Table 1.

All HNSCC Patients	Patients with R/M HNSCC
Low performance status	Low performance status
Extent of prior treatment	Lack of response to prior chemotherapy
Substance abuse (tobacco, alcohol, betel quid)	Prior radiation therapy
Low reported quality of life	Hypopharynx or oral cavity primary site
Lack of private medical insurance (in the United States)	Weight loss > 5%
	Well/moderate tumor cell differentiation
	Malignant hypercalcemia (end-stage disease)

Factors Associated With Inferior Overall Survival for Patients With HNSCC

Abbreviation: R/M HNSCC, recurrent and/or metastatic head and neck squamous cell cancer.

Table 2.

Authors (y)	No. of Subjects	Treatment Groups	Response Rate (%)	Median Overall Survival (mo)	Reference
Jacobs et al. (1992)	249	Cisplatin + 5-FU	32^*	5.5	16
		Cisplatin	17	5.0
		5-FU	13	6.1
Forastiere et al. (1992)	227	Cisplatin + 5-FU	32^*	6.6	20
		Carboplatin + 5-FU	21	5.0
		Cisplatin	10	5.6
Clavel et al. (1994)	382	CABO^†	34^*		17
		Cisplatin + 5-FU	31	6.7^‡
		Cisplatin	15
Gibson et al. (2005)	218	Cisplatin + 5-FU	27	8.7	23
Gibson et al. (2005)	218	Cisplatin + paclitaxel	26	8.1	23
Burtness et al. (2005)	117	Cisplatin + cetuximab	26^*	9.2	45
Burtness et al. (2005)	117	Cisplatin + placebo	10	8.0	45
Vermorken et al. (2008)	442	Platinum + 5-FU + cetuximab^†	36^*	10.1^§	46
Vermorken et al. (2008)	442	Platinum + 5-FU	20	7.4	46

Selected Randomized Phase III Trials of Cisplatin-Containing Regimens for Patients With Recurrent or
Metastatic Head and Neck Squamous Cell Carcinoma

Abbreviations: 5-FU, 5-fluorouracil; CABO, cisplatin, methotrexate, bleomycin, and vincristine.
^*Higher response rates were statistically significant.
^†In both arms, substitution of carboplatin for cisplatin was allowed, at investigator’s discretion. In the experimental arm, maintenance cetuximab was allowed until disease progression or unacceptable toxicity.
^‡Overall survival was 29 weeks (6.7 months) for the entire study, with no significant differences among groups.
^§Higher overall survival was statistically significant.

