Current status and future directions in induction chemotherapy for head and neck cancer.

As a component of multimodal therapy in locally advanced head and neck cancer, induction chemotherapy represents a strategy to reduce tumor burden and target distant metastases prior to definitive treatment. Although the addition of taxanes to the cisplatin and 5-fluorouracil induction regimen (TPF) has greatly benefitted outcomes in comparison with PF alone, recent phase III trials have not shown a survival advantage for TPF induction followed by chemoradiotherapy vs. chemoradiotherapy alone. While these trials may have been underpowered to demonstrate a survival benefit, additional phase III trials are ongoing, with highly anticipated results. "Next-generation" sequential regimens that include targeted agents such as cetuximab are emerging as an approach to increase activity while decreasing toxicity. In addition, patient selection based on individual disease characteristics may identify ideal candidates for induction therapy. These developments may result in personalized therapeutic regimens that improve clinical outcomes.