Table 1: Most common chemotherapeutic regimens14
PHARMACOLOGY OF DRUGS:
CISPLATIN:
CETUXIMAB:
The inhibitor of EGF receptor is a chimeric monoclonal antibody directed to the extracellular domain of the receptor.
Binding to the receptor, it prevents signalling across the membrane resulting in blockade of cell growth, proliferation and metastasis.
DOCETAXEL:
It binds to beta-tubulin and enhances its polymerization.
Microtubules are stabilized and their depolymerization is prevented. This results in inhibition of normal dynamic reorganization of the microtubule network that is essential for interphase and mitotic functions.
FLUOROURACIL (5-FU):
It is converted in the body to the corresponding nucleotide 5-fluoro-2-deoxyuridine monophosphate which forms a covalent ternary complex with methyl-THFA and thymidylate synthase (TS) resulting in irreversible inhibition of TS.
It is rapidly metabolized by DPD resulting in plasma t1/2 of 15-20 minutes after i.v infusion.15
In general, there are 3 main approaches to the initial treatment of locally advanced disease: (1) concurrent platinum-based chemoradiation, with surgery reserved for residual disease;
(2) surgery with neck dissection and reconstruction, followed by adjuvant radiation or chemoradiation, depending on the presence of adverse risk factors; or
(3) induction chemotherapy followed by definitive chemoradiation or surgery.
Approximately 60% of patients with HNSCC present at a locally advanced stage, in which combined modality therapy with curative intent is recommended. Data shows that radiation therapy combined with simultaneous 5-fluorouracil (5-FU), cisplatin, carboplatin as single or combinations therapy of 5-FU with other drugs results in a increasing survival rate irrespective the radiation regimen. Cetuximab in combination with platinum or 5- FU has emerged as a new alternative regimen for patients who are not treated based on results from the first line treatment. The data from a phase III trial support the role of cetuximab plus radiotherapy as an effective treatment option for patients with advanced HNSCC. Moreover, cetuximab plus radiotherapy led to significant improvements in locoregional control and these survival improvements may be maintained over a long time, with a nine-percentage point advantage for cetuximab plus radiotherapy in the 5-year overall survival rate, compared with radiotherapy alone16.
CONCLUSION:
Head and neck squamous cell carcinoma is a severe type of cancer where the survival rates are very less. Improper or negligence in treatment may lead to fall in lifespan very rapidly. The main culprits of head and neck cancers are tobacco and excess alcohol intake but, in some cases, genetic factors and human papilloma virus. Preventive measures are much more helpful than treating it, which include remission of tobacco and alcohol intake. Early diagnosis is would be beneficial in increasing lifespan of the patients. Treating with combination therapy is more followed when compared to monotherapy.
ACKNOWLEDGEMENT:
We acknowledge the continuous support of Dr. M.B.V Raju(principal) for successfully completing the work.
CONFLICT OF INTEREST:
There was no conflict of interest.
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