• 6/30/2006
  • Boston, MA
  • R Haddad et al.
  • Arch Otolaryngol Head Neck Surg, June 1, 2006; 132(6): 678-81

Objective:
To report the rate of pathological complete response after induction chemotherapy with the docetaxel, cisplatin, and fluorouracil (TPF) combination.

Design:
Retrospective cohort analysis. SETTING: Tertiary care academic cancer center, between June 1999 and May 2004.

Patients:
Seventy-two patients with newly diagnosed squamous cell carcinoma of the head and neck; 68 (95%) of the patients had stage IV, locally advanced disease.

Interventions:
Three cycles of induction chemotherapy followed by a biopsy of the primary site. All patients subsequently underwent chemotherapy with 3 cycles of TPF.

Main Outcome Measure:
Rate of pathological complete response at the primary site after induction chemotherapy with 3 cycles of TPF.

Results:
Biopsy results were negative for cancer in 64 patients (89%) and positive in 8 patients (11%). The median follow-up was 2 years. In the positive biopsy result group, 2 (25%) of 8 patients died of disease vs 3 (4%) of 64 patients in the negative biopsy result group. Twenty-nine neck dissections were performed; results were positive in 7 patients (all alive with no evidence of disease) and negative in 22 patients (21 alive with no evidence of disease). The overall 2- and 5-year progression-free survival is currently projected at 85% and 85%, respectively; the overall 2- and 5-year survival, at 95% and 90%, respectively. Importantly, T4 presentation did not predict a positive biopsy result at the primary site or a positive neck dissection result (P = .60 and P = .56, respectively). N3 presentation (12 patients) did not predict a positive biopsy result at the primary site (P = .87) but did correlate with positive neck dissection results in 6 of 12 patients (P<.001).

Conclusions:
Induction chemotherapy with the TPF regimen results in a high pathological complete response rate (89%). This rate is higher than with the cisplatin plus fluorouracil combination therapy, which was reported to be between 25% and 50% in previous studies. Chemoradiotherapy is currently an accepted standard of care, but induction chemotherapy continues to be investigated. Based on recent phase 3 trial results and the data presented herein, we propose that the 3-drug combination be used as the new platform when administering induction chemotherapy.

Authors:
R Haddad, R Tishler, L Wirth, CM Norris, L Goguen, C Sullivan, L O’Donnell, Y Li, and M Posner

Authors’ affiliation:
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass, USA