Systemic Treatments: Chemotherapy and Targeted Therapies

Introduction Squamous cell carcinoma of the head and neck (SCCHN) affl icts an estimated 600,000 patients annually worldwide and is the seventh most common cancer. Less than 50 % of the patients with locoregional advanced disease (American Joint Committee on Cancer (AJCC) stages III, IV) remain free of disease at 3 years despite aggressive multimodal local therapy with surgery and/or chemoradiation [ 1 – 3 ]. Cancer that recurs after multimodal local treatment and not amenable to salvage surgery (Chap. 12 ) or radiation (Chap. 13 ) is considered incurable (median survival around 10 months) [ 4 , 5 ]. Different prognosis factors for patients with palliative SCCHN have been identifi ed. In two phase III trials from the Eastern Oncology Cooperative Group (E1393 and E1395) that investigated platinum-based chemotherapy, the following parameters were associated with a poor survival in the multivariate analysis: weight loss more than 5 %, Eastern Oncology Cooperative Group performance status (ECOG PS) >0, well and moderate differentiated tumor, primary tumor localized in the oropharynx and oral cavity, and prior radiation therapy [ 6 ]. Patients with ≥3 of these parameters had a median survival of 6 months compared with patients with ≤2 of these parameters who had a median overall survival of 2 years. Alcohol and tobacco are still responsible for the majority of SCCHN. Another cause of oropharyngeal cancer that increases in incidence is the human papillomavirus (HPV). HPV-positive and negative tumors are different entities based on differences in their clinical and molecular behaviors [ 7 ]. The prognosis of HPV-positive SCCHN is better than HPV-negative tumor even in case of relapsing disease [ 8 ]