|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 388-389
Neoadjuvant chemotherapy in oral cavity cancer: A new horizon?
Supriya Mallick, Prashanth Giridhar
Department of Radiation Oncology, National Cancer Institute, AIIMS, New Delhi, India
|Date of Submission||09-Mar-2020|
|Date of Decision||09-Mar-2020|
|Date of Acceptance||23-Mar-2020|
|Date of Web Publication||19-Jun-2020|
AIIMS, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mallick S, Giridhar P. Neoadjuvant chemotherapy in oral cavity cancer: A new horizon?. Cancer Res Stat Treat 2020;3:388-9
Oral cavity cancer poses a great challenge as it constitutes nearly 10% of all cancers in India  and nearly 80% cases present in the advanced stage. An R0 surgical resection is considered the cornerstone of therapy followed by adjuvant radiation. Achieving an R0 surgical resection may be difficult in many cases. The article by Goel et al. has nicely summarized the evidence of using neoadjuvant chemotherapy (NACT) in oral cavity cancer. The authors have done an extensive narrative review on the existing evidence of NACT in oral cavity cancer and not attempted to do a systematic review which may be considered a limitation of the article. NACT was evaluated for early oral cancer in two trials by Licitra et al. and Zhong et al. Both the trials failed to show any survival advantage when added to standard surgery followed by adjuvant radiation. In a subset analysis, NACT was found to be associated with less mandible resections. NACT in advanced head and neck cancer was used in TAX 323 and TAX 324 trials with a promising 10% survival advantage with the three drug docetaxel, cisplatin, 5-fluorouracil (TPF) regimen. But, these trials were criticized as both compared TPF to PF as NACT regimen and lacked the standard of care concurrent chemoradiation (CTRT) without NACT arm. Subsequently, few other trials including PARADIGM  and DeCIDE  trials failed to show an improvement in outcome with NACT in locally advanced head and neck cancer compared to standard CTRT. The subsequent hypothesis of survival improvement with NACT for high risk N2 or N3 locally advanced head and neck cancer also failed to show additional benefit. NACT in laryngeal cancer was initially tried with a promise of organ preservation  but was replaced by CTRT afterwards. These findings significantly dent the hypothesis that NACT may control micro-metastases which can translate into survival. Interestingly, NACT in other solid tumors (breast cancer, lung cancer, carcinoma cervix, carcinoma esophagus, carcinoma stomach) has not dramatically changed the survival outcome. A couple of hypotheses may explain the situation. First, after exposure of chemotherapy, cancer cells develop higher potential to develop newer mutations and become more resistant to therapy. Second, after the use of NACT, the sensitive tumor cells are killed easily and then the resistant cells show accelerated repopulation which ultimately leads to poorer disease control. A point should also be made that the addition of one more modality adds to the toxicity and cost of care. It may also happen that many patients with borderline performance status become ineligible for the definitive treatment. So, NACT should not be used as a regular treatment option and should be evaluated in unresectable oral cavity cancer in a well-designed clinical trial.
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Conflicts of interest
There are no conflicts of interest.
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