Source: CancerConsultants
Author: Staff

Researchers from Italy have reported that induction (neoadjuvant) chemotherapy prior to concomitant chemoradiotherapy improves outcomes of patients with locally advanced head and neck cancer. The details of this Phase II randomized trial were published early online in the Annals of Oncology on December 23, 2009.[1]

There have been several randomized and non-randomized clinical trials suggesting that the concomitant administration of platinum-based chemotherapy and radiotherapy is superior to radiotherapy alone for the treatment of patients with advanced head and neck cancer for local and regional control. Most trials, but not all, have also shown a survival advantage for combined treatment. Two randomized trials in the May 7, 2004 issue of the New England Journal of Medicine documented the effects of adding platinum-based chemotherapy to post-operative radiotherapy for the treatment of patients with advanced head and neck cancers. A recent large randomized trial performed by the UK Head and Neck (UKHAN1) trial reported that concurrent chemoradiotherapy reduces recurrences and death in patients with advanced head and neck cancer. However, researchers are still attempting to determine the optimal way to administer radiotherapy and chemotherapy to improve outcomes of patients with advanced head and neck cancer. Previous Phase II non-randomized studies have suggested benefit from neoadjuvant induction chemotherapy prior to the administration of definitive concomitant chemoradiotherapy for treatment of patients with locally advanced head and neck cancer.

The current study involved 101 patients with locally advanced head and neck cancer who were randomly allocated to treatment with concomitant chemoradiotherapy alone or to receive Platinol® (cisplatin) and 5-FU prior to concomitant chemoradiotherapy.

  • Complete remission rates were 50% for patients receiving induction chemotherapy compared with 21.2% for patients receiving only concomitant chemoradiotherapy.
  • Median progression-free survival was 33.3 months for patients receiving induction chemotherapy compared with 19.7 months for patients receiving only concomitant chemoradiotherapy.
  • Median overall survival was 39.6 months for patients receiving induction chemotherapy compared with 30.4 months for patients receiving only concomitant chemoradiotherapy.
  • There were no apparent adverse effects of induction chemotherapy. Chemoradiotherapy was tolerated the same in both arms of the study.

Comments: This study confirms that induction chemotherapy before chemoradiotherapy can improve outcomes of patients with locally advanced head and neck cancer.

Reference:

Paccagnella A, Ghi MG, Loreggian L, et al. Concomitant chemoradiotherapy versus induction docetaxel, cisplatin and 5 fluorouracil (TPF) followed by concomitant chemoradiotherapy in locally advanced head and neck cancer: a phase II randomized trial. Annals of Oncology [early online publication]. December 23, 2009.