Drug resistance against 5-fluorouracil and cisplatin in the treatment of head and neck squamous cell carcinoma: A systematic review

Head and neck cancers are highly prevalent worldwide. Most of these lesions are diagnosed in advanced stages of disease. Thus, they do not often have a good long-term prognosis. Similar to other cancer types, head and neck cancers are managed by surgery, radiotherapy and chemotherapy. Despite the great advances in treatment of oral squamous cell carcinoma (OSCC), physicians encounter several challenges in the course of treatment. Clinical responses of a certain cancer to medications are mediated by various mechanisms. Thus, efficient treatment planning requires adequate knowledge about the genes involved in drug resistance, and evaluation of the frequency percentage of resistance. Several studies have evaluated the causes and frequency percentage of 5-fluorouracil (5-FU) and cisplatin resistance. In this systematic review, all related articles published until November 30, 2019 were retrieved from the Scopus, Embase, Medline, ISI, Web of Science, and Cochrane databases using certain MeSH and EMTTree keywords. A total of 2,164 articles were retrieved; out of which, 18 were included in the review since they had reported the frequency percentage of drug resistance. Of all, 10 articles had evaluated cisplatin (1,317 samples). Meta-analysis of the results revealed the frequency of cisplatin resistance to be 34.21%. Eight studies had evaluated 5-FU (476 samples). Meta-analysis of the results revealed the frequency of 5-FU resistance to be 43.76%. Overcoming cisplatin resistance or 5-FU resistance can greatly enhance recovery in advanced HNSCC. Attempts should be made to eliminate the cause and use multi-drug regimens to increase the success rate of treatment.