Induction chemotherapy in locally advanced head and neck cancers, is there a best choice?

Locally advanced stages of squamous cancers of the head and neck (LAHNCs) acquire high propensity for local and systemic relapse. Addition of systemic therapy as an induction (IC) to the standard concurrent chemoradiotherapy (CCRT) has become an approach of many practitioners. This strategy has shown to reduce metastases but did not affect survival in unselected populations. Meanwhile, the induction regimen including docetaxel, cisplatin, 5-FU (TPF) has shown superiority over other combinations, however, a survival advantage was not detected when compared to CCRT alone. This may be attributed to its high toxicity profile, inducing treatment delay, resistance, or variations in tumor sites and responses. Currently, newer systemic therapy combinations are being tested and indicators of benefit are being identified. The focus of this review is on the development of the choice of combination regimen for induction, next, proposed alternatives and strategies for patient selection will be introduced.