Use of paclitaxel (Taxol) in squamous cell carcinoma of the head and neck.

The identification of new active agents is essential if we are to alter the current survival rates for patients with squamous cell carcinoma of the head and neck. Paclitaxel (TAXOL) is a taxane derivative isolated from the bark of the western yew Taxus brevifolia. The drug has a novel mechanism of action promoting microtubule assembly and stabilizing the tubulin polymers. One phase II trial of paclitaxel (250 mg/m2) in head and neck cancer patients is in progress. The preliminary results of this Eastern Cooperative Oncology Group trial indicate that paclitaxel has activity against this tumor: two complete and seven partial responses in 19 patients assessable for response. Grades 3 and 4 neutropenia and grades 1 and 2 neuropathy were frequently observed toxicities. Future directions include a National Cancer Institute-sponsored confirmatory trial using the same dose and schedule of paclitaxel. The European Organization for Research and Treatment of Cancer plans a randomized comparison of paclitaxel versus weekly methotrexate. The Eastern Cooperative Oncology Group will pursue testing of paclitaxel at two different doses (200 and 135 mg/m2) in combination with cisplatin in patients with advanced head and neck cancer.