et al. Erlotinib and bevacizumab in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck: a phase I/II study. Lancet Oncol 2009; 10: 247–57PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2011

Authors and Affiliations

  1. 1.Hematology/OncologyNorthShore University HealthSystemEvanstonUSA

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