Is the new era of personalized medicine coming in head and neck cancer?

Abstract

The multidisciplinary approach is the standard for treatment of advanced head and neck cancer. Recent progress in molecular biology and translational research has initiated an era of personalized medicine in head and neck clinical oncology. The epidermal growth factor receptor (EGFR) signaling pathway is an important therapeutic target in squamous cell carcinoma of the head and neck (SCCHN). The use of an anti- EGFR monoclonal antibody (Ab), cetuximab, has been approved for the treatment of patients with locally advanced SCCHN in combination with radiotherapy. However, it is unclear what type of patient with locally advanced SCCHN can benefit most from cetuximab plus radiotherapy. Furthermore, although several clinical trials have investigated the benefit of induction chemotherapy (ICT) for locally advanced SCCHN, we still do not know the appropriate population of SCCHN to be treated with ICT. To pursue successful outcomes in the treatment of locally advanced SCCHN, multidisciplinary supportive care is indispensable. I will be also focusing on the management of side effects induced by radiotherapy, from the aspect of mucositis, skin reaction/radiation dermatitis, and nutrition support. In the recurrent and/or metastatic setting, the standard of care is combination treatment with cisplatin, 5-FU and cetuximab. The exciting clinical development of immune checkpoint inhibitors has evolved into phase III trials with anti PD-1 or anti-PD-L1 mAbs in combination with cytotoxic agents or anti-CTLA-4 Ab for patients with recurrent and/or metastatic SCCHN.