A prospective evaluation of 5-fluorouracil plus cisplatin in advanced squamous-cell cancer of the head and neck.

Abstract

Recent studies have shown improved efficacy of chemotherapy in patients with advanced squamous-cell cancer of the head and neck. Our purpose was to evaluate prospectively the activity of cisplatin plus 5-fluorouracil (5FU) in 37 patients with advanced stage IV squamous-cell cancer of the head and neck. There were two groups. Group 1 consisted of 19 previously untreated patients with either T4 or N3 disease. They received 100 mg/m2 cisplatin (days 1 and 28) and 120-hour infusion of 1,000 mg/m2/24 hours 5FU (days 1 to 5 and 28 to 32). They subsequently were offered preoperative radiotherapy (RT) and surgery. Group 2 consisted of 18 previously treated patients. They received 5FU and cisplatin in the same dosage every 28 days for either recurrent or metastatic disease. It was found that in group 1 there was an 84% response rate (five complete responses (CR) and 11 partial responses (PR) ). Three of those with PR achieved a CR after RT. Seven patients have had RT plus surgery and are disease free at 8 to 27 month follow-up. Six patients (one CR, five PR) refused surgery and progressed within 4 months. In group 2 there was an 11% response rate after two cycles (two PR), three patients had a minimal response (MR, less than 50% response) and received a mean of four cycles of treatment. Three patients with stable disease received a mean of four cycles of chemotherapy until progression. Two of 11 patients who had received previous chemotherapy plus RT showed an MR; nine of these patients had shown a response to their previous chemotherapy. Only one of 14 patients who had RT plus chemotherapy had a PR, and three had MR. Of five patients who had previous surgery, only one had a PR. All five had received chemotherapy as well. It was concluded that 5FU plus cisplatin is an effective combination in previously untreated patients. In previously treated patients with recurrent disease, there is a substantially lower response rate.

Intratumoral cisplatin/epinephrine‐injectable gel as a palliative treatment for accessible solid tumors: A multicenter pilot study

“…The drug was administered intratumorally by Squamous cell 32 12 3 13 2 2 carcinoma Adenocarcinoma 36 21 3 2 3 7 Melanoma 9 -2 5 1 1 Chordoma 2 Cisplatin as a single agent or in combination with other cytotoxic agents has significant activity in many solid tumors, particularly head and neck cancer. [23][24][25][26] There is evidence to support a dose-response relationship for this drug in sensitive tumors. However, attempts to increase dose intensity have been limited by the attendant toxicity, commonly nephrotoxicity, peripheral neuropathy, ototoxicity, myelosuppression, and electrolyte and magnesium wasting.…”

Paclitaxel, cisplatin, and 5-fluorouracil for patients with advanced or recurrent squamous cell carcinoma of the head and neck

“…Higher response rates have been reported using the combination of cisplatin and 5-FU, but reported response rates with this combination have varied significantly. 5,7 Clinical assessment of response with both physical examination and radiologic evaluation is known to be difficult in these patients, which may partly account for the variability in response rates. Because median survival has not been significantly impacted despite the high reported response rates with different combinations, other outcomes, such as the proportion of patients surviving at 1 and 2 years and the response duration, may provide intermediate surrogates for treatment efficacy in this difficult clinical setting.…”

“…3,4 The combination of cisplatin and 5-fluorouracil (5-FU) is considered the standard, with reported response rates varying from 11% to 80% but without a demonstrable impact on survival. [5][6][7][8] Paclitaxel 250 mg/m 2 given as a 24-hour infusion has demonstrated clinical activity in patients with advanced SCCHN, with a single-agent response rate of 40% (4 complete and 8 partial responses in 30 patients). 9 Experimentally, it has been shown that paclitaxel can induce p53-independent apoptosis in tumor cells; 10 this is a noteworthy feature because the majority of head and neck cancers develop p53 mutations.…”

Kombinierte Therapie bei lokal fortgeschrittenen Plattenepithelkarzinomen im Kopf- und Halsbereich

“…The group included 31 men and 6 women with a medium age of 54 ) and a performance status of 80 (60-90). Primary sites were nasopharynx (13), oropharynx (5), hypopharynx (3), sinus (3), ethmoids (2), tongue (2), floor of the mouth (2), larynx (6) and unknown (1). 25 patients received 3 cycles of induction therapy whereas 22 completed the whole treatment programme.…”