Docetaxel in squamous cell cancer of the head and neck

Single-agent docetaxel induces a response in 21-42% of patients with recurrent squamous cell cancer of the head and neck (SCCHN). When used in combination with 5-fluorouracil (5-FU), response rates (RRs) of between 24 and 27% have been reported. In contrast, in combination with cisplatin, docetaxel has achieved a RR of 33% in previously treated patients and 86% in a subgroup of chemotherapy-naive advanced stage patients. The docetaxel/cisplatin combination appears to be highly active. High-dose induction chemotherapy for patients with locally advanced but potentially curable SCCHN is producing promising results: following combination therapy involving docetaxel, cisplatin, 5-FU and leucovorin (TPFL), RR are high and 75% of patients are alive at 2 years. Intermediate-dose induction chemotherapy involving docetaxel is also promising: the TAX 708 trial found an excellent 93% RR in 41 evaluable patients treated with docetaxel plus cisplatin and 5-FU (TPF). The rate of pathological complete response was also high. The toxicities with TPF therapy were similar to those seen with cisplatin/5-FU regimens without docetaxel. A phase III trial of this approach is currently being conducted.