Langer Corey J
Department of Medical Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania 19111-2412, USA.
Cancer. 2008 Jun 15;112(12):2635-45. doi: 10.1002/cncr.23521.
In patients with squamous cell carcinoma of the head and neck (SCCHN), tumor recurrence, secondary tumors, and comorbidities contribute to therapy failure, and treatment approaches often are limited by their toxicity. With the incorporation of targeted therapies, the number of options available for patients with SCCHN is growing. The epidermal growth factor receptor (EGFR) is involved in the development and progression of SCCHN and is associated with a poor prognosis. The anti-EGFR monoclonal antibody (MoAb) cetuximab is the first targeted therapy to be developed for SCCHN. Recent data confirmed a survival advantage and enhanced locoregional control of SCCHN with cetuximab plus radiotherapy (RT) in patients with locally advanced (LA) SCCHN. Single-agent cetuximab conferred clinical benefits for patients with platinum-refractory metastatic disease, and a recent phase 3 trial demonstrated a survival benefit with cetuximab and standard platinum-based therapy in the front-line treatment of recurrent/metastatic disease. Cetuximab has a toxicity profile milder than that of cytoxic agents and does not exacerbate RT toxicity when it is used in combination. Small-molecule EGFR-tyrosine kinase inhibitors also have shown promise in combination with chemoradiotherapy or as single agents, although they are in earlier stages of developmental. Other targeted approaches (eg, antiangiogenics) are also under investigation. Ongoing clinical trials will further define targeted treatment roles in all stages of SCCHN.
在头颈部鳞状细胞癌(SCCHN)患者中,肿瘤复发、继发肿瘤和合并症导致治疗失败,且治疗方法常受其毒性限制。随着靶向治疗的引入,可供SCCHN患者选择的治疗方案数量不断增加。表皮生长因子受体(EGFR)参与SCCHN的发生和发展,并与预后不良相关。抗EGFR单克隆抗体(MoAb)西妥昔单抗是首个为SCCHN研发的靶向治疗药物。近期数据证实,对于局部晚期(LA)SCCHN患者,西妥昔单抗联合放疗(RT)可带来生存获益并增强局部区域控制。单药西妥昔单抗可为铂类难治性转移性疾病患者带来临床益处,且近期一项3期试验表明,西妥昔单抗与标准铂类疗法联合用于复发/转移性疾病的一线治疗可带来生存获益。西妥昔单抗的毒性比细胞毒性药物轻,联合使用时不会加重放疗毒性。小分子EGFR酪氨酸激酶抑制剂尽管尚处于研发早期阶段,但与放化疗联合或作为单药使用也已显示出前景。其他靶向治疗方法(如抗血管生成药物)也在研究中。正在进行的临床试验将进一步明确靶向治疗在SCCHN各阶段中的作用。
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