Adjuvant chemotherapy in head and neck cancer

Stell, P. M.; Rawson, Nigel S. B.

doi:10.1038/bjc.1990.175

Cited by 152 publications

(49 citation statements)

References 39 publications

(48 reference statements)

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“…The data on local control are consistent This overview of trials of adjuvant chemotherapy in head and neck cancer suggests that chemotherapy might improve survival and that this improvement is more apparent for single-agent chemotherapy given synchronously with radiotherapy. Since two previous meta-analyses (Stell and Rawson, 1990;Stell, 1992) failed to show benefit from chemotherapy, the discrepancies between these previous analyses and the current results must be explained. Stell and Rawson's first analysis (1990) included 23 trials, and the updated analysis added five newer trials to give a total of 28 trials (Stell, 1992 Cumulative meta-analyses, and the current study could be regarded as the third in a sequence for head and neck cancer, can be useful for the prompt detection of therapeutic advances.…”

Section: Reksmentioning

confidence: 52%

“…The values were obtained by applying a set square to the survival curve at the specified time point, reading off the percentage surviving, and thereby calculating, from the total number randomised to that group, the absolute number of survivors. The validity of the abstracted data was assessed by repeated cross-checking and also, where possible, by comparison with the data presented in previous overviews (Stell and Rawson, 1990;Stell, 1992). Of necessity, however, the data used are crude and, at best, approximate.…”

Section: Methodsmentioning

confidence: 99%

“…Response rates to chemotherapy are high, but this responsiveness does not appear to translate into durable benefit in terms of survival. Recent metaanalyses of adjuvant chemotherapy for squamous cell carcinoma of the head and neck failed to show any benefit from such treatment (Stell and Rawson, 1990;Stell, 1992). However, several randomised trials published subsequently have been reported as showing benefit from adding chemotherapy to standard therapy.…”

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confidence: 99%

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An overview of randomised controlled trials of adjuvant chemotherapy in head and neck cancer

1995

Br J Cancer

315

120

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Summary Meta-analysis of the published results from 54 randomised controlled trials of adjuvant chemotherapy in head and neck cancer suggests that chemotherapy might increase absolute survival by 6.5% (95% confidence interval 3.1-9.9%). The odds ratio in favour of chemotherapy is 1.37 (95% confidence interval 1.24-1.5). Single-agent chemotherapy given synchronously with radiotherapy increased survival by 12.1% (95% confidence interval 5-19%). The benefit from neoadjuvant chemotherapy was less: a rate difference of 3.7% (95% confidence interval 0.9-6.5%). The results suggest that the investigation of optimal agents and scheduling for synchronous radiotherapy and chemotherapy might still be important in clinical trials in head and neck cancer.Keywords: overview; randomised trials; head and neck cancer Attitudes towards cytotoxic chemotherapy for squamous carcinomas of the head and neck range from enthusiasm (Dimery and Hong, 1993) to disdain (Tannock and Browman, 1986;Taylor, 1987). Response rates to chemotherapy are high, but this responsiveness does not appear to translate into durable benefit in terms of survival. Recent metaanalyses of adjuvant chemotherapy for squamous cell carcinoma of the head and neck failed to show any benefit from such treatment (Stell and Rawson, 1990;Stell, 1992). However, several randomised trials published subsequently have been reported as showing benefit from adding chemotherapy to standard therapy. In order better to define the possible role for chemotherapy and to suggest possibly fruitful avenues for exploration, a further meta-analysis of published randomised clinical studies of adjuvant chemotherapy in head and neck cancer has been performed.The primary purpose of this overview was to discover whether the addition of chemotherapy to definitive standard therapy improved survival in patients with cancer of the head and neck. Secondary objectives included an assessment of whether the timing of chemotherapy, before, during or after standard therapy, was important; a specific assessment of the effectiveness of platinum/5-fluorouracil (5-FU) regimens; an evaluation of single-agent chemotherapy given synchronously with radiotherapy; an assessment of the effect of chemotherapy upon locoregional control rates; an assessment of the effect of chemotherapy upon the occurrence of distant metastases. Materials and methodsA structured search was conducted to identify randomised clinical trials of chemotherapy in head and neck cancer. A trial was suitable for inclusion if it fulfilled the following criteria. *

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Section: Reksmentioning

confidence: 52%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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An overview of randomised controlled trials of adjuvant chemotherapy in head and neck cancer

1995

Br J Cancer

315

120

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“…Therefore, an effective systemic adjuvant therapy is needed. To date, there is no evidence that adjuvant chemotherapy has any survival benefit (Stell and Rawson, 1990). Among the innovative approaches for improving the therapy of cancer is the use of monoclonal antibodies (MAbs).…”

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confidence: 99%

Selection of monoclonal antibody E48 IgG or U36 IgG for adjuvant radioimmunotherapy in head and neck cancer patients

