Clinical consensus on the treatment of locally advanced squamous cell carcinoma of the head and neck with anti-EGFR monoclonal antibody (2023 edition)

Abstract

Squamous cell carcinoma of the head and neck (SCCHN) is the most common head and neck tumor. Patients are generally diagnosed with advanced stage attributed to no clinically evident symptom at the early stage. For locally advanced SCCHN, cisplatin-based concurrent chemoradiotherapy (CRT) is the standard non-surgical treatment. However, the tolerance to high-dose cisplatin is poor owing to the high prevalence of comorbidities in patients with SCCHN. There are also concerns on the acute and late toxicities of CRT. Epidermal growth factor receptor (EGFR) is proved to be overexpressed in most SCCHN and it is associated with resistance to cytotoxic agents and radiotherapy leading to poor prognosis. Anti-EGFR antibody, which competes with EGFR ligands, can lead to receptor internalization, antibody-receptor complex down-regulation and tumor death. In addition, anti-EGFR antibody can play a role in radiosensitization by affecting cell cycle, DNA damage repair and angiogenesis. Radiotherapy combined with anti-EGFR antibody was demonstrated to improve survival when compared to radiotherapy alone, while consensus on anti-EGFR antibody delivery in the eligible patients, optimal intervention time and the management of adverse effects when combined with radiotherapy are yet warranted. According to the current recommendations, all patients with locally advanced SCCHN should be assessed for the tolerance of standard dose cisplatin prior to CRT. Radiotherapy with cetuximab is an alternative for patients who cannot tolerate. For those who received induction chemotherapy with the purpose of tumor downstaging or organ preservation, the standard regimen is TPF (docetaxel+cisplatin+5-fluorouracil) scheme. TPE scheme, using cetuximab as a substitution for fluorouracil, is an option for toxicities reducing. Managements of skin reactions, oral mucositis and radiation dermatitis are proposed.

Keywords

• |anti-egfr monoclonal antibody|locally advanced|squamous cell carcinoma of the head and neck|clinical consensus