Safety of drug treatments for head and neck cancer

Introduction: The treatment of squamous cell carcinoma of the head and the neck depends on the disease’s stage. In locally-advanced stage disease, multimodal treatment strategies, including surgery, radiotherapy and chemotherapy, give the best outcome in terms of overall survival. Those treatments are not without negligeable adverse events, which can lead to late debilitating toxicities. In recurrent/metastatic disease, not amenable to surgery or radiation therapy, palliative chemotherapy is the most appropriate treatment.

Areas covered: This review aims to provide an overview of the safety of standard drug regimens used to treat SCCHN in daily practice, including platinum-based chemoradiation, induction chemotherapy, cetuximab and immunotherapy. The toxicities induced by single modality radiotherapy, or those resulting from surgery, are not part of the discussion.

Expert opinion: Toxicities observed with multimodal treatment of SCCHN are the highest we can tolerate in terms of treatment-related mortality, morbidity and late consequences. Patients at high risk of developing such complications should be identified upfront for optimal prevention and management. There is a medical need to identify less toxic regimens without compromising the treatment efficacy, especially for patients with Human Papilloma Virus-induced oropharyngeal cancers. Finally, it is crucial in future trials to better standardize the scales used to report treatment related adverse events.