Carboplatin and continuous infusion 5-fluorouracil for advanced head and neck cancer

Olver, Ian; Dalley, D.; Woods, Robert L.; Aroney, R. S.; Hughes, Peter; Bishop, James F.; Cruickshank, Deborah

doi:10.1016/0277-5379(89)90004-7

Cited by 14 publications

(8 citation statements)

References 10 publications

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“…Single institution pilot trials of carboplatin and infusional 5FU in recurrent SCCHN patients reported response rates of 32% to 48% (Forastiere et al, 1987;Olver et al, 1989). This study demonstrated a response rate of 37.5 %.…”

Section: Discussionmentioning

confidence: 60%

Carboplatin/5-fluorouracil as an Alternative to Cisplatin/5-Fluorouracil for Metastatic and Recurrent Head and Neck Squamous Cell Carcinoma and Nasopharyngeal Carcinoma

Kua

Ismail²,

Phua

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: Palliative chemotherapy with cisplatin/5-fluorouracil (5FU) is the commonest regimen employed for metastatic and recurrent head and neck squamous cell carcinoma (SCCHN) and nasopharyngeal carcinoma (NPC). However, this regimen is cumbersome requiring 5 days of admission to hospital. Carboplatin/5FU may be an alternative regimen without compromising survival and response rates. This study aimed to compare the efficacy and toxicity of carboplatin/5FU regimen with the cisplatin/5FU regimen. Materials and Methods: This retrospective study looked at patients who had palliative chemotherapy with either cisplatin/5FU or carboplatin/5FU for metastatic and recurrent SCCHN and NPC. It included patients who were treated at UKMMC from 1 st January 2004 to 31 st December 2009 with either palliative IV cispaltin 75 mg/m 2 D1 only plus IV 5FU 750 mg/m 2 D1-5 infusion or IV Carboplatin AUC 5 D1 only plus IV 5FU 500 mg/m 2 D1-2 infusion plus IV 5FU 500 mg/m 2 D1-2 bolus. The specific objectives were to determine the efficacy of palliative chemotherapy in terms of overall response rate (ORR), median progression free survival (PFS) and median overall survival (OS) and to evaluate the toxicities of both regimens. Results: A total of 41 patients were eligible for this study. There were 17 in the cisplatin/5FU arm and 24 in the carboplatin/5FU arm. The ORR was 17.7 % for cisplatin/5FU arm and 37.5 % for carboplatin/5FU arm (p-value=0.304). The median PFS was 7 months for cisplatin/5FU and 9 months for carboplatin/5FU (p-value=1.015). The median OS was 10 months for cisplatin/5FU arm and 12 months for carboplatin/5FU arm (p-value=0.110). There were 6 treatment-related deaths (6/41=14.6%), four in the carboplatin/5FU arm (4/24=16.7%) and 2 in the cisplatin/5FU arm (2/17=11.8%). Grade 3 and 4 hematologic toxicity was also more common with carboplatin/5FU group, this difference being predominantly due to grade 3-4 granulocytopenia (41.6% vs. 0), grade 3-4 anemia (37.5% vs. 0) and grade 3-4 thrombocytopenia (16.6% vs. 0). Conclusions: Carboplatin/5FU is not inferior to cisplatin/5FU with regard to its efficacy. However, there was a high rate of treatment-related deaths with both regimens. A better alternative needs to be considered.

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Section: Discussionmentioning

confidence: 60%

Carboplatin/5-fluorouracil as an Alternative to Cisplatin/5-Fluorouracil for Metastatic and Recurrent Head and Neck Squamous Cell Carcinoma and Nasopharyngeal Carcinoma

Kua

Ismail²,

Phua

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…Those results and our results do not ap-pear to be better at equivalent disease volumes than the classic platin, bleomycin, and methotrexate (PBM),9 the cyclophosphamide, Adriamycin, bleomycin, and oncovin (CAB0),3' the cisplatin and b l e~m y c i n , '~, '~, '~ or the cisplatin and 5-FU regimens,7~8.30.33-34 or carboplatin-based schemes. 35 In all' of these studies and in others, the response to chemotherapy. is significantly influenced by tumoral volume (particularly nodal disease) and…”

Section: Discussionmentioning

confidence: 98%

“…This low incidence of hematologic toxicity compares favorably with that of other active combinations. 7,8,[30][31][32][33][34][35] Gr ade I1 mucositis occurred after seven courses and Grade I11 after six courses. Nausea and vomiting were controlled by the antiemetic therapy and were transient.…”

Section: Tolerance and Toxicitymentioning

confidence: 99%

Neoadjuvant chemotherapy consisting of cisplatin and continuous infusions of bleomycin and 5-fluorouracil for advanced head and neck cancer. The need for a new stratification for stage IV (MO) disease

