Induction chemotherapy with paclitaxel and cisplatin to concurrent radiotherapy and weekly paclitaxel in the treatment of loco-regionally advanced, stage IV (M0), head and neck squamous cell carcinoma. Mature results of a prospective study

Abstract

Backgroundto evaluate activity and toxicity of a sequential treatment in advanced, non metastatic, mostly unresectable, head and neck squamous cell carcinoma.MethodsPatients with loco-regionally advanced or unresectable, head and neck cancer, were prospectively treated with 3 courses of induction chemotherapy followed by concurrent chemoradiation. Induction chemotherapy consisted of paclitaxel 175 mg/m2 day 1 and cisplatin 75 mg/m2 day 2, given every 3 weeks, to a total of three courses. Curative radiotherapy started 4 weeks after the last cycle of chemotherapy with the goal of delivering a total dose ≥ 66 Gy. During RT weekly paclitaxel (40 mg/m2) was administered.ResultsThe trial accrued 43 patients from January 1999 to December 2002. All patients received 3 courses of induction chemotherapy and the planned dose of radiotherapy. Thirty-eight patients were able to tolerate weekly paclitaxel during irradiation at least for 4 courses. After induction therapy there were 32 overall responses, 74.4% (23 partial and 9 complete); at completion of concomitant treatment overall responses were 42, 97.7% (20 partial and 22 complete). Median time to treatment failure was 20 months and the disease progression rate at 3 and 5 years was 33% and 23%, respectively. The median overall survival time was 24 months and 3 and 5 years overall survival rates were 37% and 26%, respectively. The major toxicity was mucositis.ConclusionsThis combined treatment was found to be feasible and active in advanced or unresectable, head and neck squamous cell carcinoma patients. Long-term results observed in this trial encourage to consider this approach in further investigation using newer radiation delivering technique and new molecularly agents.

Neoadjuvant chemotherapy in geriatric head and neck cancers

“…Multiple single arm studies have shown a promising response rate of 60% to 80% with the 2-drug taxane and platinum regimen. [21][22][23][24] Even these response rates seem higher than the response rate seen in our study. This may be due to a predominant proportion of patients having laryngeal or oropharyngeal primary tumors in these studies compared to our study.…”

“…However, whether the TPF regimen is associated with a better response rate than the 2‐drug regimen of taxane and platinum is unknown. Multiple single arm studies have shown a promising response rate of 60% to 80% with the 2‐drug taxane and platinum regimen . Even these response rates seem higher than the response rate seen in our study.…”

Current concepts in clinical radiation oncology

“…As to be expected, several of these drugs exhibited synergistic effects when being combined with exposure to ionizing radiation (Griem and Malkinson 1966 ; Brues et al 1940 ; Tishler et al 1992 ; Milas et al 1994 , 1996 ; Milross et al 1997 ). This is why some of them (e.g., taxol) not only are adopted in radiochemotherapy but even still are in the focus of current clinical research (Pergolizzi et al 2011 ; Combs et al 2012 ). However, these drugs not only lack the level of specificity current therapies demand for, but they also exhibit side effects, which, in worst case, even limit the therapeutic effort.…”

Efficacy and safety of neoadjuvant chemotherapy (NACT) with paclitaxel plus carboplatin and oral metronomic chemotherapy (OMCT) in patients with technically unresectable oral squamous cell carcinoma (OSCC)

“…Triple metronomic chemotherapy (methotrexate, celecoxib and erlotinib) was selected as the MCT schedule based on favourable response rate in platinum-refractory/early failure oral cancers [ 10 ]. Paclitaxel and carboplatin were selected as MTD schedules based on the efficacy and favourable safety profile of this combination [ 11 , 12 ].…”