Locally advanced squamous cell head and neck cancer remains a therapeutic challenge for multidisciplinary teams. Despite high objective response rates, induction chemotherapy has not resulted in tangible benefit in multiple randomized trials. In recent years, as most evidence solidified the role of concurrent chemotherapy and radiation as either primary or postoperative therapy for locally advanced head and neck cancer, induction chemotherapy fell out of scope and practice. The failure of older randomized trials to show a survival benefit from induction chemotherapy can be attributed to several factors. It is possible that the predominance of locoregional failure did not allow any added benefit from better systemic control to translate into a survival advantage. Alternatively, seemingly active chemotherapy regimens may have been suboptimal. Nevertheless, recent developments have altered our perception of head and neck cancer and its treatment. Locoregional control has dramatically improved with concurrent chemoradiotherapy. Of note is that none of the previously conducted randomized trials of induction chemotherapy used concurrent chemoradiotherapy in the control arm. Moreover, we witnessed the development of better combination regimens that improved efficacy in the induction setting. The previously standard cisplatin/5-fluoruracil (5-FU) combination is being replaced by the triple combination of taxane/cisplatin/5-FU. Randomized trials showed that increased activity with the triplet regimen resulted in improved long-term disease control and survival. Finally, cetuximab, an active epidermal growth factor receptor inhibitor, is entering clinical practice and is expected to change the standard of therapy. With the emergence of more efficacious systemic therapies, the role of induction therapy warrants reevaluation. A number of randomized trials are planned or currently ongoing to investigate concurrent chemoradiotherapy with or without induction. These trials are anticipated to redefine the role of induction chemotherapy for head and neck cancer.
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Erin Reid, Gita Suneja, Richard F. Ambinder, Kevin Ard, Robert Baiocchi, Stefan K. Barta, Evie Carchman, Adam Cohen, Neel Gupta, Kimberly L. Johung, Ann Klopp, Ann S. LaCasce, Chi Lin, Oxana V. Makarova-Rusher, Amitkumar Mehta, Manoj P. Menon, David Morgan, Nitya Nathwani, Ariela Noy, Frank Palella, Lee Ratner, Stacey Rizza, Michelle A. Rudek, Jeff Taylor, Benjamin Tomlinson, Chia-Ching J. Wang, Mary A. Dwyer, and Deborah A. Freedman-Cass
months, then every 3 months) may be needed if systemic cancer therapy is used, especially if treatment is anticipated to cause lymphopenia. 49 In the setting of chemotherapy-associated lymphopenia, HIV viral load monitoring more accurately reflects
Kah Poh Loh, Vivian Lam, Katey Webber, Simran Padam, Mina S. Sedrak, Vivek Musinipally, Madison Grogan, Carolyn J. Presley, Janice Grandi, Chandrika Sanapala, Daniel A. Castillo, Grace DiGiovanni, Supriya G. Mohile, Louise C. Walter, and Melisa L. Wong
inclusion criteria: (1) the study included patients aged ≥65 years with any cancer type; (2) participants received systemic cancer therapy; (3) FS was quantitatively measured using physical performance tests, patient-reported outcomes (PROs; eg, instrumental
Piet Dirix, Lynda Wyld, Shani Paluch-Shimon, and Philip Poortmans
reduced or excellent performance status derive the same clinical benefit from novel systemic cancer therapies? A systematic review and meta-analysis . ESMO Open 2017 ; 2 :e000225. 29209535 10.1136/esmoopen-2017-000225 8. Denduluri N , Pratt DA
Elliott K. Yee, Natalie G. Coburn, Laura E. Davis, Alyson L. Mahar, Victoria Zuk, Vaibhav Gupta, Ying Liu, Craig C. Earle, and Julie Hallet
cancer therapy improve the quality of cancer care? J Oncol Pract 2019 ; 15 : 349 – 356 . 31112481 10.1200/JOP.18.00671 14. Lin CC , Bruinooge SS , Kirkwood MK , . Association between geographic access to cancer care, insurance, and receipt
NCCN Guidelines Insights: Survivorship, Version 2.2020
Featured Updates to the NCCN Guidelines
Crystal S. Denlinger, Tara Sanft, Javid J. Moslehi, Linda Overholser, Saro Armenian, K. Scott Baker, Gregory Broderick, Wendy Demark-Wahnefried, Debra L. Friedman, Mindy Goldman, Norah Lynn Henry, Christine Hill-Kayser, Melissa Hudson, Nazanin Khakpour, Divya Koura, Allison L. McDonough, Michelle Melisko, Kathi Mooney, Halle C. F. Moore, Natalie Moryl, Tracey O’Connor, Electra D. Paskett, Chirayu Patel, Lindsay Peterson, William Pirl, M. Alma Rodriguez, Kathryn J. Ruddy, Lillie Shockney, Sophia Smith, Karen L. Syrjala, Amye Tevaarwerk, Phyllis Zee, Nicole R. McMillian, and Deborah A. Freedman-Cass
most cancers have a markedly increased risk of developing CVD compared with noncancer populations. 8 – 10 One reason for this increased CVD risk in cancer survivors is that cytotoxic, hormonal, and targeted systemic cancer therapies (eg, HER2-directed
Lindsey Robert Baden, Sankar Swaminathan, Michael Angarone, Gayle Blouin, Bernard C. Camins, Corey Casper, Brenda Cooper, Erik R. Dubberke, Ashley Morris Engemann, Alison G. Freifeld, John N. Greene, James I. Ito, Daniel R. Kaul, Mark E. Lustberg, Jose G. Montoya, Ken Rolston, Gowri Satyanarayana, Brahm Segal, Susan K. Seo, Shmuel Shoham, Randy Taplitz, Jeffrey Topal, John W. Wilson, Karin G. Hoffmann, and Courtney Smith
. 230 A recent publication from MD Anderson Cancer Center retrospectively evaluated the use of HIV screening in patients before initiation of systemic cancer therapy. 231 Of the 18,874 patients in this study, 3,514 tested positive for HIV at the
Erin Reid, Gita Suneja, Richard F. Ambinder, Kevin Ard, Robert Baiocchi, Stefan K. Barta, Evie Carchman, Adam Cohen, Oxana V. Crysler, Neel Gupta, Chelsea Gustafson, Allison Hall, Kimberly L. Johung, Ann Klopp, Ann S. LaCasce, Chi Lin, Amitkumar Mehta, Manoj P. Menon, David Morgan, Nitya Nathwani, Ariela Noy, Lee Ratner, Stacey Rizza, Michelle A. Rudek, Julian Sanchez, Jeff Taylor, Benjamin Tomlinson, Chia-Ching J. Wang, Sai Yendamuri, Mary A. Dwyer, CGC, and Deborah A. Freedman-Cass
month for the first 3 months and then every 3 months) may be needed if systemic cancer therapy is used. 34 Opportunistic Infection Prophylaxis The occurrence of opportunistic infections in PLWH has decreased in the ART era, mainly because effective ART