Colevas AD. Chemotherapy options for patients with metastatic or recurrent squamous cell carcinoma of the head and neck. J Clin Oncol 2006;24:2644–2652.
Vermorken JB, Specenier P. Optimal treatment for recurrent/metastatic head and neck cancer. Ann Oncol 2010;21(Suppl 7): vii252–vii261.
Al-Sarraf M. Chemotherapy strategies in squamous cell carcinoma of the head and neck. Crit Review Oncol Hematol 1984;1:323–355.
Deleyiannis FW, Thomas DB, Vaughan TL, Davis S. Alcoholism: independent predictor of survival in patients with head and neck cancer. J Natl Cancer Inst 1996;88:542–549.
Karnoven-Gutierrez CA, Ronis DL, Fowler KE, et al. Quality of life scores predict survival among patients with head and neck cancer. J Clin Oncol 2008;26:2754–2760.
Kwok J, Langevein SM, Argiris A, et al. The impact of health insurance status on the survival of patients with head and neck cancer. Cancer 2010;116:476–485.
Lee JJ, Jeng JH, Wang HM, et al. Univariate and multivariate analysis of prognostic significance of betel quid chewing in squamous cell carcinoma of the buccal mucosa in Taiwan. J Surg Oncol 2005;91:41–47.
Argiris A, Li Y, Forastiere A. Prognostic factors and long-term survivorship in patients with recurrent or metastatic carcinoma of the head and neck: an analysis of two Eastern Cooperative Oncology Group randomized trials. Cancer 2004;101:2222–2229.
Penel N, Berthon C, Everard F, et al. Prognosis of hypercalcemia in aerodigestive tract cancers: a study of 136 recent cases. Oral Oncol 2005;41:884–889.
Ang KK, Harris J, Wheeler R, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. New Engl J Med 2010;363:24–35.
Wittes RE, Cvitkovic E, Shah J, et al. CIS-Dichlorodiammineplatinum (II) in the treatment of epidermoid carcinoma of the head and neck. Cancer Treat Rep 1977;61:359–366.
Morton RP, Rugman F, Dorman EB, et al. Cisplatinum and bleomycin for advanced or recurrent squamous cell carcinoma of the head and neck: a randomised factorial phase III controlled trial. Cancer Chemother Pharmacol 1985;15:283–289.
Hong WK, Schaefer S, Issell B, et al. A prospective randomized trial of methotrexate versus cisplatin in the treatment of recurrent squamous cell carcinoma of the head and neck. Cancer 1983;52:206–210.
Grose WE, Lehane DE, Dixon DO, et al. Comparison of methotrexate and cisplatin for patients with advanced squamous cell carcinoma of the head and neck: a Southwest Oncology Group Study. Cancer Treat Rep 1985;69:577–581.
Kish JA, Weaver A, Jacobs J, et al. Cisplatin and 5-fluorouracil infusion in patients with recurrent and disseminated epidermoid carcinoma of the head and neck. Cancer 1984;53:1819–1824.
Jacobs C, Lyman G, Velez-Garcia E, et al. A phase III randomized study comparing cisplatin and fluorouracil as single agents and in combination for advanced squamous cell carcinoma of the head and neck. J Clin Oncol 1992;10:257–263.
Clavel M, Vermorken JB, Cognetti F, et al. Randomized comparison of cisplatin, methotrexate, bleomycin and vincristine (CABO) versus cersus cisplatin and 5-fluorouracil (CF) versus cisplatin (C) in recurrent or metastatic squamous cell carcinoma of the head and neck. A phase III study of the EORTC Head and Neck Cancer Cooperative Group. Ann Oncol 1994;5:521–526.
Eisenberger M, Hornedo J, Silva H, et al. Carboplatin (NSC-241-240): an active platinum analog for the treatment of squamous-cell carcinoma of the head and neck. J Clin Oncol 1986;4:1506–1509.
Al-Sarraf M, Metch B, Kish J, et al. Platinum analogs in recurrent and advanced head and neck cancer: a Southwest Oncology Group and Wayne State University Study. Cancer Treat Rep 1987;71:723–726.
Forastiere AA, Metch B, Schuller DE, et al. Randomized comparison of cisplatin plus fluorouracil and carboplatin plus fluorouracil versus methotrexate in advanced squamous-cell carcinoma of the head and neck: a Southwest Oncology Group study. J Clin Oncol 1992;10:1245–1251.
Forastiere A, Shank D, Neuberg D, et al. Final report of a phase II evaluation of paclitaxel in patients with advanced squamous cell carcinoma of the head and neck: an Eastern Cooperative Oncology Group trial (PA390). Cancer 1998;82:2270–2274.
Dreyfuss AI, Clark JR, Norris CM, et al. Docetaxel: an active drug for squamous cell carcinoma of the head and neck. J Clin Oncol 1996;14:1672–1678.
Gibson MK, Li Y, Murphy B, et al. Randomized phase III evaluation of cisplatin plus fluorouracil versus cisplatin plus paclitaxel in advanced head and cancer (E1395): an Intergroup Trial of the Eastern Cooperative Oncology Group. J Clin Oncol 2005;23:3562–3567.
Clark JI, Hofmeister C, Choudhury A, et al. Phase II evaluation of paclitaxel in combination with carboplatin in advanced head and neck carcinoma. Cancer 2001;92:2334–2340.
