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Chemotherapy and immunotherapy for recurrent and metastatic head and neck cancer: a systematic review

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Abstract

Head and neck cancer (HNC) is a fatal malignancy with an overall long-term survival of about 50% for all stages. The diagnosis is not rarely delayed, and the majority of patients present with loco-regionally advanced disease. The rate of second primary tumors after a diagnosis of HNC is about 3–7% per year, the highest rate among solid tumors. Currently, a single-modality or a combination of surgery, radiotherapy and chemotherapy (CHT), is the standard treatment for stage III–IV HNC. For the recurrent/metastatic setting, in the last 40 years great efforts have been made in order to develop a more effective CHT regimen, from the use of methotrexate alone, to the combination of cisplatin (CDDP) and 5-fluorouracile (5FU) or paclitaxel. Recently, the introduction of cetuximab, an anti-EGFR monoclonal antibody, to the CDDP–5FU doublet (EXTREME regimen) has improved the overall response rate, the progression-free survival and the overall survival (OS) compared to CHT alone. Nowadays, the EXTREME regimen is the standard of care for the first-line treatment of recurrent/metastatic head and neck carcinoma (RMHNC). In the last years, new promising therapies for RMHNC such as immune checkpoint inhibitors (ICIs), which have demonstrated favorable results in second-line clinical trials, gained special interest. Nivolumab and pembrolizumab are the first two ICIs able to prolong OS in the second-, later-line and platinum-refractory setting, with tolerable toxicities. This review summarizes the current state of the art in RMHNC treatment options.

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Authors and Affiliations

  1. Department of Medical Oncology, San Paolo Hospital, Via Antonio di Rudinì, 8, 20142, Milan, Italy

    Alessandro Guidi, Carla Codecà & Daris Ferrari

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  1. Alessandro Guidi
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  2. Carla Codecà
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  3. Daris Ferrari
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Correspondence to Alessandro Guidi.

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Guidi, A., Codecà, C. & Ferrari, D. Chemotherapy and immunotherapy for recurrent and metastatic head and neck cancer: a systematic review. Med Oncol 35, 37 (2018). https://doi.org/10.1007/s12032-018-1096-5

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  • DOI: https://doi.org/10.1007/s12032-018-1096-5

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