Download PDF
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

Somnath Roy 
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
› Further Information
   Permissions and Reprints

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/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 356-india-fact-sheets.pdf [Internet]. [cited 2020 Sep 6]. Accessed December 7, 2021: https://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf
    Google Scholar
  • 2 Shah SB, Sharma S, D'Cruz AK. Head and neck oncology: the Indian scenario. South Asian J Cancer 2016; 5 (03) 104-105
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Mohanti BK, Nachiappan P, Pandey RM, Sharma A, Bahadur S, Thakar A. Analysis of 2167 head and neck cancer patients' management, treatment compliance and outcomes from a regional cancer centre, Delhi, India. J Laryngol Otol 2007; 121 (01) 49-56
    CrossrefPubMedGoogle Scholar
  • 4 Parikh P, Patil V, Agarwal JP. et al; Indian Cooperative Oncology Network. Guidelines for treatment of recurrent or metastatic head and neck cancer. Indian J Cancer 2014; 51 (02) 89-94
    CrossrefPubMedGoogle Scholar
  • 5 Vermorken JB, Mesia R, Rivera F. et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med 2008; 359 (11) 1116-1127
    CrossrefPubMedGoogle Scholar
  • 6 Ferris RL. Immunology and immunotherapy of head and neck cancer. J Clin Oncol 2015; 33 (29) 3293-3304
    CrossrefPubMedGoogle Scholar
  • 7 Patil V, Noronha V, Dhumal SB. et al. Low-cost oral metronomic chemotherapy versus intravenous cisplatin in patients with recurrent, metastatic, inoperable head and neck carcinoma: an open-label, parallel-group, non-inferiority, randomised, phase 3 trial. Lancet Glob Health 2020; 8 (09) e1213-e1222
    CrossrefPubMedGoogle Scholar
  • 8 Ministry of Statistics and Program Implementation | Government Of India [Internet]. [cited 2020 Oct 13]. Accessed December 7, 2021: http://www.mospi.gov.in/
    Google Scholar
  • 9 Grose WE, Lehane DE, Dixon DO, Fletcher WS, Stuckey WJ. Comparison of methotrexate and cisplatin for patients with advanced squamous cell carcinoma of the head and neck region: a Southwest Oncology Group Study. Cancer Treat Rep 1985; 69 (06) 577-581
    Google Scholar
  • 10 Al-Sarraf M, Metch B, Kish J. et al. Platinum analogs in recurrent and advanced head and neck cancer: a Southwest Oncology Group and Wayne State University Study. Cancer Treat Rep 1987; 71 (7-8): 723-726
    Google Scholar
  • 11 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 (08) 1245-1251
    CrossrefPubMedGoogle Scholar
  • 12 Gibson MK, Li Y, Murphy B. et al; Eastern Cooperative Oncology Group. 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 (15) 3562-3567
    CrossrefPubMedGoogle Scholar
  • 13 Schöffski P, Catimel G, Planting AST. 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 (01) 119-122
    CrossrefPubMedGoogle Scholar
  • 14 Baur M, Kienzer H-R, Schweiger J. et al. Docetaxel/cisplatin as first-line chemotherapy in patients with head and neck carcinoma: a phase II trial. Cancer 2002; 94 (11) 2953-2958
    CrossrefPubMedGoogle Scholar
  • 15 Urba S, van Herpen CML, Sahoo TP. et al. Pemetrexed in combination with cisplatin versus cisplatin monotherapy in patients with recurrent or metastatic head and neck cancer: final results of a randomized, double-blind, placebo-controlled, phase 3 study. Cancer 2012; 118 (19) 4694-4705
    CrossrefPubMedGoogle Scholar
