The role of cetuximab in treatment of squamous cell carcinoma of the head and neck

Squamous cell carcinoma of the head and neck (SCCHN) is one of the causes of cancer mortality. The mortality rate of patients within a year from the moment of diagnosis reaches 27% in patients with tumors of the oral cavity and 35.2% in patients with tumors of the pharynx. Despite the visual localization of SCCHN more than 50% of patients at the time of diagnosis are not subject to radical surgical treatment. More than half of the patients develop relapses of SCCHN within 3 years after the end of radical treatment. Most patients with SCCHN receive antitumor drug therapy either when an unresectable/metastatic tumor is detected or when a relapse develops after previously performed radical treatment. Epidermal growth factor receptor (EGFR) is expressed in almost 100% SCCHN and its expression is generally associated with decreased overall survival and progression-free survival. EGFR is a target receptor for targeted drugs. Cetuximab is a monoclonal antibody that blocks EGFR. The review examines the role of cetuximab in the treatment of recurrent and/or metastatic SCCHN in combination with chemotherapy and radiation therapy. The main undesirable phenomenon of cetuximab is dermatological toxicity: acne-like rash, dry skin, paronychia. Preventive therapy, including the antibiotic doxycycline, avoids the development of dermatological toxicity of 2–3 degrees. One of the most important biological processes involved in the progression of SCCHN is tumor escape from immune response associated with the expression of programmed death receptor 1 (PD-1), which inhibits the anti-tu mor immune response. Immunotherapy with checkpoint inhibitors pembrolizumab and nivolumab has shown a significant improvement in the survival of patients with progressing SCCHN after previously performed chemotherapy with the inclusion of cisplatin. Pembrolizumab in combination with cytostatics is an effective first-line therapy regimen for SCCHN in the presence of PD-L1 expression (CPS ≥ 1). In approximately 10–20% of patients, effective therapy changes due to poor tolerability. Timely prevention and relief of adverse events, control of disease manifestations, and a multidisciplinary approach to the patient make it possible to achieve optimal treatment results.