How Should We Approach Locally Advanced Squamous Cell Carcinoma of Head and Neck Cancer Patients Ineligible for Standard
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HEAD AND NECK CANCERS (EY HANNA, SECTION EDITOR)
How Should We Approach Locally Advanced Squamous Cell Carcinoma of Head and Neck Cancer Patients Ineligible for Standard Non-surgical Treatment? Tomoya Yokota 1 & Satoshi Hamauchi 1 & Hiromichi Shirasu 2 & Yusuke Onozawa 2 & Hirofumi Ogawa 3 & Tsuyoshi Onoe 3 & Tetsuro Onitsuka 4 Accepted: 7 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Cisplatin has been established as one of the most important agents in multidisciplinary treatment for head and neck cancer (HNC). However, since HNC patients are often elderly and typically have several comorbidities, a limited number of patients can tolerate high-dose cisplatin in real-world HNC populations. We will provide a review of therapeutic alternatives to high-dose cisplatin-based treatment in the setting of definitive and postoperative chemoradiotherapy (CRT) or induction chemotherapy. Recent Findings Clinical criteria for CDDP ineligibility have been discussed in HNC. When considering cisplatin-based chemotherapy as part of a non-surgical approach, precise evaluation of the patient’s physical condition, nutritional status, and comorbidities is needed. Upfront surgery is an important option with high curability, if a de-intensified non-surgical approach is estimated to be unavoidable. Although no prospective data are available regarding alternatives to definitive cisplatin-based combination therapy for patients undergoing a non-surgical approach, cetuximab, carboplatin, or split-dose cisplatin-based regimens may be employed for cisplatin-ineligible patients in clinical practice. The combination of immune checkpoint inhibitors with radiotherapy may be a promising novel approach, and some trials are currently targeting the specific cohort of patients ineligible for high-dose cisplatin. Summary There are no standard treatments for patients ineligible for high-dose cisplatin. A personalized treatment strategy should be proposed based on the individual benefit-to-risk ratio of each treatment option in patients ineligible for the standard of care. Prospective clinical trials for cisplatin-ineligible patients with locally advanced HNC still need to be performed Keywords Head and neck cancer . Locally advanced disease . CDDP ineligibility . Non-surgical and surgical approach . Immunotherapy . Multidisciplinary approach
Introduction This article is part of the Topical Collection on Head and Neck Cancers * Tomoya Yokota [email protected] 1
Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
2
Division of Medical Oncology, Shizuoka Cancer Center, Shizuoka, Japan
3
Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan
4
Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
Chemoradiotherapy (CRT) with concurrent high-dose cisplatin (CDDP) is the gold standard of care as a non-surgical approach for patients with locally advanced squamous cell carcinoma of the head and neck (LASCCHN) [1–3]. However,
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