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Crit Rev Oncol Hematol. 2017 Jul;115:50-58. doi: 10.1016/j.critrevonc.2017.04.011. Epub 2017 Apr 27.

Toxicities of systemic agents in squamous cell carcinoma of the head and neck (SCCHN); A new perspective in the era of immunotherapy.

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Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA. Electronic address:
Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA.
University of Udine School of Medicine, Udine, Italy.
Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France; Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France.
Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium.
Department of Medicine, Division of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
International Head and Neck Scientific Group.


Squamous cell carcinoma of the head and neck (SCCHN) is a difficult to treat malignancy and represents the seventh most common cancer worldwide. Systemic therapy has a critical role in the treatment of locally advanced and recurrent/metastatic disease. Cytotoxic chemotherapy has been primarily used along with radiation and surgery, with cisplatin being the standard of care choice of therapy. When contraindications to cisplatin exist, other agents such as carboplatin, taxanes, 5-fluorouracil, and cetuximab are used. Similarly, in the advanced or metastatic setting, platinum agents, taxanes and cetuximab have been predominantly utilized. With the recent approval of novel agents such as pembrolizumab and nivolumab, and their distinct toxicity profiles, an understanding of the potential sequelae of the different systemic agents is essential to the careful selection of agents in the advanced disease setting. Going forward, choosing novel agents will be weighed against traditional chemotherapy, and understanding the toxicities at stake is critical in this process. In addition to providing an overview of the toxicity profile of the different systemic agents, we also provide a perspective into the future of SCCHN treatment.


Adverse events; Chemotherapy; Head and neck cancer; Immunotherapy; Squamous cell carcinoma; Toxicities

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