Recondo

Cvitkovic

Azli

et al. 1991

Cancer

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A Phase II study of cisplatin (100 mg/m2 on day 1 and bleomycin (15 mg intravenous push day 1) followed by 5 days of continuous intravenous infusions of 5‐fluorouracil (5‐FU) (650 mg/m2/d) and bleomycin (16 mg/m2/d) repeated at 21‐day intervals was performed in 54 previously untreated patients with nonmetastatic (MO), locoregionally advanced head and neck squamous cell carcinoma (SCC). The aim of this study was to increase the complete response rate to chemotherapy and to identify prognostic factors that may influence local control and disease‐free survival. From April 1986 until August 1988, 5 patients with Stage III and 49 with Stage IV (International Union Against Cancer‐American Joint Committee on Cancer 1986 [UICC‐AJCC]) disease received this regimen. Thirty (61%) patients with Stage IV disease had bulky nodal disease (9 N2c and 21 N3) and 29 (53%) had T4 primary lesions. The response rate was 59% (95% confidence interval, 47% to 71%) and the complete response rate to chemotherapy was 13% (95% confidence interval, 0% to 26%). The response rate was greatly influenced by tumoral volume and performance status (PS). The complete response rate to chemotherapy was 40% for patients with Stage III disease (2 of 5 patients) versus 10% for patients with Stage IV disease (5 of 49 patients; P = 0.02). The response rate for patients with Stage III disease was 100% (5 of 5 patients) versus 55% for patients with Stage IV disease (27 of 49 patients; P = 0.14). For patients with Stage IV bulky nodal disease (N2c‐N3), the response rate was 43% (13 of 30 patients) and the complete response rate to chemotherapy was 3% (1 of 30 patients) versus 68% (13 of 19 patients; P = 0.13) and 21% (4 of 19 patients; P = 0.07), respectively, for patients with Stage IV less than N2b disease. The local control rate after definitive therapy was 100% for patients with Stage III disease, 70% (17 of 24 patients) for patients with Stage IV less than N2b disease, and 17% (5 of 30 patients) for patients with bulky nodal disease (P = 0.0005). As of February 1991, with a median follow‐up time of 38 months (range, 30 to 53 months), 4 of 5 patients with Stage III disease and 7 of 19 patients with Stage IV less than N2b disease were alive with no evidence of disease (37%) versus 0 of 30 patients with bulky nodal disease (P = 0.001). In advanced head and neck SCC, the variations in the complete response rate to chemotherapy, the obtaining of local control, and the success of multimodality treatment depend on tumoral volume, especially nodal tumoral volume. The differences between Stages III and IV, and within the Stage IV category for greater than N2c‐N3 disease, point to the need for a better definition of prognostic groups in future trials. Cancer 68:2109–2119.

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“…Both carboplatin and 5-FU selected for the current study were demonstrated to be radiosensitisers in preclinical (Byfield et al, 1982;Begg et al, 1987;Havemann et al, 1992) and clinical studies (Lo et al, 1976;Wolf et al, 1992;Belani and Aisner, 1994;Belani et al, 1996). In addition, a combination of platinum compound and 5-FU was shown to have synergistic antitumour activity (Scanlon et al, 1986;Olver et al, 1989;Esaki et al, 1992;Saikawa et al, 1994). In the phase I part of the current study, the recommended dose of daily carboplatin was determined to be 35 mg m À2 because at 40 mg m À2 , patients experienced grade 4 neutropenia and/or grade 3 thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the raidosensitising effect of these agents, a combination of platinum compound and 5-FU has been shown to have synergistic antitumour activity in both preclinical and clinical studies (Scanlon et al, 1986;Olver et al, 1989;Esaki et al, 1992;Saikawa et al, 1994). The mechanism of synergism of these two agents remains unclear, although there are various hypotheses concerning the modulatory effect of platinum compounds on 5-FU.…”

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confidence: 99%

Phase I/II study of daily carboplatin, 5-fluorouracil and concurrent radiation therapy for locally advanced non-small-cell lung cancer

et al. 2003

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A study was undertaken to determine the maximum tolerated dose, the dose-limiting toxicities and the response rate of carboplatin and 5-fluorouracil administered daily with concurrent thoracic radiation therapy in patients with locally advanced non-small-cell lung cancer. In a phase I/II clinical trial, patients with histologically documented, unresectable stage IIIA or IIIB non-small-cell lung cancer (NSCLC) were enrolled. Carboplatin (20 -40 mg m À2 2-h infusion, daily) and 5-fluorouracil (200 mg m À2 24-h continuous infusion, daily) were administered concurrently with radiotherapy on days 1 -33. Radiotherapy, with a total dose of 60 Gy, was delivered in 30 fractions on days 1 -40. In the phase I portion, the daily dose of carboplatin was escalated from 20 to 40 mg m À2 . Once the maximum tolerated dose (MTD) and recommended dose (RD) of carboplatin was determined, the study entered the phase II portion. In the phase I portion, the daily MTD and RD of carboplatin were 40 and 35 mg m À2 , respectively. The dose-limiting toxicity was neutropenia. In the following phase II study, 30 patients were entered and the objective response rate was 76.7% (95% CI, 62 -92%) and the local control rate was 85.7%. The median survival time was 19.8 months, with a survival rate of 70% at 1 year, 36.7% at 2 years. The major toxicities of treatment were neutropenia (Xgrade 3, 87.9%) and thrombocytopenia (Xgrade 3, 23.3%). This combined therapy for locally advanced non-small-cell lung cancer is promising and shows acceptable toxicity.

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Carboplatin and continuous infusion 5-fluorouracil for advanced head and neck cancer

Cited by 14 publications

References 10 publications

Carboplatin/5-fluorouracil as an Alternative to Cisplatin/5-Fluorouracil for Metastatic and Recurrent Head and Neck Squamous Cell Carcinoma and Nasopharyngeal Carcinoma

Carboplatin/5-fluorouracil as an Alternative to Cisplatin/5-Fluorouracil for Metastatic and Recurrent Head and Neck Squamous Cell Carcinoma and Nasopharyngeal Carcinoma

Neoadjuvant chemotherapy consisting of cisplatin and continuous infusions of bleomycin and 5-fluorouracil for advanced head and neck cancer. The need for a new stratification for stage IV (MO) disease

Phase I/II study of daily carboplatin, 5-fluorouracil and concurrent radiation therapy for locally advanced non-small-cell lung cancer

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