Bree

Roos²,

Plaizier

et al. 1997

Br J Cancer

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Summary Preliminary data from recent clinical radioimmunoscintigraphy studies indicate that 99mTc-labelled murine monoclonal antibodies (MAbs) E48 and U36 have a similar ability to target squamous cell carcinoma of the head and neck (HNSCC) selectively. In the present study we describe additional aspects of murine and chimeric MAb (mMAb and cMAb) E48 and U36, which might influence the selection of one MAb for adjuvant radioimmunotherapy. To make direct comparison possible, ten patients received 11.2 ± 0.3 and 11.1 ± 0.2 mg (n = 5) or 51.1 ± 0.1 and 51.0 ± 0.4 mg (n= 5) of both mE48 IgG and mU36 IgG labelled with 1311 and 1251 simultaneously and underwent surgery 7-8 days after injection. The mean uptake of iodine-labelled mE48 IgG and mU36 was highest in tumour tissue, 8.9 ± 8.9 and 8.2 ± 4.4 %ID kg-' respectively. Tumour to non-tumour ratios for oral mucosa, skin, muscle, blood and bone marrow aspirate were 2.5, 5.5, 25.2, 4.7 and 4.0 respectively in the case of mE48 IgG and 2.3, 4.1, 21.0, 5.8 and 5.8 respectively in the case of mU36 IgG. The distribution of mMAbs E48 and U36 throughout tumours that had been collected in previous studies was heterogeneous when administered at a dose of 1 or 12 mg, and homogeneous when administered at a dose of 52 mg. Administration of mE48 IgG (1-52 mg) resulted in a human anti-mouse antibody response in 12 out of 28 patients, while for mU36 IgG (1-52 mg), this figure was three out of 18 patients. cMAb E48 was shown to be highly effective in mediating antibody-dependent cellular cytotoxicity in vitro, while cMAb U36 and mMAbs E48 and U36 were not effective at all. Rationales are provided that give priority to the start of adjuvant radioimmunotherapy trials with 1'6Re-labelled cMAb U36 IgG in head and neck cancer patients who are at high risk for the development of locoregional recurrences and distant metastases.Keywords: monoclonal antibodies; head and neck cancer; squamous cell carcinoma; biodistribution; human anti-mouse antibody response; antibody-dependent cellular cytotoxicityDuring 1996 approximately 41 090 Americans will develop head and neck cancer and 12 510 will die from it. Worldwide more than 500 000 new cases are projected annually, and the incidence is rising. In head and neck cancer, squamous cell carcinoma accounts for approximately 90% of all tumours (Parker et al, 1996). About one-third of these patients present with early-stage (I and II) head and neck squamous cell carcinoma (HNSCC), while two-thirds present with advanced disease (stage III and IV) (Vernham and Crowther, 1994). Although early-stage HNSCC can, in the great majority of cases, be cured with surgery or radiotherapy alone, the local failure rate after surgery and/or radiotherapy in advanced stages is more than 50%. Moreover, about 25% of these patients develop distant metastases (Stupp et al, 1994).Despite an increase in the locoregional control of HNSCC, owing to improved surgery and radiotherapy, current therapy regimens have failed to increase the 5-year survival rate in HNSCC patients (Pa...

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“…Four meta-analyses have examined data from the published phase III trials in head and neck cancer, and all have concluded that concurrent rather than neoadjuvant induction chemotherapy regimens lead to improved survival (Stell, 1992;Munro, 1995;El-Sayed and Nelson, 1996;Pignon et al, 2000). The benefit appears to be 7% at 2 years and 8% at 5 years.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant chemotherapy prior to preoperative chemoradiation or radiation in rectal cancer: should we be more cautious?

et al. 2006

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Neoadjuvant chemotherapy (NACT) is a term originally used to describe the administration of chemotherapy preoperatively before surgery. The original rationale for administering NACT or so-called induction chemotherapy to shrink or downstage a locally advanced tumour, and thereby facilitate more effective local treatment with surgery or radiotherapy, has been extended with the introduction of more effective combinations of chemotherapy to include reducing the risks of metastatic disease. It seems logical that survival could be lengthened, or organ preservation rates increased in resectable tumours by NACT. In rectal cancer NACT is being increasingly used in locally advanced and nonmetastatic unresectable tumours. Randomised studies in advanced colorectal cancer show high response rates to combination cytotoxic therapy. This evidence of efficacy coupled with the introduction of novel molecular targeted therapies (such as Bevacizumab and Cetuximab), and long waiting times for radiotherapy have rekindled an interest in delivering NACT in locally advanced rectal cancer. In contrast, this enthusiasm is currently waning in other sites such as head and neck and nasopharynx cancer where traditionally NACT has been used. So, is NACT in rectal cancer a real advance or just history repeating itself? In this review, we aimed to explore the advantages and disadvantages of the separate approaches of neoadjuvant, concurrent and consolidation chemotherapy in locally advanced rectal cancer, drawing on theoretical principles, preclinical studies and clinical experience both in rectal cancer and other disease sites. Neoadjuvant chemotherapy may improve outcome in terms of disease-free or overall survival in selected groups in some disease sites, but this strategy has not been shown to be associated with better outcomes than postoperative adjuvant chemotherapy. In particular, there is insufficient data in rectal cancer. The evidence for benefit is strongest when NACT is administered before surgical resection. In contrast, the data in favour of NACT before radiation or chemoradiation (CRT) is inconclusive, despite the suggestion that response to induction chemotherapy can predict response to subsequent radiotherapy. The observation that spectacular responses to chemotherapy before radical radiotherapy did not result in improved survival, was noted 25 years ago. However, multiple trials in head and neck cancer, nasopharyngeal cancer, non-small-cell lung cancer, small-cell lung cancer and cervical cancer do not support the routine use of NACT either as an alternative, or as additional benefit to CRT. The addition of NACT does not appear to enhance local control over concurrent CRT or radiotherapy alone. Neoadjuvant chemotherapy before CRT or radiation should be used with caution, and only in the context of clinical trials. The evidence base suggests that concurrent CRT with early positioning of radiotherapy appears the best option for patients with locally advanced rectal cancer and in all disease sites where radiation is the primary l...

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Adjuvant chemotherapy in head and neck cancer

Cited by 152 publications

References 39 publications

An overview of randomised controlled trials of adjuvant chemotherapy in head and neck cancer

An overview of randomised controlled trials of adjuvant chemotherapy in head and neck cancer

Selection of monoclonal antibody E48 IgG or U36 IgG for adjuvant radioimmunotherapy in head and neck cancer patients

Neoadjuvant chemotherapy prior to preoperative chemoradiation or radiation in rectal cancer: should we be more cautious?

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