Chemotherapy of head and neck cancer

Many drugs have been shown to have activity against head and neck cancer. Cisplatin, bleomycin, methotrexate, and 5-fluorouracil are considered to be the most active drugs. The search for new drugs through phase one and two trials and effective combination chemotherapy with tolerable toxicity is a major task at present. Simultaneous chemotherapy and radiotherapy provide no significant advantages over radiotherapy alone. Simultaneous intra-arterial and intravenous chemotherapy may be a reasonable approach to pursue, not only to improve local control but to decrease distant metastases. It is well established that those patients who achieve a complete response to chemotherapy show improved survival. Therefore, the important task is to attain a higher complete response rate with strategies, either by using intensive regimens or by alternating non-cross-resistant drugs. Sequential chemotherapy and radiotherapy are also interesting, providing an approach that is feasible and without increased morbidity. This approach is especially attractive in therapeutic trials because it allows the close monitoring of response and thereby helps to delineate any need for surgical salvage. Many questions regarding the selection of drugs, the intensity and duration of treatment and its timing, and the sequence of chemotherapy with respect to surgery and radiotherapy have yet to be answered.