Is There Still a Role for Induction Chemotherapy for Head and Neck Cancer?

Nasopharynx cancer is a disease known for chemosensitivity compared with its counterparts in the head and neck, and is also notorious for a greater incidence of systemic spread compared with squamous cancers arising fromotherheadandnecksites.Thus,theappealofsystemic therapies to treat this disease is great. In the current issue of theJournalofClinicalOncology,Chuaetal 1 reportaformof meta-analysis evaluating cisplatin-based induction therapy for nasopharynx cancer. By pooling the data from the two largest trials exploring the role of induction chemotherapy, it was hoped that the combination of two independently negative trials would gain sufficient statistical power to result in a positive result. Alas, with respect to overall survival, the overall trial results remain negative. The current analysis adds to the growing database of neoadjuvant chemotherapy trials in head and neck cancer that have not demonstrated a survival advantage for the use of induction therapy. These results are consistent with the Meta-Analysis of Chemotherapy in Head and Neck Cancer Collaborative Group’s finding, which revealed no significant survival benefit associated with the use of neoadjuvant chemotherapy. 2 In the 1990s, induction chemotherapy was a critical component in the management of patients when organ preservationwasthegoal.Often,survivalequivalencewasa