Paclitaxel in head and neck and other cancers: future prospects

Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ), a member of the taxanes, has been shown to have antitumor activity in a wide variety of cancers, such as breast cancer and ovarian cancer. Paclitaxel also has antitumor activity in certain previously relatively unresponsive tumors, such as lung, head and neck, esophageal, and bladder cancers. The optimal dose for each tumor has not been well defined. While 3-hour infusion appears to be the most convenient, studies of both longer and shorter infusions are in progress. Any incremental benefit of higher dose or longer schedule will need to be evaluated on the basis of the higher costs and toxicities. The results of many initial studies using combination chemotherapy with paclitaxel have generated considerable enthusiasm, but careful comparison studies and evaluation of toxicities are needed. Additional roles of paclitaxel include its ability to act synergistically with radiotherapy, and thus possibly help improve the local control of tumors, such as head and neck, esophageal, bladder, and lung cancers. Studies testing the role of the taxanes in neoadjuvant therapy before radiotherapy or surgery are just beginning. Paclitaxel is thus one of the very important new agents in the treatment of cancer, and further work is needed to define its optimal use.