Istituto Oncologico Veneto-IRCCS, Oncology Unit 2, Via Gattamelata 64, 35128, Padua, Italy.
Medical Oncology Department, Ospedale dell'Angelo, Venice, Italy.
Curr Treat Options Oncol. 2019 Jan 11;20(2):2. doi: 10.1007/s11864-019-0599-4.
The treatment of HNSCC has rapidly evolved over the past 30 years and multidisciplinary management is required, especially for locally advanced disease (LAHNSCC). Concomitant chemoradiation (cCRT) is the standard of care and cetuximab/RT (CET/RT) is an alternative treatment option, especially for patients unfit for concurrent cisplatin. Several intensification strategies have been explored to improve the outcome of the concomitant treatment. The combination of cisplatin plus cetuximab concurrent to RT failed to improve overall survival (OS) in two phase III trials. Induction chemotherapy (IC) has a proven role in organ preservation; however, its ability in prolonging OS has not been clearly demonstrated. Immune checkpoint inhibitors (ICIs), specifically anti PD-1 inhibitors, have been recently approved for the treatment of patients with recurrent/metastatic platinum-refractory disease. Recent clinical trials are exploring the role of immunotherapy at earlier stages of the disease in combination with concomitant treatments. The purpose of this article is to review current evidence regarding treatment intensification strategies for LAHNSCC (except nasopharyngeal carcinomas) with particular emphasis on the role of induction chemotherapy.
过去 30 年来，头颈部鳞状细胞癌（HNSCC）的治疗方法迅速发展，需要多学科管理，特别是对于局部晚期疾病（LAHNSCC）。同期放化疗（cCRT）是标准治疗方法，西妥昔单抗/放疗（CET/RT）是一种替代治疗选择，特别是对于不适合同期顺铂治疗的患者。已经探索了几种强化策略来改善同期治疗的效果。在两项 III 期试验中，顺铂联合西妥昔单抗同期放疗未能改善总生存期（OS）。诱导化疗（IC）在器官保存方面具有明确的作用；然而，其延长 OS 的能力尚未得到明确证实。免疫检查点抑制剂（ICI），特别是抗 PD-1 抑制剂，最近已被批准用于治疗复发性/转移性铂类耐药疾病的患者。最近的临床试验正在探索免疫疗法在疾病早期与同期治疗相结合的作用。本文的目的是回顾目前关于 LAHNSCC（不包括鼻咽癌）强化治疗策略的证据，特别强调诱导化疗的作用。