Ferrari D, Fiore J, Codeca C, et al. A phase II study of carboplatin and paclitaxel for recurrent and metastatic head and neck cancer. Anticancer Drugs 2009;20:185–190.
Moosmann P, Egli F, Stahel RA, Jost L. Weekly paclitaxel and carboplatin combination chemotherapy in patients with advanced squamous cell carcinoma of the head and neck. Onkologie 2003;26:568–572.
Shin DM, Glisson BS, Khuri FR, et al. Phase II trial of paclitaxel, ifosfamide, and cisplatin in patients with recurrent head and neck squamous cell carcinoma. J Clin Oncol 1998;16:1325–1330.
Shin DM, Khuri FR, Glisson BS, et al. Phase II study of paclitaxel, ifosfamide, and carboplatin in patients with recurrent or metastatic head and neck squamous cell carcinoma. Cancer 2001;91:1316–1323.
Janinis J, Papadakou M, Xidakis E, et al. Combination chemotherapy with docetaxel, cisplatin and 5-fluorouracil in previously treated patients with advanced/recurrent head and neck cancer: a phase II feasibility study. Am J Clin Oncol 2000;23:126–131.
Pivot X, Raymond E, Laguerre B, et al. Pemetrexed disodium in recurrent locally advanced or metastatic squamous cell carcinoma of the head and neck. Br J Cancer 2001;85:649–655.
Fury MG, Haque S, Stambuk H, et al. A phase 2 study of pemetrexed plus gemcitabine every 2 weeks for patients with recurrent or metastatic head and neck squamous cell cancer. Cancer 2011;117:795–801.
Zhang L, Zhang Y, Huang PY, et al. Phase II clinical study of gemcitabine in the treatment of patients with advanced nasopharyngeal carcinoma after the failure of platinum-based chemotherapy. Cancer Chemother Pharmacol 2008;61:33–38.
Catimel G, Vermorken JB, Clavel M, et al. A phase II study of gemcitabine (LY 188011) in patients with advanced squamous cell carcinoma of the head and neck. EORTC Early Clinical Trials Group. Ann Oncol 1994;5:543–547.
Samlowski WE, Gundacker H, Kuebler JP, et al. Evaluation of gemcitabine in patients with recurrent or metastatic squamous cell carcinoma of the head and neck: a Southwest Oncology Group phase II study. Invest New Drugs 2001;19:311–315.
Degardin M, Oliveira J, Geoffrois L, et al. An EORTC-ECSG phase II study of vinorelbine in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck. Ann Oncol 1998;9:1103–1107.
Saxman S, Mann B, Canfield V, et al. A phase II trial of vinorelbine in patients with recurrent or metastatic squamous cell carcinoma of the head and neck. Am J Clin Oncol 1998;21:398–400.
Airoldi M, Cortesina G, Giordano C, et al. Ifosfamide in the treatment of head and neck cancer. Oncology 2003;65(Suppl 2):37–43.
Murphy BA. Topoisomerases in the treatment of metastatic or recurrent squamous cell carcinoma of the head and neck. Expert Opin Pharmacother 2005;6:85–92.
Wittes RE. Chemotherapy of head and neck cancer. Otolaryngol Clin North Am 1980;13:515–520.
Ang KK, Berkey BA, Tu X, et al. Impact of epidermal growth factor receptor expression on survival and pattern of relapse in patients with advanced head and neck carcinoma. Cancer Res 2002;62:7350–7356.
Rubin Grandis J, Melhem MF, Gooding WE, et al. Levels of TGF-alpha and EGFR protein in head and neck squamous cell carcinoma and patient survival. J Natl Cancer Inst 1998;90:824–832.
Baselga J, Trigo JM, Bourhis J, et al. Phase II multicenter study of the antiepidermal growth factor receptor monoclonal antibody cetuximab in combination with platinum based chemotherapy in patients with platinum-refractory metastatic and/or recurrent squamous cell carcinoma of the head and neck. J Clin Oncol 2005;23:5568–5577.
Herbst RS, Arquette M, Shin DM, et al. Phase II multicenter study of the epidermal growth factor receptor antibody cetuximab and cisplatin for recurrent and refractory squamous cell carcinoma of the head and neck. J Clin Oncol 2005;23:5578–5587.
Vermorken JB, Trigo J, Hitt R, et al. Open-label, uncontrolled, multicenter phase II study to evaluate the efficacy and toxicity of cetuximab as a single agent in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck who failed to respond to platinum-based chemotherapy. J Clin Oncol 2007;25:2171–2177.
Burtness B, Goldwasser MA, Flood W, et al. Phase III randomized trial of cisplatin plus placebo compared with cisplatin plus cetuximab in metastatic/recurrent head and neck cancer. J Clin Oncol 2005;23:8646–8654.
Vermorken JB, Mesia R, Rivera F, et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. New Engl J Med 2008;359:1116–1127.
Kies MS, Holsinger FC, Lee JJ, et al. Induction chemotherapy and cetuximab for locally advanced squamous cell carcinoma of the head and neck: results from a phase II prospective trial. J Clin Oncol 2010;28:8–14.
