Systemic therapy strategies for head-neck carcinomas: Current status.
Systemic therapy strategies for head-neck carcinomas: Current status.
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DOI：
10.3205/cto000085
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Hoffmann TK
中科院分区：
文献类型：
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作者：
Hoffmann TK
头颈部癌症，其中大多数是鳞状细胞肿瘤，尽管进行了密集的局部治疗，预后仍不令人满意。除其他因素外，这可归因于治疗区域内或治疗区域外的肿瘤复发，以及更远端位置的转移。因此，这些肿瘤不仅需要标准的手术和放射治疗，而且还需要有效的全身治疗。这里的主要选择是姑息化疗，这是在疾病的复发或转移阶段的姑息治疗中确立的，并且以联合同步或辅助放化疗的形式用于不可手术或晚期肿瘤患者的治愈目的。手术前减少肿瘤的新辅助治疗策略尚未获得认可。迄今为止，放疗前的诱导化疗方案已用于远处转移风险高的患者，或在确定性放化疗或喉切除术前，作为广泛性喉癌患者决策（“化疗选择”）的辅助手段。三联诱导治疗（紫杉烷类、顺铂、5-氟尿嘧啶）显示出高缓解率和显著毒性，与（化疗）放疗联合使用，目前正在与同步放化疗进行比较;目前的金标准是疗效和长期毒性。另一种称为“靶向治疗”的全身治疗策略已经开发出来，以帮助增加特异性和减少毒性。靶向治疗的一个例子，EGFR特异性抗体，可用于姑息治疗，并与放射治疗相结合，以治疗晚期头颈癌。一系列其他新的生物制剂，如信号级联抑制剂，遗传因子或免疫疗法，目前正在大规模临床研究中进行评估，并可能证明对晚期，复发或转移性头颈癌患者有用。在开发持久的个体化全身肿瘤治疗时，关键的评估标准不仅是疗效和急性毒性，而且是（长期）生活质量和专用预测生物标志物的鉴定。
Head and neck cancers, most of which are squamous cell tumours, have an unsatisfactory prognosis despite intensive local treatment. This can be attributed, among other factors, to tumour recurrences inside or outside the treated area, and metastases at more distal locations. These tumours therefore require not only the standard surgical and radiation treatments, but also effective systemic modalities. The main option here is antineoplastic chemotherapy, which is firmly established in the palliative treatment of recurrent or metastatic stages of disease, and is used with curative intent in the form of combined simultaneous or adjuvant chemoradiotherapy in patients with inoperable or advanced tumour stages. Neoadjuvant treatment strategies for tumour reduction before surgery have yet to gain acceptance. Induction chemotherapy protocols before radiotherapy have to date been used in patients at high risk of distant metastases or as an aid for decision-making (“chemoselection”) in those with extensive laryngeal cancers, prior to definitive chemoradiotherapy or laryngectomy. Triple-combination induction therapy (taxanes, cisplatin, 5-fluorouracil) shows high remission rates with significant toxicity and, in combination with (chemo-)radiotherapy, is currently being compared with simultaneous chemoradiotherapy; the current gold standard with regards to efficacy and long-term toxicity. A further systemic treatment strategy, called “targeted therapy”, has been developed to help increase specificity and reduce toxicity. An example of targeted therapy, EGFR-specific antibodies, can be used in palliative settings and, in combination with radiotherapy, to treat advanced head and neck cancers. A series of other novel biologicals such as signal cascade inhibitors, genetic agents, or immunotherapies, are currently being evaluated in large-scale clinical studies, and could prove useful in patients with advanced, recurring or metastatic head and neck cancers. When developing a lasting, individualised systemic tumour therapy, the critical evaluation criteria are not only efficacy and acute toxicity but also (long-term) quality-of-life and the identification of dedicated predictive biomarkers.