Chemotherapy of head and neck cancer

Numerous studies have shown cisplatin-based chemotherapy to be effective in the treatment of head and neck cancer. Cisplatin/5-fluorouracil (5-FU) is the most frequently used combination regimen, but neurotoxicity, ototoxicity, and renal toxicity limit repeated dosing (for long-term treatment of responding patients) and dose intensification. In studies to date, the analogue carboplatin appears to have activity similar to cisplatin, the advantage of no significant neurotoxicity, ototoxicity, or renal toxicity, and less emetic potential. Two randomized trials have shown cisplatin/5-FU and carboplatin/5-FU superior in terms of response rate compared to single-agent therapy. Treatment with combinations of carboplatin/methotrexate and carboplatin/cisplatin is feasible, but myelosuppression is dose-limiting. As an induction regimen, carboplatin/5-FU yields response rates similar to cisplatin/5-FU. Overall, carboplatin has a more favorable toxicity profile for treating head and neck cancer patients who often have multiple medical problems when presenting for palliation of cancer. Reversible myelosuppression is dose-limiting. However, the availability of hematopoietic growth factors may allow investigators to safely intensify dosing, particularly in combined-modality curative treatment regimens for the newly diagnosed patient.