Head and neck squamous cell cancers (HNSCCs) represent 4 to 5% of all
solid malignancies. Despite improvements in diagnostic techniques, 60% of patients
will present with locally advanced HNSCCs with a median 5-year overall survival of
approximately 40-60%. Recent clinical trials have altered the treatment landscape by
refining existing forms of radiation, incorporation of IMRT, choice of chemotherapeutic
agents, introduction of biological and targeted therapy, immunotherapy and gene
therapy. The curative treatment of locally advanced head and neck squamous cell cancer
has been advanced greatly with the establishment of chemotherapy. More recently,
Cetuximab, a monoclonal antibody directed against the human epidermal growth factor
receptor (EGFR), has been approved in combination with RT in patients with locally
advanced HNSCCs. Researchers have focused on other monoclonal antibodies against
EGFR (Zalutumumab, Nimotuzumab), anti-angiogenic agents (Bevacizumab), tyrosine
kinase inhibitors (gefitinib, erlotinib, sorafenib, sunitinib), Vandetanib, an antagonist of
both vascular endothelial growth factor receptor (VEGFR) and the EGFR, monoclonal
antibodies against EGFR (Zalutumumab, Nimotuzumab), CUDc-101, a mutli-targeted
agent against histone deacetylase (HDAC), epidermal growth factor receptor (EGFR)
and human epidermal growth factor receptor 2 (HER2) inhibitors are currently being
tested in different phases of clinical trials. Other treatments modalities like gene therapy
and immune therapy has shown promise in the management of these cancers.
Nevertheless, identification of predictive biomarkers of resistance or sensitivity to these
therapies remains a fundamental challenge in the optimal selection of patients most
likely to benefit from them. However, increase in efficacy comes at the cost of
increased toxicity. The discovery of human papilloma virus (HPV) as a prognostic tool
is likely to change the landscape of treatment of HNSCCs. The current chapter focuses
on insight into current treatment options in the management of locally advanced head
and neck cancers and updates on the clinical trials and patents using new investigational
agents in the management for HNSCCs.
Keywords: Cetuximab, cisplatin, CRT, EGFR, erlotinib, gefitinib, head and neck
squamous cell cancers, head-shock protein, hypoxia, human papilloma virus,
immunotherapy, intensity modulated radiation therapy, lonafarnib, nimotuzumab,
Phase III, proteosome inhibitors, sorafenib, vandetanib, VEGF, zalutumumab.
