Taxane-cisplatin-fluorouracil as induction chemotherapy for advanced head and neck cancer: a meta-analysis of the 5-year efficacy and safety

Abstract

BackgroundThe objective of this study was to compare the efficacy and safety of taxane (docetaxel or paclitaxel), cisplatin, and fluorouracil (Tax-PF) with cisplatin plus fluorouracil (PF) regimen by a meta-analysis of data retrieved from the literature.MethodsSeven randomized clinical trials were identified, which included patients with advanced head and neck cancer who underwent induction chemotherapy with either a Tax-PF or PF protocol. The outcomes included the 3-year and 5-year overall survival (OS) and progression-free survival (PFS), overall response rate (ORR) and different types of adverse events.ResultsThe 3-year OS rate (HR: 1.14; 95% CI: 1.03 to 1.25; P = 0.008), 3-year PFS rate (HR: 1.24; 95% CI: 1.08 to 1.43; P = 0.002), 5-year OS rate (HR: 1.30; 95% CI, 1.09 to 1.55;P = 0.003), 5-year PFS rate (HR: 1.39; 95% CI, 1.14 to 1.70; P = 0.001) and ORR to chemotherapy (OR 1.66; 95% CI, 1.35 to 2.05; P < 0.001) of the patients in the Tax-PF group were statistically superior to those in the PF group. In terms of toxicities, the incidence of febrile neutropenia (OR 2.36; 95% CI, 1.62 to 3.46; P < 0.001), alopecia (OR 8.22; 95% CI, 3.99 to 16.92; P < 0.001), diarrhea (OR 1.57; 95% CI, 1.05 to 2.36; P = 0.03) and leukopenia (OR 2.79; 95% CI, 1.86 to 4.21; P < 0.001) was higher in the Tax-PF group.ConclusionThe Tax-PF induction chemotherapy improved PFS and OS, and the ORR was better as compared to PF-based therapy regimens at the cost of a higher incidence of adverse events.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-0988-5) contains supplementary material, which is available to authorized users.

Efficacy and toxicity of docetaxel combination chemotherapy for advanced squamous cell cancer of the head and neck

“…Other modified designs reached comparable results, with ORRs of up to 100% (6). In a recent meta-analysis, seven clinical trials that investigated 3-and 5-year efficacy were reviewed, and ORR was found to be better in the TPF induction chemotherapy group compared with that in the PF-based therapy group (8). In the present retrospective study, an ORR of 86% was achieved; therefore, the data are comparable with the results of already published reports.…”

“…Consistent with other clinical trials, hematological and non-hematological treatment-related side effects (particularly grade 3 and 4 leukopenia and gastrointestinal reactions) were observed in nearly all investigated patients (5,6,8,18,19). Another concern is the high rate of neutropenia during chemotherapy with TPF.…”

“…However, a major disadvantage of induction chemotherapy is severe treatment-induced toxicity. TPF treatment was associated with a high percentage of patients experiencing (5,6,13,14), as recently reported by a meta-analysis (8). The high incidence of toxicity may be the cause for the limited use of this combination treatment in the palliative setting.…”

“…In the present retrospective study, an ORR of 86% was achieved; therefore, the data are comparable with the results of already published reports. Different to other studies, the present study also included patients treated with a palliative intent, while the majority of other studies only analyzed patients treated with a curative intent (5,6,8,18). The ORR in the palliative treatment group was 75%, while the group treated with a curative intent reached an ORR of 93%.…”

“…Docetaxel promotes tubulin polymerization and affects the formation of stable microtubules, which leads to cell death (7). Recent results from multicenter studies and a current meta-analysis demonstrated that the combination of docetaxel with 5-fluorouracil (5-FU) and cisplatin (TPF regimen) is more efficacious compared with the classic regimen of cisplatin plus 5-FU (PF regimen) as induction chemotherapy for advanced head and neck cancer (8). The TPF regimen achieved longer progression-free survival, better locoregional control and higher response rates (9,10).…”