Klinghammer K, Knodler M, Schmittel A, et al. Association of epidermal growth factor receptor polymorphism, skin toxicity, and outcome in patients with squamous cell carcinoma of the head and neck receiving cetuximab-docetaxel treatment. Clin Cancer Res 2010;16:304–310.
Licitra L, Mesia R, Rivera F, et al. Evaluation of EGFR gene copy number as a predictive biomarker for the efficacy of cetuximab in combination with chemotherapy in the first-line treatment of recurrent and/or metastatic squamous cell carcinoma of the head and neck: EXTREME study. Ann Oncol, in press.
Yarbrough WG, Shores C, Witsell DL, et al. ras mutations and expression in head and neck squamous cell carcinomas. Laryngoscope 1994;104:1337–1347.
Anderson JA, Irish JC, Ngan BY. Prevalence of RAS oncogene mutation in head and neck carcinomas. J Otolaryngol 1992;21:321–326.
Loeffler-Ragg J, Witsch-Baumgartner M, Tzankov A, et al. Low incidence of mutations in EGFR kinase domain in Caucasian patients with head and neck squamous cell carcinoma. Eur J Cancer 2006;42:109–111.
Lee JW, Soung YH, Kim SW, et al. Somatic mutations of EGFR gene in squamous cell carcinoma of the head and neck. Clin Cancer Res 2005;11:2879–2882.
Sok JC, Coppelli FM, Thomas SM, et al. Mutant epidermal growth factor recepor (EGFRvIII) contributes to head and neck cancer growth and resistance to EGFR targeting. Clin Cancer Res 2006;12:5064–5073.
Tabernero J, Ciardiello F, Rivera F, et al. Cetuximab administered once every second week to patients with metastatic colorectal cancer: a two-part pharmacokinetic/pharmacodynamic phase I dose escalation cetuximab. Ann Oncol 2010;21:1537–1545.
ClinicalTrials.gov. Cetuximab at either 500 or 750 mg/m² every other week for recurrent or metastatic head and neck squamous cell cancer. Available at: http://clinicaltrials.gov/ct2/show/NCT00661427. Accessed April 6, 2011.
Cohen EE, Rosen F, Stadler WM, et al. Phase II trial of ZD1839 in recurrent or metastatic squamous cell carcinoma of the head and neck. J Clin Oncol 2003;21:1980–1987.
Stewart JWS, Cohen EEW, Licitra L, et al. Phase III study of gefitinib compared with intravenous methotrexate for recurrent squamous cell carcinoma of the head and neck. J Clin Oncol 2009;27:1864–1871.
Soulieres D, Senzer NN, Vokes EE, et al. Multicenter phase II study of erlotinib, an oral epidermal growth factor receptor tyrosine kinase inhibitor, in patients with recurrent or metastatic squamous cell cancer of the head and neck. J Clin Oncol 2004;22:77–85.
Kyzas PA, Cunha IW, Ionnidis JP. Prognostic significance of vascular endothelial growth factor immunohistochemical expression in head and neck squamous cell carcinoma: a meta-analysis. Clin Cancer Res 2005;11:1434–1440.
Machiels J-PH, Henry S, Zanetta S, et al. Phase II study of sunitinib in recurrent or metastatic squamous cell carcinoma of the head and neck: GORTEC 2006-01. J Clin Oncol 2010;28:21–28.
Williamson SK, Moon J, Huang CH, et al. Phase II evaluation of sorafenib in advanced and metastatic squamous cell carcinoma of the head and neck: Southwest Oncology Group study S0420. J Clin Oncol 2010;28:3330–3335.
Cohen EEW, Davis DW, Karrison TG, et al. Erlotinib and bevacizumab in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck: a phase I/II study. Lancet Oncol 2009;10:247–257.
Molinolo AA, Hewitt SM, Amornphimoltham P, et al. Dissecting the Akt/mammalian target of rapamycin signaling network: emerging results from the Head and Neck Cancer Tissue Array Initiative. Clin Cancer Res 2007;13:4964–4973.
Figlin RA, Brown E, Armstrong AJ, et al. NCCN Task Force Report: mTOR inhibition in solid tumors. J Natl Compr Canc Netw 2008;6(Suppl 5):S1–22.
Ekshyyan O, Rong Y, Rong X, et al. Comparison of radiosensitizing effects of the mammalian target of rapamycin inhibitor CCI-779 to cisplatin in experimental models of head and neck squamous cell carcinoma. Mol Cancer Ther 2009;8:2255–2265.
Raimondi AR, Molinolo A, Gutkind JS. Rapamycin prevents early onset of carcinogenesis in an oral-specific K-ras and p53 two-hit carcinogenesis model. Cancer Res 2009;69:4159–4166.
Ekshyyan O, Mills GM, Lian T, et al. Pharmacodynamic evaluation of temsirolimus in patients with newly diagnosed advanced stage head and neck squamous cell carcinoma. Head Neck 2010;32:1619–1628.
Shi Y, Frankel A, Radvanyi LG, et al. Rapamycin enhances apoptosis and increases sensitivity to cisplatin in vitro. Cancer Res 1995;55:1982–1988.
Beuvink I, Boulay A, Fumagalli S, et al. The mTOR inhibitor RAD001 sensitizes tumor cells to DNA-damage induced apoptosis though inhibition of p21 translation. Cell 2005;120:747–759.
Aissat N, Le Tourneau C, Ghoul A, et al. Antiproliferative effects of rapamycin as a single agent and in combination with carboplatin and paclitaxel in head and neck cancer cell lines. Cancer Chemother Pharmacol 2008;62:305–313.

