Paclitaxel (Taxol) for the treatment of head and neck cancer

The mainstay of treatment for head and neck cancer patients with recurrent disease has been chemotherapy with cisplatin/5-fluorouracil or methotrexate. Clearly, new drugs are needed to improve response rates and prolong survival. One new chemotherapeutic agent that has shown activity in head and neck cancer, as well as other tumor types, is paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ). In a recently completed phase II trial in patients with recurrent head and neck cancer, the complete and partial response rate to high-dose paclitaxel (250 mg/m2) given as a 24-hour infusion with granulocyte colony-stimulating factor support was 40% (12 of 30 patients). The principal toxicities were similar to those reported in other trials: neutropenia, peripheral neuropathy, and arthralgias/myalgias. Other single-agent trials with paclitaxel currently are in progress, as are trials of paclitaxel--containing combination therapy using cisplatin, carboplatin, ifosfamide, and/or methotrexate. Also under evaluation are paclitaxel combined with radiotherapy and given in lower doses and alternative infusion schedules. Findings, to date suggest that paclitaxel may be the most active single chemotherapeutic agent for the treatment of head and neck cancer.