  • 16 Williams SD, Velez-Garcia E, Essessee I, Ratkin G, Birch R, Einhorn LH. Chemotherapy for head and neck cancer. Comparison of cisplatin + vinblastine + bleomycin versus methotrexate. Cancer 1986; 57 (01) 18-23
    CrossrefPubMedGoogle Scholar
  • 17 Levels of TGF-α and EGFR Protein in Head and Neck Squamous Cell Carcinoma and Patient Survival | JNCI: Journal of the National Cancer Institute | Oxford Academic [Internet]. [cited 2020 Sep 13]. Accessed December 7, 2021: https://academic.oup.com/jnci/article/90/11/824/916287
    Google Scholar
  • 18 Chung CH, Ely K, McGavran L. et al. Increased epidermal growth factor receptor gene copy number is associated with poor prognosis in head and neck squamous cell carcinomas. J Clin Oncol 2006; 24 (25) 4170-4176
    CrossrefPubMedGoogle Scholar
  • 19 Fan Z, Baselga J, Masui H, Mendelsohn J. Antitumor effect of anti-epidermal growth factor receptor monoclonal antibodies plus cis-diamminedichloroplatinum on well established A431 cell xenografts. Cancer Res 1993; 53 (19) 4637-4642
    PubMedGoogle Scholar
  • 20 Kang X, Patel D, Ng S, Melchior M, Ludwig D, Hicklin J. High affinity Fc receptor binding and potent induction of antibody-dependent cellular cytotoxicity (ADCC) in vitro by anti-epidermal growth factor receptor antibody cetuximab. J Clin Oncol 2007; 25 (18) 3041-3041
    CrossrefGoogle Scholar
  • 21 Guigay J, Fayette J, Mesia R. et al. TPExtreme randomized trial: TPEx versus Extreme regimen in 1st line recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). J Clin Oncol 2019; 37 (15) 6002-6002
    CrossrefGoogle Scholar
  • 22 Weber J, McCormack PL. Panitumumab: in metastatic colorectal cancer with wild-type KRAS. BioDrugs 2008; 22 (06) 403-411
    CrossrefPubMedGoogle Scholar
  • 23 Vermorken JB, Stöhlmacher-Williams J, Davidenko I. et al; SPECTRUM investigators. Cisplatin and fluorouracil with or without panitumumab in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck (SPECTRUM): an open-label phase 3 randomised trial. Lancet Oncol 2013; 14 (08) 697-710
    CrossrefPubMedGoogle Scholar
  • 24 Ancevski Hunter K, Socinski MA, Villaruz LC. PD-L1 testing in guiding patient selection for PD-1/PD-L1 inhibitor therapy in lung cancer. Mol Diagn Ther 2018; 22 (01) 1-10
    CrossrefPubMedGoogle Scholar
  • 25 Bauml JM, Aggarwal C, Cohen RB. Immunotherapy for head and neck cancer: where are we now and where are we going?. Ann Transl Med 2019; 7 (3, Suppl 3) S75
    CrossrefPubMedGoogle Scholar
  • 26 Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE- 048): a randomised, open-label, phase 3 study. - The Lancet [Internet] [cited 2020 Sep 20]. Accessed December 7, 2021: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32591–7/fulltext
    Google Scholar
  • 27 Dabkara D, Ganguly S, Biswas B, Ghosh J. Metronomic therapy in metastatic castrate-resistant prostate cancer: experience from a tertiary cancer care center. Indian J Cancer 2018; 55 (01) 94-97
    CrossrefPubMedGoogle Scholar
  • 28 De Felice F, Musio D, Tombolini V. Head and neck cancer: metronomic chemotherapy. BMC Cancer 2015; 15: 677 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603691/ Accessed December 7, 2021 [Internet]
    CrossrefPubMedGoogle Scholar
  • 29 Ferris RL, Licitra L, Fayette J. et al. Nivolumab in patients with recurrent or metastatic squamous cell carcinoma of the head and neck: efficacy and safety in CheckMate 141 by prior cetuximab use. Clin Cancer Res 2019; 25 (17) 5221-5230
    CrossrefPubMedGoogle Scholar
