Combination chemotherapy with vinblastine, bleomycin, and cis‐diamminedichloroplatinum (ii) in squamous cell carcinoma of the head and neck

Abstract

Forty-five patients with advanced squamous cell carcinoma of the head and neck, 23 of whom had received no prior therapy, were given the combination of vinblastine, 4 mg/m2 intravenously (IV) on Day 1; bleomycin, 15 mg/day intramuscularly on Days 1-7; and cis-diamminedichloroplatinum (II), 60 mg/m2 with mannitol diuresis on Day 8. The regimen was repeated at three-week intervals, for a maximum of three cycles. Among the 23 patients without prior surgery or radiation, there were 5 complete responses and 12 partial responses, a 74% response rate; whereas, among the 22 with prior therapy, there were 2 complete responses and 8 partial responses, a response rate of 45%. Nineteen of 23 previously untreated patients were subsequently given radiation, 1 had surgery, and 1 had surgery plus radiation. Twelve of these 19 patients are currently free of disease, with a median duration of ten months from initial response. Four of the 22 previously treated patients received radiation and 2, surgery; 4 of these 6 patients are without evidence of disease. Renal dysfunction with elevation of serum creatinine occurred in 5 patients, a leukocyte count of less than 3,000/mm3 in 3, a platelet count of less than 100,000/mm3 in 2, skin changes in 11, hearing loss in 1, and both peripheral neuropathy and pulmonary changes in 1 patient. This combination of agents has substantial activity in untreated patients and may be useful as initial therapy in advanced head and neck malignancies by diminishing the incidence of local recurrence and distant metastasis.

Safe and effective induction chemotherapy without cisplatin for squamous cell carcinoma of the head and neck: Impact on complete response rate and survival at five years, following local therapy

“…These results contrast with the toxicity and inconvenience which have been a consistent feature of several recent reports (summarized in Table IX) describing studies where cisplatin has been included in combination chemotherapy protocols used as initial therapy for squamous cell carcinomas of the head and neck. Although Brown et a1 [17] did not observe serious renal damage in their study, nephrotoxicity has consistently been noted in most studies [ 13,[15][16][17]191, although it can be at least partly prevented by vigorous prehydration [20]. In summary, therefore.…”

Chemotherapy in the Management of Advanced Cutaneous Squamous Cell Carcinoma in Organ Transplant Recipients: Theoretical and Practical Considerations

“…Potential advantages of induction chemotherapy include the fact that patients with previously untreated disease respond almost twice as often to induction chemotherapy when compared to patients with recurrent disease after initial locoregional therapy 17,18 . Nevertheless, clinical data are conflicted as to whether induction chemotherapy improves tumor control and survival.…”

The future of radiotherapy and chemotherapy in head and neck cancer

“…7 Previously untreated patients are almost twice as likely to respond to chemotherapy as those who have undergone prior surgery or irradiation. 8,9 This is attributed to the presence of an undisturbed blood supply and better performance status and has led to the use of chemotherapy in the neoadjuvant setting in the hope of improving local control and survival. Many phase III trials whilst showing a reduction in distant metastases and increased organ preservation have shown no survival bene t. Even those patients in whom complete response is achieved require either surgery or radiotherapy, otherwise relapse is inevitable.…”