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Drug Insight: cetuximab in the treatment of recurrent and metastatic squamous cell carcinoma of the head and neck

Nature Clinical Practice Oncology volume 5, pages 705–713 (2008)Cite this article

Abstract

Patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN) have a poor prognosis, particularly those whose disease has progressed on previous platinum-containing therapy. The epidermal growth factor receptor (EGFR) is expressed at very high levels in SCCHN and is associated with a poor prognosis. Several phase II–III studies have shown that the EGFR-targeting monoclonal antibody, cetuximab, offers clinical benefit for patients with SCCHN. Cetuximab monotherapy is active in patients whose cancer progresses on platinum-containing therapy. Tumor response and patient survival are in excess of what is achieved with commonly used therapies in this setting. Addition of a platinum regimen to cetuximab in patients with disease that progresses on platinum seems to confer no further benefit over cetuximab alone, either in terms of response rate or survival. In the first-line setting, cetuximab plus platinum and 5-fluorouracil significantly prolongs overall survival compared with platinum and 5-fluorouracil alone. The superior survival observed with cetuximab compared with platinum-based treatment demonstrates that cetuximab is the most active treatment for recurrent and/or metastatic SCCHN, and is of particular clinical significance.

Key Points

  • Cetuximab is approved for use in combination with radiotherapy in locally advanced squamous cell carcinoma of the head and neck (SCCHN) and in combination with irinotecan for the treatment of patients with EGFR-expressing, KRAS wild-type metastatic colorectal cancer

  • Administration of cetuximab at the recommended dose can be achieved without the need for modification in the dose or schedule of planned chemotherapy

  • Phase II studies of cetuximab in combination with platinum-based chemotherapy showed there was no indication that cetuximab increased the toxicity expected with platinum therapy

  • Cetuximab monotherapy offers an active approach for patients with recurrent and/or metastatic SCCHN progressing on prior platinum therapy who are unable or unwilling to undergo treatment with chemotherapy

  • Adding cetuximab to platinum/5-FU improves survival in the first-line treatment of recurrent and/or metastatic SCCHN

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Figure 1: Median overall survival: comparison of cetuximab-based treatment in three single-arm studies with data from a retrospective study in patients with recurrent and/or metastatic SCCHN progressing on platinum-containing therapy.9,36,37,38
Figure 2: Grade 3/4 side effects in patients randomized to receive either cisplatin plus cetuximab or cisplatin plus placebo.39

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Author notes

  1. Department of Radiation Oncology, Genolier Swiss Medical Network, CH-1272 Genolier, Switzerland jbernier@genolier.net

Authors and Affiliations

  1. J Bernier is Chairman of the Radio-Oncology Division at the Genolier Swiss Medical Network, Genolier, Switzerland.,

    Jacques Bernier

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J Bernier declared he is a consultant and is on the Advisory Board for Merck AG.

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Bernier, J. Drug Insight: cetuximab in the treatment of recurrent and metastatic squamous cell carcinoma of the head and neck. Nat Rev Clin Oncol 5, 705–713 (2008). https://doi.org/10.1038/ncponc1228

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