  • 30 Cohen EEW, Soulières D, Le Tourneau C. et al; KEYNOTE-040 investigators. Pembrolizumab versus methotrexate, docetaxel, or cetuximab for recurrent or metastatic head-and-neck squamous cell carcinoma (KEYNOTE-040): a randomised, open-label, phase 3 study. Lancet 2019; 393 (10167): 156-167
    CrossrefPubMedGoogle Scholar
  • 31 Pêtre A, Dalban C, Karabajakian A. et al. Carboplatin in combination with weekly paclitaxel as first-line therapy in patients with recurrent/metastatic head and neck squamous cell carcinoma unfit to EXTREME schedule. Oncotarget 2018; 9 (31) 22038-22046
    CrossrefPubMedGoogle Scholar
  • 32 Rapidis A, Sarlis N, Lefebvre J-L, Kies M. Docetaxel in the treatment of squamous cell carcinoma of the head and neck. Ther Clin Risk Manag 2008; 4 (05) 865-886
    CrossrefPubMedGoogle Scholar
  • 33 Vermorken JB, Trigo J, Hitt R, Koralewski P, Diaz-rubio E, Rolland F, Knecht R, Amellal N, Schueler A, Baselga J. 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; Jun 1; 25 (16) 2171-2177
    CrossrefPubMedGoogle Scholar
  • 34 Baselga J, 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 (24) 5568-5577
    CrossrefPubMedGoogle Scholar
  • 35 Zandberg DP, Algazi AP, Jimeno A. et al. Durvalumab for recurrent or metastatic head and neck squamous cell carcinoma: results from a single-arm, phase II study in patients with ≥25% tumour cell PD-L1 expression who have progressed on platinum-based chemotherapy. Eur J Cancer 2019; 107 (107) 142-152
    CrossrefPubMedGoogle Scholar
  • 36 Ferris RL, Haddad R, Even C. et al. Durvalumab with or without tremelimumab in patients with recurrent or metastatic head and neck squamous cell carcinoma: EAGLE, a randomized, open-label phase III study. Ann Oncol 2020; 31 (07) 942-950
    CrossrefPubMedGoogle Scholar
  • 37 Stewart JSW, Cohen EEW, Licitra L. et al. Phase III study of gefitinib compared with intravenous methotrexate for recurrent squamous cell carcinoma of the head and neck [corrected]. [corrected] J Clin Oncol 2009; 27 (11) 1864-1871
    CrossrefPubMedGoogle Scholar
  • 38 Guo Y, Ahn M-J, Chan A. et al. Afatinib versus methotrexate as second-line treatment in Asian patients with recurrent or metastatic squamous cell carcinoma of the head and neck progressing on or after platinum-based therapy (LUX-Head & Neck 3): an open-label, randomised phase III trial. Ann Oncol 2019; 30 (11) 1831-1839
    CrossrefPubMedGoogle Scholar
  • 39 Patil VM, Noronha V, Joshi A. et al. Phase I/II Study of Palliative Triple Metronomic Chemotherapy in Platinum-Refractory/Early-Failure Oral Cancer. J Clin Oncol 2019; 37 (32) 3032-3041
    CrossrefPubMedGoogle Scholar
  • 40 Michel L, Ley J, Wildes TM. et al. Phase I trial of palbociclib, a selective cyclin dependent kinase 4/6 inhibitor, in combination with cetuximab in patients with recurrent/metastatic head and neck squamous cell carcinoma. Oral Oncol 2016; 58: 41-48
    CrossrefPubMedGoogle Scholar
  • 41 Adkins D, Ley J, Neupane P. et al. Palbociclib and cetuximab in platinum-resistant and in cetuximab-resistant human papillomavirus-unrelated head and neck cancer: a multicentre, multigroup, phase 2 trial. Lancet Oncol 2019; 20 (09) 1295-1305
    CrossrefPubMedGoogle Scholar
  • 42 Soulières D, Faivre S, Mesía R. et al. Buparlisib and paclitaxel in patients with platinum-pretreated recurrent or metastatic squamous cell carcinoma of the head and neck (BERIL-1): a randomised, double-blind, placebo-controlled phase 2 trial. Lancet Oncol 2017; 18 (03) 323-335
    CrossrefPubMedGoogle Scholar
  • 43 Keam B, Kim S, Ahn Y-O. et al. In vitro anticancer activity of PI3K alpha selective inhibitor BYL719 in head and neck cancer. Anticancer Res 2015; 35 (01) 175-182
