What is the treatment approach for squamous cell carcinoma of the head and neck?

From the Guidelines

The treatment approach for squamous cell carcinoma of the head and neck should prioritize a multidisciplinary strategy based on the cancer's stage, location, and patient factors, with a focus on organ preservation and supportive care to optimize morbidity, mortality, and quality of life outcomes. According to the most recent evidence 1, early-stage disease (stages I-II) is generally treated with single-modality therapy, either surgery or radiation therapy alone. For more advanced disease (stages III-IV), a combination approach is recommended, including surgery followed by adjuvant radiation or chemoradiation, or definitive chemoradiation without surgery. The standard chemotherapy regimen for concurrent treatment is high-dose cisplatin (100 mg/m² every 3 weeks for 3 cycles), though alternatives like weekly cisplatin (40 mg/m²) or carboplatin with 5-fluorouracil may be used for patients who cannot tolerate high-dose cisplatin, as supported by previous studies 1. Key considerations in treatment planning include:

• Staging and risk assessment using the TNM system and physical examination, head and neck endoscopy, and head and neck CT-scan or MRI, with thoracic CT-scan for metastatic disease evaluation 1
• Multidisciplinary treatment schedule establishment, with patient nutritional status correction and maintenance, and dental rehabilitation before radiotherapy 1
• Chemoradiotherapy for unresectable tumors, with platinum-based regimens as the standard chemotherapy for concurrent chemoradiotherapy 1
• Palliative chemotherapy as the standard option for recurrent or metastatic disease, with weekly methotrexate as a considered treatment, although combination chemotherapy may produce higher response rates without survival benefit 1
• Supportive care throughout treatment, including nutritional support, pain management, and addressing treatment-related toxicities such as mucositis and xerostomia, to optimize quality of life outcomes. Overall, the goal of treatment is to achieve the best possible outcomes in terms of morbidity, mortality, and quality of life, while considering the individual patient's needs and circumstances.

From the FDA Drug Label

1.1 Squamous Cell Carcinoma of the Head and Neck (SCCHN) ERBITUX® is indicated: in combination with radiation therapy for the initial treatment of locally or regionally advanced squamous cell carcinoma of the head and neck (SCCHN). in combination with platinum-based therapy with fluorouracil for the first-line treatment of patients with recurrent locoregional disease or metastatic SCCHN as a single-agent for the treatment of patients with recurrent or metastatic SCCHN for whom prior platinum-based therapy has failed.

The treatment approach for Squamous Cell Carcinoma of the Head and Neck includes:

• Combination therapy: ERBITUX with radiation therapy for initial treatment of locally or regionally advanced SCCHN.
• Combination therapy: ERBITUX with platinum-based therapy and fluorouracil for first-line treatment of patients with recurrent locoregional disease or metastatic SCCHN.
• Single-agent therapy: ERBITUX for patients with recurrent or metastatic SCCHN who have failed prior platinum-based therapy. Alternatively, docetaxel can be used in combination with cisplatin and fluorouracil for the induction treatment of patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) 2. For ERBITUX, the recommended dosage is:
• 400 mg/m2 as an initial dose, administered as a 120-minute intravenous infusion, one week prior to initiating a course of radiation therapy.
• 250 mg/m2 as subsequent doses, administered as a 60-minute infusion, every week for the duration of radiation therapy (6–7 weeks) 3.

From the Research

Diagnosis and Treatment of Squamous Cell Carcinoma of the Head and Neck

• Squamous cell carcinoma of the head and neck (HNSCC) is a complex cancer that requires a multidisciplinary approach for treatment 4.
• The treatment approach for HNSCC depends on the stage and location of the cancer, as well as the patient's overall health.

Treatment Options

• For patients with locally or regionally advanced disease, surgery and/or radiation are the cornerstones of definitive treatment 4.
• Medical therapy plays an important adjunct role in this setting, typically consisting of a platinum-based regimen given as induction, concurrent, or adjuvant treatment 4.
• Chemotherapy is increasingly being incorporated into the treatment of HNSCC, with concurrent chemoradiotherapy being the recommended approach for unresectable disease 5.
• Novel targeted agents, such as epidermal growth factor receptor antagonists, are showing promise in the treatment of patients with both locoregionally advanced and recurrent/metastatic HNSCC 5.

Chemotherapy Regimens

• The combination of cisplatin, 5-fluorouracil (5-FU), and cetuximab (PFC) is the reference first-line treatment for recurrent/metastatic (R/M) HNSCC 6.
• However, some patients may be ineligible for this regimen due to age, severe comorbidities, or poor performance status, and alternative regimens such as weekly paclitaxel, carboplatin, and cetuximab (PCC) may be considered 7.
• The efficacy and safety of these regimens have been evaluated in clinical trials, with mixed results 8, 6, 7.

Clinical Trials and Future Directions

• Clinical trials are ongoing to investigate novel approaches, including new and combination immunotherapies, targeted therapies, therapeutic vaccines, antibody-drug conjugates, and cellular therapies 4.
• The results of these trials will help to further optimize the treatment of HNSCC and improve patient outcomes.