Advanced head and neck cancer and clinical experience of an effective new agent: Docetaxel

Introduction: Docetaxel is a taxoid cytotoxic agent known to have considera ble clinical activity in a broad range of malignancies. A series of phase I /II studies have been performed to elucidate its toxicity and antitumor act ivity in advanced squamous cell carcinoma of the head and neck. Docetaxel a s first-line monotherapy: Docetaxel administered at 100 mg/m(2) as a 1-hour infusion every 3-4 weeks initiated an overall response of 27-42% for a dur ation of 5-6.5 months in patients with recurrent locoregional or metastatic disease. These results compare favourably with other single-agents in this setting. Docetaxel in combination chemotherapy: Preliminary analysis of co mbined docetaxel/cisplatin with or without 5-fluorouracil in locally advanc ed, unresectable or metastatic disease resulted in complete responses of 11 -25%, partial responses of 50-67%, and overall responses of 75% or over. A docetaxel-based induction regimen in chemonaive patients gave a universal c omplete response for primary disease and a 57% complete response for nodal involvement. Safety and toxicity: Short lasting neutropenia rarely complica ted by fever or infection is the main dose limiting toxicity of docetaxel. Acute hypersensitivity reactions and fluid retention are commonly associate d with this agent but are markedly reduced by prophylactic corticosteroids. Conclusion: Docetaxel appears to have substantial antitumour activity in a dvanced head and neck cancer and further studies are justified to determine its full role in the management of this disease.