New Hope for Head and Neck Cancer Patients Ineligible for Cisplatin

Head and neck squamous cell carcinoma (LAHNSCC) is a type of cancer that affects the head and neck area. It is often treated with radiotherapy, either as the main treatment or after surgery to remove the cancer. Adding platinum chemotherapy, like cisplatin, to radiotherapy can improve the chances of successfully treating the cancer and the patient's overall survival. When cisplatin chemotherapy is administered together with radiotherapy, it improves tumor control, decreases the chances of it coming back thus improving life expectancy. This is largely due to its property of radiosensitizer. However, cisplatin can cause serious side effects, including kidney damage and hearing loss, which can make it unsuitable for some patients. Due to this unmet need in such patients an alternative radiosensitizer was required. However, which radiosensitizer to be used was unknown.

In a randomized clinical trial assessing the efficacy of docetaxel, a chemotherapy drug, as an alternative radiosensitizer, researchers evaluated patients with locally advanced head and neck cancer who were treated with radiotherapy alone or after surgery and required cisplatin but were unfit for it due to comorbidities such as hearing loss or tinnitus, kidney problems, heart problems, or multiple uncontrolled conditions. A total of 356 patients were selected for the study and received either radiotherapy or radiotherapy with a weekly small dose of docetaxel for six or seven doses. The study found that the addition of docetaxel resulted in a statistically significant decrease in the likelihood of disease recurrence, an improvement in quality of life, and an increase in overall survival. The addition of docetaxel led to an improvement of disease control by nearly 12% and an average increase in lifespan of 10 months.

The publication of these results in the Journal of Clinical Oncology, a leading journal from the American Society of Clinical Oncology (ASCO), established a new standard of care for cisplatin-unfit patients. Today, patients requiring radiotherapy and those who are unfit for cisplatin need to be treated with docetaxel and radiotherapy. This study is one of the first randomized studies conducted in this setting, not only in India but also globally.

With the development of this new regimen, a major unsolved problem in head and neck cancer has been addressed. Docetaxel is readily available in India, and the development of this therapy has made an accessible, affordable, and scientifically validated treatment option available for cisplatin-unfit patients. However, the use of docetaxel can lead to adverse events and has a learning curve, so experienced head and neck medical oncologists who are well versed in managing the side effects of chemotherapy and radiation should administer it.

This important study throws light on a more cost-effective treatment option for head and neck cancer patients who can't take cisplatin. It demonstrates how docetaxel can improve the chances of being disease-free and living longer compared to only receiving radiation treatment in patients who cannot be given cisplatin and also highlights the importance of continued research into alternative treatments for head and neck cancer.

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Here's the study: https://ascopubs.org/doi/abs/10.1200/JCO.22.00980.