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Author(s)

Matthew G. Fury, MD, PhD

Head and Neck Medical Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY

Disclosures

Disclosure: Matthew G. Fury, MD, PhD, has disclosed the following relevant financial relationships:
Participated in funded or unfunded research on a technology, process, or product development for: Novartis Pharmaceuticals Corporation; Genentech Inc.; Bristol-Myers Squibb Company
Served as an advisory board member, speakers bureau member, expert witness, or consultant for: Boehringer Ingelheim Pharmaceuticals, Inc.

David G. Pfister, MD

Head and Neck Medical Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY

Disclosures

Disclosure: David G. Pfister, MD, has disclosed the following relevant financial relationships:
Participated in funded or unfunded research on a technology, process, or product development for: Novartis Pharmaceuticals Corporation; Imclone

Editor(s)

Kerrin M. Green, MA

Assistant Managing Editor, Journal of the National Comprehensive Cancer Network

Disclosures

Disclosure: Kerrin M. Green, MA, has disclosed no relevant financial relationships.

CME Author(s)

Charles P. Vega, MD

Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine

Disclosures

Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.

CME Reviewer(s)

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Sarah Fleischman

CME Program Manager, Medscape, LLC

Disclosures

Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

CME

Current Recommendations for Systemic Therapy of Recurrent and/or Metastatic Head and Neck Squamous Cell Cancer

Authors: Matthew G. Fury, MD, PhD; David G. Pfister, MD
CME Released: 6/1/2011
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 6/1/2012, 11:59 PM EST

Start Activity

Target Audience and Goal Statement

This activity is intended for oncologists, otolaryngologists, and other physicians who care for patients with R/M HNSCC.

