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September 2016

The Evolving and Future Role of Taxanes in Squamous Cell Carcinomas of the Head and NeckA Review

Author Affiliations
  • 1Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
  • 2Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Otolaryngol Head Neck Surg. 2016;142(9):898-905. doi:10.1001/jamaoto.2016.1238

Importance  Since their discovery in the 1970s, taxanes have maintained widespread clinical use in solid tumors, including squamous cell carcinoma of the head and neck (SCCHN), but SCCHN remains a difficult malignancy to treat, often requiring a multidisciplinary approach involving surgery, radiotherapy, and chemotherapy. Taxanes have been heavily studied in the treatment of SCCHN, and their use is currently in the setting of induction chemotherapy with the TPF (docetaxel, FU, cisplatin) regimen for locally advanced SCCHN, as well as in the concurrent therapy setting. However, there is still no clear guideline or indication for the use of taxanes in SCCHN.

Observations  A literature search was completed in PubMed using the search terms “taxane,” “head and neck cancer,” “docetaxel,” “paclitaxel,” and “chemotherapy,” for articles published between 1990 to 2015. In this review, we provide an overview of the evidence thus far supporting the use of taxanes in the concurrent, induction, and adjuvant settings, as well as their use in the treatment of recurrent or metastatic SCCHN. For locally advanced disease, docetaxel is part of the first line regimen for induction therapy, although the superiority of sequential therapy compared with concurrent therapy is still in question. In addition, several studies have shown at least equivalent outcomes for regimens including taxanes compared with standard platinum-based regimens. In the adjuvant setting, RTOG (Radiation Therapy Oncology Group) 1216 is looking into the prospect of docetaxel as a first-line agent for systemic therapy following surgery. In metastatic disease, various second-line regimens include taxanes, and their use is being considered in first-line therapies as well. Several phase 3 trials involving taxanes are underway, with the possibility that they will provide results that increase taxane use in SCCHN. In addition to reviewing their current use, we also provide an analytical discussion of the projected future role of taxanes in the management of SCCHN. Ongoing and future studies involving taxanes are also discussed.

Conclusions and Relevance  While the current role of taxane use in SCCHN remains to be established, ongoing and future studies involving taxanes will hopefully solidify their role in the treatment of SCCHN. The future role of taxanes will also be influenced by the introduction of novel taxanes, as well as immunotherapy in the treatment of SCCHN.