Is this patient really incurable?
The first question to ask when addressing incurable SCCHN is to be sure that the cancer really is incurable. When SCCHN recurs, it often recurs locally, at or near the site of the original cancer. For this reason, local salvage therapies such as surgery, radiation, chemoradiation or even repeat chemoradiation can sometimes elicit a cure for the patient with a local or local-regional recurrence. These topics are important and will likely be the subject of future posts on GRACE. The rest of this post will assume that the patient truly is incurable, either because local maneuvers are no longer possible, the cancer has spread to distant sites, or the patient has made a choice to not receive further surgeries or radiation.
Why Chemotherapy for Incurable Disease?
Every cancer therapy has two purposes: to improve duration of life, and to improve quality of life. Every other measure of chemotherapy success, such as response rate or progression-free-survival, is a surrogate to these two true goals.
For the patient with metastatic disease, chemotherapy is the most important treatment for achieving these two goals. “Incurable” is not the same as “untreatable.” Cure means eliminating every last cancer cell. Treatment means providing real benefit, in the form of achieving these two goals.
