Systemic treatment and medical management of metastatic squamous cell carcinoma of the head and neck: Review of the literature and proposal for management changes

Objective: Worldwide, head and neck carcinomas account for 5% of all malignancies. Two-thirds of patients relapse after initial multimodal therapy. Until early 2000, the median overall survival (OS) of metastatic patients was about 6 months. Recently, new drugs have been incorporated in patient management, thus enabling an increase in OS. This review aims to define the comprehensive medical management of patients with relapsing head and neck carcinoma. Methods: A comprehensive review of the literature was made targeting four topics: first-and second-line treatment, supportive care, and management of elderly patients. Results: The choice of first-or second-line treatments is mainly based on performance status. In the elderly, geriatric assessment could be helpful. For PS 0.1 patients, the standard first-line treatment is 6 cycles of cisplatin-5FU-cetuximab. In the event of response, cetuximab alone is prolonged until progression or unacceptable toxicity. For second-line treatment, several options are currently available: enrolment in clinical trials, single-agent therapy (methotrexate, taxane, cetuximab), and best supportive care (BSC). Supportive care has to be initiated very early in the course of the disease to prevent pain, dysphagia and malnutrition. In elderly patients, the therapeutic options are: first-line treatment with the EXTREME regimen replacing cisplatin by carboplatin for patients in good general condition or methotrexate alone for other patients. BSC continues to be given to all patients (i.e. poor general conditions). Conclusion: In spite of numerous pending issues requiring further investigation, these recommendations seem to be routinely applicable. (C) 2013 Elsevier Ltd. All rights reserved.