New Forays in Head and Neck Cancer Management
12/24/2004 Avraham Eisbruch, MD Medscape (medscape.com) The superiority of radiation concurrent with chemotherapy in local/regional tumor control and disease-free survival, compared with radiation alone, has been established in several randomized studies and meta-analyses.[1] The combination of chemotherapy and radiotherapy is characterized by increased toxicity, notably acute mucositis and late dysphagia, which limit the intensity of therapy and further improvement of the therapeutic results. A new and exciting radiosensitizing strategy which has emerged in recent years for head and neck cancer is the blockage of the epidermal growth factor receptor (EGFR), which is overexpressed in the majority of head and neck carcinoma cells. Such blockage can be done by antibodies to EGFR (C225, or cetuximab), or by inhibitors of tyrosine kinase, the enzyme that is activated when EGFR is expressed. Encouraging results of phase 1/2 studies suggesting radiosensitization of head and neck cancer by cetuximab were presented several years ago. Radiotherapy in Tandem With Cetuximab In a special session devoted to the topic of innovations in head and neck cancer management at the 46th Annual Meeting of the American Society of Therapeutic Radiology and Oncology (ASTRO), J.A. Bonner, MD, University of Alabama, Birmingham, and colleagues[2] presented initial results of a phase 3 study of radiotherapy with and without cetuximab for locally advanced head and neck cancer. This group of investigators randomized 424 patients with stage III or IV cancer, the majority having larynx, oropharynx, and hypopharynx cancer. The 2 treatment arms were well balanced and several radiation regimens were used, including [...]