Department of Internal Medicine, Division of Hematology, Rush University Medical Center, Oncology & Cell Therapy, Chicago, IL, 60612, USA.
Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, 60612, USA.
Curr Treat Options Oncol. 2023 Jun;24(6):680-692. doi: 10.1007/s11864-023-01080-5. Epub 2023 Apr 17.
Epidermal growth factor receptor (EGFR) is commonly overexpressed in many head and neck squamous cell carcinomas (HNSCC). With the success of EGFR inhibition in other cancer types, there was optimism for efficacy in HNSCC. Unfortunately, the clinical outcomes of EGFR-directed therapy have not provided overwhelming benefit. In the curative-intent setting, cisplatin has proven superior over cetuximab, an EGFR monoclonal antibody, in multiple large trials, and cisplatin should continue to be the treatment of choice when administered with definitive or adjuvant radiation. For cisplatin-ineligible patients, we prefer carboplatin-based treatment over cetuximab. We reserve cetuximab for a small group of patients who are eligible for radiation and systemic treatment but have contraindications to any platinum therapy. The role of EGFR inhibitors in the recurrent/metastatic setting is more robust. Although supplanted by immunotherapy as front-line treatment, cetuximab remains a meaningful second-line option for patients who have progressed on immune checkpoint inhibitors. Overall, EGFR-directed therapies have been of modest value in the treatment of both locally advanced and metastatic HNSCC. The future of EGFR-directed therapies will likely develop from exploring combination therapies, especially with immunotherapy. Early evidence suggests synergistic effects allowing for a more robust immune response, which holds promise for novel regimens in the treatment of HNSCC.
表皮生长因子受体（EGFR）在许多头颈部鳞状细胞癌（HNSCC）中常过度表达。随着 EGFR 抑制在其他癌症类型中的成功，人们对 HNSCC 的疗效持乐观态度。不幸的是，EGFR 靶向治疗的临床结果并没有带来压倒性的益处。在根治性治疗环境中，顺铂在多项大型试验中已被证明优于 EGFR 单克隆抗体西妥昔单抗，并且当与根治性或辅助性放疗联合使用时，顺铂应继续作为治疗选择。对于不能耐受顺铂的患者，我们更倾向于使用卡铂联合治疗，而非西妥昔单抗。我们将西妥昔单抗保留给一小部分有放疗和全身治疗资格但对任何铂类治疗有禁忌症的患者。在复发/转移性环境中，EGFR 抑制剂的作用更为强大。尽管免疫疗法已取代西妥昔单抗作为一线治疗，但对于免疫检查点抑制剂治疗进展的患者，西妥昔单抗仍然是一种有意义的二线选择。总的来说，EGFR 靶向治疗在局部晚期和转移性 HNSCC 的治疗中价值有限。EGFR 靶向治疗的未来可能来自于探索联合治疗，尤其是与免疫治疗联合。早期证据表明联合治疗具有协同作用，可以增强更强大的免疫反应，这为 HNSCC 的新治疗方案带来了希望。
