Chemotherapy of head and neck cancer

Abstract

Phase II studies and randomized trials of chemotherapy in the treatment of patients with squamous cell carcinomas of the head and neck consistently demonstrate increased response rates in patients who have not been treated previously, who have better performance status, and who have less advanced disease. To date the promise of induction chemotherapy has not been fulfilled in randomized trials. Similarly, the improved response rates observed in phase II studies of combination chemotherapy have not proved to be an improvement over weekly outpatient methotrexate for those patients with recurrent squamous cell carcinomas. Indeed, even the policy of treating patients with recurrent disease with weekly methotrexate rather than the best supportive care has not, to my knowledge, been assessed. The only glimmer of hope in this gloomy picture is the report of the Northern California Oncology Group where early results suggest an improvement in survival for patients receiving bleomycin together with radiotherapy. Beyond the rather obvious need to develop more effective new drugs or drug combinations, physicians and patients must again be reminded that promising therapies should be substantiated in controlled trials before they are put into routine clinical practice.