Taxane in Head and Neck Oncology

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Mechanism of Action:
    • Paclitaxel and docetaxel:
      • Are microtubule-stabilizing agents:
        • They bind to the β-subunit of tubulin:
          • Promoting microtubule assembly while inhibiting depolymerization
        • This leads to stabilization of the mitotic spindle:
          • Blocking cell cycle progression in the G2 /M phase, ultimately triggering apoptosis
      • Additional effects:
        • Anti-angiogenic activity at low doses
        • Modulation of apoptotic pathways:
          • Bcl-2 phosphorylation
        • Potential immune-modulatory effects
  • Indications in Head and Neck Squamous Cell Carcinoma (HNSCC):
    • Locally Advanced / Induction Therapy
      TPF regimen (Docetaxel + Cisplatin + 5-FU) has demonstrated improved survival and locoregional control compared with PF (cisplatin + 5-FU)
      • TAX 323 and TAX 324 trials showed significant OS and PFS benefit with TPF in unresectable or locally advanced disease
  • Concurrent Chemoradiation:
    • Weekly paclitaxel or docetaxel (often combined with carboplatin) is used as an alternative for patients ineligible for cisplatin
    • Demonstrated radiosensitizing effects.
  • Recurrent / Metastatic HNSCC:
    • Single-agent docetaxel or paclitaxel provides palliative benefit with response rates ~ 20% to 30%
    • Often used as part of combination chemotherapy (e.g., taxane + platinum + cetuximab)
  • Adverse Effects:
    • Hematologic:
      • Neutropenia (dose-limiting, especially with docetaxel)
      • Febrile neutropenia
    • Neurologic:
      • Peripheral neuropathy (sensory > motor), cumulative and dose-dependent
      • Hypersensitivity Reactions:
        • Due to the lipid solvent:
          • Cremophor EL in paclitaxel
          • Polysorbate 80 in docetaxel
        • Flushing, rash, bronchospasm, anaphylaxis
      • Other:
        • Mucositis
        • Stomatitis
        • Alopecia
        • Fluid retention:
          • More with docetaxel
        • Onycholysis
        • Skin / nail changes
        • Fatigue
        • Myalgia / arthralgia
  • Management of Adverse Events:
    • Premedication:
      • Paclitaxel:
        • Corticosteroids + H1/H2 antagonists (e.g., dexamethasone, diphenhydramine, ranitidine)
      • Docetaxel:
        • Dexamethasone to reduce hypersensitivity and fluid retention
    • Neutropenia:
      • Dose reduction, prophylactic G-CSF for high-risk regimens (especially TPF)
    • Neuropathy:
      • Dose modification or discontinuation
      • Supportive care:
        • Duloxetine may help with painful neuropathy
    • Mucositis:
      • Oral hygiene, saline rinses, cryotherapy, topical analgesics
    • Fluid Retention (docetaxel):
      • Steroid premedication, diuretics if symptomatic
  • Key References:
    • Vermorken JB, Remenar E, van Herpen C, et al. Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med. 2007;357(17):1695–704. 【TAX 323】
    • Posner MR, Hershock DM, Blajman CR, et al. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med. 2007;357(17):1705–15. 【TAX 324】
    • NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers. Version 2.2025.
    • Hitt R, et al. Phase III study comparing TPF with PF in locally advanced head and neck cancer. J Clin Oncol. 2005;23(34):8636–45.
    • Colevas AD, et al. Chemotherapy options for patients with cisplatin-ineligible head and neck cancer. J Clin Oncol. 2018;36(19):1942–50.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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