Clinical consensus on the treatment of locally advanced squamous cell carcinoma of the head and neck with anti-EGFR monoclonal antibody (2023 edition)

Tingting XU; Chaosu HU; Baosheng LI

doi:10.19401/j.cnki.1007-3639.2023.01.010

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Clinical consensus on the treatment of locally advanced squamous cell carcinoma of the head and neck with anti-EGFR monoclonal antibody (2023 edition)

Guideline and Consensus | 更新时间：2025-12-31

- Clinical consensus on the treatment of locally advanced squamous cell carcinoma of the head and neck with anti-EGFR monoclonal antibody (2023 edition)
- China Oncology Vol. 33, Issue 1, Pages: 81-94(2023)
- 作者机构：
  
  1. 中国临床肿瘤学会头颈肿瘤专家委员会
  2. 中国医师协会肿瘤放射治疗医师分会
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2023.01.010
  CLC： R739.91
- Received：21 October 2022，
  
  Revised：2023-01-03，
  
  Published：30 January 2023
- 稿件说明：
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Tingting XU, Chaosu HU, Baosheng LI. Clinical consensus on the treatment of locally advanced squamous cell carcinoma of the head and neck with anti-EGFR monoclonal antibody (2023 edition)[J]. China Oncology, 2023, 33(1): 81-94.
DOI：

Tingting XU, Chaosu HU, Baosheng LI. Clinical consensus on the treatment of locally advanced squamous cell carcinoma of the head and neck with anti-EGFR monoclonal antibody (2023 edition)[J]. China Oncology, 2023, 33(1): 81-94. DOI： 10.19401/j.cnki.1007-3639.2023.01.010.

摘要

头颈部鳞状细胞癌（squamous cell carcinoma of the head and neck，SCCHN）是最常见的一类头颈部肿瘤。由于早期症状不典型，大多数SCCHN患者确诊时已处于局部晚期。以标准剂量顺铂为基础的同期放化疗（chemoradiotherapy，CRT）是局部晚期SCCHN患者的标准非手术治疗模式。但同期CRT的近期和远期毒性问题不容忽视，对于无法耐受标准治疗强度的患者，在治疗策略的选择上要兼顾疗效、器官毒性和器官功能。几乎所有的SCCHN都会存在表皮生长因子受体（epidermal growth factor receptor，EGFR）过表达。抗EGFR单抗通过与EGFR结合，竞争性阻断内源性EGFR天然配体，阻碍EGFR二聚体的形成，抑制肿瘤细胞生长；此外，抗EGFR单抗可通过影响细胞周期、DNA损伤修复及血管生成等多种途径发挥放疗增敏作用。既往Ⅲ期临床研究表明，对比单纯放疗，放疗联合西妥昔单抗可显著改善局部晚期SCCHN患者的局部区域控制，延长总生存期。临床工作中合理地应用抗EGFR单抗仍面临诸多挑战，包括适用人群的判定标准、应用时机、联合方案的选择及不良事件管理等都需要进一步明确和规范。本共识专家组以循证医学证据为基础、相关指南为依据，经充分讨论形成《抗EGFR单抗治疗局部晚期头颈部鳞状细胞癌临床共识（2023年版）》。根据本共识的专家建议，局部晚期SCCHN患者在同期CRT前，应评估患者对标准剂量顺铂治疗的耐受性和治疗毒性。对于无法耐受标准剂量顺铂治疗的患者，或在接受多西他赛+顺铂+5-氟尿嘧啶（TPF）方案诱导化疗后出现顺铂相关毒性的患者，可选择放疗联合西妥昔单抗方案。对于有降期或器官功能保留需求、拟行诱导治疗的患者，标准诱导治疗方案为TPF方案，不能耐受TPF方案毒性的患者，可用西妥昔单抗替代5-氟尿嘧啶，采用TPE方案。安全性方面，放疗联合西妥昔单抗相关常见不良反应包括痤疮样皮疹、口腔黏膜炎、放射性皮炎等，可以通过治疗前预防、治疗过程中早期识别和及时干预进行全面、分级管理。

Abstract

Squamous cell carcinoma of the head and neck (SCCHN) is the most common head and neck tumor. Patients are generally diagnosed with advanced stage attributed to no clinically evident symptom at the early stage. For locally advanced SCCHN

cisplatin-based concurrent chemoradiotherapy (CRT) is the standard non-surgical treatment. However

the tolerance to high-dose cisplatin is poor owing to the high prevalence of comorbidities in patients with SCCHN. There are also concerns on the acute and late toxicities of CRT. Epidermal growth factor receptor (EGFR) is proved to be overexpressed in most SCCHN and it is associated with resistance to cytotoxic agents and radiotherapy leading to poor prognosis. Anti-EGFR antibody

which competes with EGFR ligands

can lead to receptor internalization

antibody-receptor complex down-regulation and tumor death. In addition

anti-EGFR antibody can play a role in radiosensitization by affecting cell cycle

DNA damage repair and angiogenesis. Radiotherapy combined with anti-EGFR antibody was demonstrated to improve survival when compared to radiotherapy alone

while consensus on anti-EGFR antibody delivery in the eligible patients

optimal intervention time and the management of adverse effects when combined with radiotherapy are yet warranted. According to the current recommendations

all patients with locally advanced SCCHN should be assessed for the tolerance of standard dose cisplatin prior to CRT. Radiotherapy with cetuximab is an alternative for patients who cannot tolerate. For those who received induction chemotherapy with the purpose of tumor downstaging or organ preservation

the standard regimen is TPF (docetaxel+cisplatin+5-fluorouracil) scheme. TPE scheme

using cetuximab as a substitution for fluorouracil

is an option for toxicities reducing. Managements of skin reactions

oral mucositis and radiation dermatitis are proposed.

关键词

Keywords

references

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