What are the common chemotherapy regimens for head and neck cancer?

Common Chemotherapy Regimens for Head and Neck Cancer

The most effective chemotherapy regimen for head and neck cancer is the TPF combination (docetaxel, cisplatin, and 5-fluorouracil), which has demonstrated superior response rates, longer disease-free progression, and longer overall survival compared to other regimens. 1, 2

Induction Chemotherapy Regimens

• TPF (Docetaxel, Cisplatin, 5-Fluorouracil) is the preferred induction regimen, showing significantly improved progression-free and overall survival compared to the older PF regimen 1, 3

  • Docetaxel 75 mg/m² on day 1
  • Cisplatin 75 mg/m² on day 1
  • 5-Fluorouracil 750 mg/m² per day as continuous infusion on days 1-5
  • Cycles repeated every 3 weeks for 4 cycles 1, 4

• PF (Cisplatin, 5-Fluorouracil) - historical standard regimen with lower efficacy:

  • Cisplatin 100 mg/m² on day 1
  • 5-Fluorouracil 1000 mg/m² per day as continuous infusion on days 1-5
  • Cycles repeated every 3 weeks 5, 3

Concurrent Chemoradiotherapy Regimens

• High-dose cisplatin with conventional fractionation radiotherapy is the standard treatment for locally advanced disease:

  • Cisplatin 100 mg/m² every 3 weeks with radiotherapy (70 Gy in 7 weeks) 2
  • Single-agent platinum (cisplatin) is recommended for patients with high-risk features after surgery (extracapsular extension and R1 resection) 1

• Alternative concurrent regimens:

  • Carboplatin/5-FU with radiotherapy 2
  • Cetuximab with radiotherapy - particularly for patients not medically fit for cisplatin-based therapy 2

Recurrent and/or Metastatic Disease Regimens

• Platinum-based combinations are the standard for metastatic disease:

  • Cisplatin or carboplatin plus 5-FU with cetuximab - improves median survival (10.1 vs 7.4 months) compared to platinum/5-FU alone 2
  • Cisplatin or carboplatin plus a taxane (paclitaxel or docetaxel) 2

• For palliative treatment in recurrent disease:

  • Weekly methotrexate is considered an accepted treatment 1
  • Combination chemotherapy (cisplatin, 5-fluorouracil or taxanes) produces higher response rates than single-agent methotrexate, though without demonstrated survival benefit 1

Special Considerations

• TPF regimen is associated with significant toxicities, particularly myelosuppression (78%), stomatitis/pharyngitis (24%), and gastrointestinal effects 6
• Febrile neutropenia is reported in approximately 16% of patients receiving TPF regimens 7
• For patients with poor performance status (PS 2-3), less intensive regimens should be considered 2
• Median survival with chemotherapy for metastatic disease is approximately 6-10 months, with 1-year survival rate around 20% 2, 8

Important Clinical Caveats

• All combined chemoradiotherapy regimens require close monitoring by an experienced team due to significant mucosal toxicities 2
• Nutritional status must be corrected and maintained throughout treatment 1
• Dental rehabilitation is indicated before radiotherapy to prevent complications 1
• The choice between single-agent and combination therapy should consider the patient's performance status, comorbidities, and treatment goals 2
• Evaluation of thyroid function in patients with irradiation to the neck is recommended at 1,2, and 5 years post-treatment 1