Predictive factors of toxicity of TPF induction chemotherapy for locally advanced head and neck cancers

Abstract

Background The rate of toxic deaths related to induction chemotherapy in the treatment of locally advanced head and neck cancers is unacceptable and calls into question this therapeutic strategy, which is however highly effective in terms of rate and speed of response. The purpose of the study was to investigate predictive factors of toxicity of induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (TPF) in locally advanced head and neck cancers (LAHNC). Methods Between June 2009 and December 2017, 113 patients treated consecutively with TPF were included retrospectively. Patients were receiving induction chemotherapy for either an inoperable cancer or laryngeal preservation. For inoperable cancer, induction chemotherapy was proposed to patients presenting either a large tumor with strong symptoms (dyspnea, dysphagia, pain) or a tumor with rapid progression. Risk factors were chosen among the initial patient and tumour characteristics and chemotherapy modalities. Results Eighty-nine patients (79%) were male; the median age was 58 years [32–71]. Sixty-nine (61%) patients were treated for inoperable cancer and 44 (39%) for laryngeal preservation. 45% had stage IVa cancer, 28% stage III and 25% stage IVb. Sixty percent of patients had a partial response after TPF, 22% had a complete response, 12% were stable, 5% were progressing, and 1% had a discordant response. Thirty-four patients (30%) received enteral feeding during induction chemotherapy with TPF. The possibility of oral feeding without a tube was predictive of a better response (p = 0.003). Seven (6%) patients died during TPF. There was an increased risk of death with preexisting liver dysfunction (liver dysmorphia on imaging or decrease prothrombin rate) (p = 0.032). There was an increased risk of grade ≥ 3 infection if an enteral feeding occurred during the period of induction chemotherapy (p = 0.03). Conclusions TPF induction chemotherapy had an 82% objective response rate with 6% toxic deaths. Nutritional status and the presence of hepatic dysfunction are significant risk factors to be taken into account in therapeutic decisions.

Interval changes of histogram-derived diffusion indices predict treatment response to induction chemotherapy in head and neck cancer: a feasibility study

“…Approximately 20–30% of patients do not respond to ICT ( 31 - 33 ), and our results showed similar results in that four of our enrolled patients (4/19, 21%) did not show responses to ICT. All of these four patients received concurrent chemoradiotherapy, but three died before the study endpoint due to disease progression, which implies that a poor response to ICT might be a poor prognostic factor of OS.…”

Early weight loss is an independent risk factor for shorter survival and increased side effects in patients with metastatic colorectal cancer undergoing first‐line treatment within the randomized Phase III trial FIRE‐3 (AIO KRK‐0306)

“…However, side effects occur in almost all patients and do compromise quality of life and impair physical performance 6‐8 . Literature shows that patients exhibiting loss of body weight during antineoplastic treatment have been identified being at higher risk for treatment side effects 9‐11 . The frequency of weight loss prior to chemotherapy reported in the literature ranges from 31% for non‐Hodgkin's lymphoma patients to 87% for gastric cancer patients and nearly 100% of patients with pancreatic cancer 12,13 .…”

Clinical and histopathologic effects of neoadjuvant intra-arterial chemoradiotherapy with cisplatin in combination with oral S-1 on stage III and IV oral cancer

“…Therefore, the single dose and frequency of cisplatin administration and the irradiation dose of 40 Gy are smaller than those in the Superselective cisplatin infusion with concomitant radiotherapy (RADPLAT) protocol developed by Robbins et al 8 Dose-dense cisplatin and 5-fluorouracil plus docetaxel is now widely considered to be an effective protocol for preoperative treatment of head and neck cancers 23,24 but has a high risk of severe toxicity. 23,24 Only a few cases of transient grade 3 oral mucositis were observed in the authors' study, with most being grade 2 or lower, and it was successfully treated in all cases. No late effects, such as radiation osteomyelitis and osteoradionecrosis of the jaw, have been observed.…”