Advanced head and neck cancer and clinical experience of an effective new agent: docetaxel

Docetaxel is a taxoid cytotoxic agent known to have considerable clinical activity in a broad range of malignancies. A series of phase I/II studies have been performed to elucidate its toxicity and antitumor activity in advanced squamous cell carcinoma of the head and neck. DOCETAXEL AS FIRST-LINE MONOTHERAPY: Docetaxel administered at 100 mg/m2 as a 1-hour infusion every 3-4 weeks initiated an overall response of 27-42% for a duration of 5-6.5 months in patients with recurrent locoregional or metastatic disease. These results compare favourably with other single-agents in this setting.

Preliminary analysis of combined docetaxel/cisplatin with or without 5-fluorouracil in locally advanced, unresectable or metastatic disease resulted in complete responses of 11-25%, partial responses of 50-67%, and overall responses of 75% or over. A docetaxel-based induction regimen in chemonative patients gave a universal complete response for primary disease and a 57% complete response for nodal involvement.

Short lasting neutropenia rarely complicated by fever or infection is the main dose limiting toxicity of docetaxel. Acute hypersensitivity reactions and fluid retention are commonly associated with this agent but are markedly reduced by prophylactic corticosteroids.

Docetaxel appears to have substantial antitumour activity in advanced head and neck cancer and further studies are justified to determine its full role in the management of this disease.