Specenier Pol M, Vermorken Jan B
Department of Medical Oncology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
Expert Rev Anticancer Ther. 2008 Mar;8(3):375-91. doi: 10.1586/14737140.8.3.375.
Recurrent and metastatic squamous cell carcinoma of the head and neck still carries a poor prognosis. Response rates with combination chemotherapy regimens are generally higher than those observed with single-agent chemotherapy. However, this did not translate into an overall survival benefit, not in even a single randomized trial. As none of the combination chemotherapy regimens demonstrated an overall survival benefit when compared with single-agent methotrexate, cisplatin or 5-fluorouracil, the use of combination chemotherapy outside clinical trials is usually restricted to younger patients with a good performance status and with symptomatic disease who require prompt symptom relief. After decades without real progress, a recent randomized trial showed that adding cetuximab, the first clinically available EGF receptor-directed monoclonal antibody, to a standard chemotherapy regimen (platinum/5-fluorouracil), led to an important survival benefit. In addition, the response rate nearly doubled with this approach, which has great promise for the treatment of symptomatic disease. There is now a plethora of targeted therapies in various stages of preclinical and clinical development. The next challenge will be to sort out which of them have a clinically meaningful activity and find out how to incorporate them into existing treatment regimens.
复发性和转移性头颈部鳞状细胞癌的预后仍然很差。联合化疗方案的缓解率通常高于单药化疗。然而，这并没有转化为总生存获益，甚至在任何一项随机试验中都没有。由于与单药甲氨蝶呤、顺铂或5-氟尿嘧啶相比，没有一种联合化疗方案显示出总生存获益，因此在临床试验之外，联合化疗通常仅限于年轻、体能状态良好且有症状性疾病需要迅速缓解症状的患者。在几十年没有实质性进展之后，最近一项随机试验表明，在标准化疗方案（铂类/5-氟尿嘧啶）中加入西妥昔单抗（第一种临床可用的表皮生长因子受体导向单克隆抗体）可带来显著的生存获益。此外，这种方法使缓解率几乎翻倍，对有症状性疾病的治疗很有前景。目前有大量处于临床前和临床开发各阶段的靶向治疗药物。下一个挑战将是筛选出其中哪些具有临床意义的活性，并找出如何将它们纳入现有治疗方案。
