Table 1: Most common chemotherapeutic regimens14
PHARMACOLOGY OF DRUGS:
CISPLATIN:
- It is hydrolysed intracellularly, producing a highly reactive moiety
which causes cross linking of DNA. The favoured site is
N7 of guanine residue.
- It is bound to plasma proteins, penetrates tissues and is slowly
excreted unchanged in urine.
- Its t1/2 is about 72 hours.
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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