The changing landscape of induction chemotherapy in head and neck cancers

In an attempt to improve the survival in locally advanced head and neck carcinomas, varying sequencing of treatment modalities namely surgery, radiation therapy and chemotherapy has been tried. Although concurrent chemoradiotherapy is the standard of care for these patients, induction chemotherapy is considered an effective alternative approach by head and neck oncologists worldwide. Induction chemotherapy continues to be actively pursued because of its potential to control locoregional disease, possible eradication of micrometastasis and organ preservation without jeopardizing overall survival. Inspite of the positive impact of docetaxel-based induction regimens, its direct comparison with the standard treatment failed to show superior results in terms of survival and completion of planned definitive radiation treatment. Several clinical trials have served to clarify the role of induction chemotherapy before definitive treatment in head and neck cancer, still the data remains controversial and warrants randomized controlled trials to ensure that most effective therapy is delivered with subsequent improvement in survival for these patients. This review summarizes key milestones in the evolution of induction chemotherapy in head and neck carcinoma.