CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol
DOI: 10.1055/s-0042-1742320
How I Treat

How I Treat Advanced Head Neck Cancer

1   Department of Medical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
,
Joydeep Ghosh
1   Department of Medical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
,
Sandip Ganguly
1   Department of Medical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
› Author Affiliations

Introduction

In India, head and neck cancer including all sites is the most common cancer in terms of incidence and mortality among both sexes combined as per GLOBOCAN 2018, with lip and oral cavity being the most common site.[1] Squamous cell cancer of head neck (HNSCC) constitutes the majority of all head and neck malignancies.[2] Most of the patients present in the advanced stage.[3] Even localized HNSCC are notorious for high rates of recurrence in spite of curative modalities of treatment.[4] Treatment for advanced recurrent HNSCC is palliative systemic therapy provided that patients have a good Eastern Cooperative Oncology Group (ECOG) performance score (PS) with normal organ function.

Platinum-based systemic therapy is the standard of treatment in advanced metastatic HNSCC over a long period of time. Over time, antiepidermal growth factor receptor (EGFR) monoclonal antibody like cetuximab showed additional survival benefit over platinum-based therapy.[5] Recently, immune-checkpoint inhibitors (IOs) have been found to benefit both in first- and second-line settings as a single agent or in combination with platinum-based therapy.[6] Last but not the least, metronomic therapy has shown a survival benefit in recurrent metastatic settings.[7] In addition to systemic therapy, supportive care in controlling the symptoms is absolutely essential in the management of advanced HNSCC.[4]

India is a low middle-income country with a per capita income of Rs 11,254/- only. Majority of the people are not covered by health insurance.[8] The cost of modern therapies like cetuximab and IOs are beyond the reach of most people from India. Hence, the treatment of any cancer including metastatic HNSCC has to be tailored based on the financial affordability of the patients and it should be used as an important factor to decide the systemic therapy.



Publication History

Article published online:
12 February 2022

© 2022. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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