The goal of this activity is to evaluate treatment approaches to incurable R/M HNSCC.

Upon completion of this activity, participants will be able to:

Distinguish prognostic factors for survival in cases of R/M HNSCC
Evaluate different therapeutic approaches to patients with R/M HNSCC
Analyze the use of cytotoxic agents in the management of R/M HNSCC
Analyze the use of cetuximab in the management of R/M HNSCC

Disclosures

Author(s)

Matthew G. Fury, MD, PhD

Head and Neck Medical Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY

Disclosures

Disclosure: Matthew G. Fury, MD, PhD, has disclosed the following relevant financial relationships:
Participated in funded or unfunded research on a technology, process, or product development for: Novartis Pharmaceuticals Corporation; Genentech Inc.; Bristol-Myers Squibb Company
Served as an advisory board member, speakers bureau member, expert witness, or consultant for: Boehringer Ingelheim Pharmaceuticals, Inc.

David G. Pfister, MD

Head and Neck Medical Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY

Disclosures

Disclosure: David G. Pfister, MD, has disclosed the following relevant financial relationships:
Participated in funded or unfunded research on a technology, process, or product development for: Novartis Pharmaceuticals Corporation; Imclone

Editor(s)

Kerrin M. Green, MA

Assistant Managing Editor, Journal of the National Comprehensive Cancer Network

Disclosures

Disclosure: Kerrin M. Green, MA, has disclosed no relevant financial relationships.

CME Author(s)

Charles P. Vega, MD

Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine

Disclosures

Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.

CME Reviewer(s)

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Sarah Fleischman

CME Program Manager, Medscape, LLC

Disclosures

Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

Accreditation Statements

For Physicians

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and JNCCN - The Journal of the National Comprehensive Cancer Network. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.

Medscape, LLC designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit*:

Read the target audience, learning objectives, and author disclosures.
Study the educational content online or printed out.
Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape Education encourages you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.

From JNCCN - Journal of the National Comprehensive Cancer Network

CME

Current Recommendations for Systemic Therapy of Recurrent and/or Metastatic Head and Neck Squamous Cell Cancer

Authors: Matthew G. Fury, MD, PhD; David G. Pfister, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 6/1/2011

Valid for credit through: 6/1/2012, 11:59 PM EST

processing....

Abstract

For palliation of patients with recurrent and/or metastatic head and neck squamous cell cancer (R/M HNSCC), the major classes of commonly used cytotoxic chemotherapeutic agents are platinum agents (cisplatin, carboplatin), taxanes (paclitaxel, docetaxel), and antimetabolic agents (methotrexate, 5-fluorouracil). Cetuximab, a monoclonal antibody directed against the extracellular domain of the epidermal growth factor receptor, also shows modest activity against R/M HNSCC. Because the overall management of patients with R/M HNSCC often involves multidisciplinary input, this review focuses on data that help guide decision-making in scenarios in which palliative chemotherapy is planned. Avenues for ongoing research are also presented. (JNCCN 2011;9:681–690)

Page 1 of 4

General Considerations and Prognostic Factors

CME Information

References

References

Disclaimer

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on www.medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

Published by Harborside Press

Table 1.

Table 2.

References

Faculty and Disclosures

Author(s)

Matthew G. Fury, MD, PhD

David G. Pfister, MD

Editor(s)

Kerrin M. Green, MA

CME Author(s)

Charles P. Vega, MD

CME Reviewer(s)

Nafeez Zawahir, MD

Sarah Fleischman

CME

Current Recommendations for Systemic Therapy of Recurrent and/or Metastatic Head and Neck Squamous Cell Cancer

Target Audience and Goal Statement

Disclosures

Author(s)

Matthew G. Fury, MD, PhD

David G. Pfister, MD

Editor(s)

Kerrin M. Green, MA

CME Author(s)

Charles P. Vega, MD

CME Reviewer(s)

Nafeez Zawahir, MD

Sarah Fleischman

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Current Recommendations for Systemic Therapy of Recurrent and/or Metastatic Head and Neck Squamous Cell Cancer

Abstract

Table of Contents