    Google Scholar
  • 44 Zeng Z, Fan S, Zhang X. et al. Epstein-Barr virus-encoded small RNA 1 (EBER-1) could predict good prognosis in nasopharyngeal carcinoma. Clin Transl Oncol 2016; 18 (02) 206-211
    CrossrefPubMedGoogle Scholar
  • 45 Jeon YK, Lee BY, Kim JE, Lee SS, Kim CW. Molecular characterization of Epstein-Barr virus and oncoprotein expression in nasopharyngeal carcinoma in Korea. Head Neck 2004; 26 (07) 573-583
    CrossrefPubMedGoogle Scholar
  • 46 Zhang W, Chen Y, Chen L. et al. The clinical utility of plasma Epstein-Barr virus DNA assays in nasopharyngeal carcinoma: the dawn of a new era?: a systematic review and meta-analysis of 7836 cases. Medicine (Baltimore) 2015; 94 (20) e845
    CrossrefPubMedGoogle Scholar
  • 47 Lee AW, Ng WT, Chan LL. et al. Evolution of treatment for nasopharyngeal cancer–success and setback in the intensity-modulated radiotherapy era. Radiother Oncol 2014; 110 (03) 377-384
    CrossrefPubMedGoogle Scholar
  • 48 Al-Sarraf M, LeBlanc M, Giri PG. et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol 1998; 16 (04) 1310-1317
    CrossrefPubMedGoogle Scholar
  • 49 Chan AT, Leung SF, Ngan RK. et al. Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst 2005; 97 (07) 536-539
    CrossrefPubMedGoogle Scholar
  • 50 Baujat B, Audry H, Bourhis J. et al; MAC-NPC Collaborative Group. Chemotherapy in locally advanced nasopharyngeal carcinoma: an individual patient data meta-analysis of eight randomized trials and 1753 patients. Int J Radiat Oncol Biol Phys 2006; 64 (01) 47-56
    CrossrefPubMedGoogle Scholar
  • 51 Ribassin-Majed L, Marguet S, Lee AWM. et al. What is the best treatment of locally advanced nasopharyngeal carcinoma? An individual patient data network meta-analysis. J Clin Oncol 2017; 35 (05) 498-505
    CrossrefPubMedGoogle Scholar
  • 52 Wang M, Tian H, Li G. et al. Significant benefits of adding neoadjuvant chemotherapy before concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: a meta-analysis of randomized controlled trials. Oncotarget 2016; 7 (30) 48375-48390
    CrossrefPubMedGoogle Scholar
  • 53 Zhang Y, Chen L, Hu GQ. et al. Gemcitabine and cisplatin induction chemotherapy in nasopharyngeal carcinoma. N Engl J Med 2019; 381 (12) 1124-1135
    CrossrefPubMedGoogle Scholar
  • 54 Sun Y, Li WF, Chen NY. et al. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial. Lancet Oncol 2016; 17 (11) 1509-1520
    CrossrefPubMedGoogle Scholar
  • 55 Zhang L, Huang Y, Hong S. et al. Gemcitabine plus cisplatin versus fluorouracil plus cisplatin in recurrent or metastatic nasopharyngeal carcinoma: a multicentre, randomised, open-label, phase 3 trial. Lancet 2016; 388 (10054): 1883-1892
    CrossrefPubMedGoogle Scholar
  • 56 Chan AT, Hsu MM, Goh BC. et al. Multicenter, phase II study of cetuximab in combination with carboplatin in patients with recurrent or metastatic nasopharyngeal carcinoma. J Clin Oncol 2005; 23 (15) 3568-3576
    CrossrefPubMedGoogle Scholar
  • 57 Hsu C, Lee SH, Ejadi S. et al. Safety and antitumor activity of pembrolizumab in patients with programmed death-ligand 1-positive nasopharyngeal carcinoma: results of the KEYNOTE-028 study. J Clin Oncol 2017; 35 (36) 4050-4056
    CrossrefPubMedGoogle Scholar
  • 58 Ma BBY, Lim WT, Goh BC. et al. Antitumor activity of nivolumab in recurrent and metastatic nasopharyngeal carcinoma: an International, Multicenter Study of the Mayo Clinic Phase 2 Consortium (NCI-9742). J Clin Oncol 2018; 36 (14) 1412-1418
    CrossrefPubMedGoogle Scholar