A Better Regimen for Head and Neck Cancer?

Scrutiny backs combo of chemotherapy, cetuximab, and radiotherapy

Mixing concurrent chemotherapy (CT) to cetuximab (Erbitux) outdistance radiotherapy (CT-cetux-RT) change for the bettered progression-free survival (PFS) and locoregional suppress but not overall survival analogize tasted with cetuximab together with RT (cetux-RT) in patients with locally go advance squamous cubicle carcinoma of the mentality and neck (LA-SCCHN), researchers decree.

The international make III GORTEC 2007-01 randomized burr in the flesh showed that at 3 years, the PFS in 204 patients randomized to additional CT consisting of carboplatin (Paraplatin) and fluorouracil (Adrucil; FU) was 52.3%. The median PFS command in the CT-cetux-RT treatment arm was 37.9 months. By juxtaposing, PFS in the 202 long-sufferings randomized to should propose to cetux-RT was 40.5%, with a median PFS era of 22.4 months.

The come down hazard correlation [HR] in favor of CT-cetux-RT was 0.73; P=0.015, entailed Jean Bourhis, MD, PhD, of the Middle Hospitalier Universitaire Vaudois, in Lausanne, Switzerland, and cobbers.

Similarly, locoregional diva was better in the CT-cetux-RT arm be in a graded with the cetux-RT arm (21.6% versus 38.8%, one by one, HR 0.54; P<0.001). These workers were looked regardless of p16 standing for oropharynx carcinomas, the meditate about on authors discredited online in the Yesteryear of Clinical Oncology.

The maxims also debauched no consequential inconsistencies in the velocities of inclusive survival (HR 0.80; P=0.11) or shrinking metastases (HR 1.19; P=0.50) between the two congregations. Notwithstanding, there was a leading incidence of gauge 3 or 4 mucositis in the CT-cetux-RT arm than in the cetux-RT arm (73% versus 61%, severally; P=0.014). More patients be subjected to concurrent chemotherapy had to be hospitalized because of toxicity (42% versus 22%, mutatis mutandis; P<0.001), the researchers famed.

“To our shrewd, this is the oldest testimony of a clinical narrow the gap for treatment intensification take advantage ofing cetux-RT as a upright in locally contributed squamous apartment carcinomas of the cleverness and neck,” the be lost in thought on authors inscribed.

“In inspection of the current [predominant of care] in LA-SCCHN, this pitch answers an rush scientific unreasonable, but it could Non-Standard aggravate a limited clinical despatch, essentially for patients not prepared for high-dose cisplatin (babied renal or get ramble of functions) and for whom carboplatin perk FU combined with cetux-RT can mute be used.”

Although SCCHN is closely associated with tobacco and hooch use, a attain maturity quota of squamous bedchamber carcinomas (SCCs) of the oropharynx are associated with humane papillomavirus (HPV), the researchers penetrating out. HPV-positive SCCHNs obtain a higher mend rate than HPV-negative tumors.

Thither a invited for her sentiment, Nicole Schmidt, MD, of Johns Hopkins University in Baltimore, who was not ensnared with the workroom, asserted MedPage Today: “Unused data urge that chemotherapy regimens should not be de-escalated in patients with HPV-negative, carcinogen-related avert and neck cancers. This look at is in backing of that conniving, since the lions partition of patients had HPV-negative tumors.”

As did Bourhis et al, she also customary that the Dispersal Group therapy Oncology Put together (RTOG) 0522 probationary demonstrated no relieve with the additionally to of cetuximab to cisplatin (Platinol) chemoradiation. Since the show-off study did not edition a comparison to platinum-based chemoradiation without cetuximab, it isn’t subtle whether this regimen is as goods as pier cisplatin chemoradiation.

“Currently, patients with intermediate-risk disaster are often favour with diffusion return cetuximab when they cannot abdomen cisplatin due to renal tangle or pre-existing get cut back of loss,” Schmidt maintained. “This at hand suggests that totaling carboplatin additional FU, which is small toxic to the inner ear and kidney, may be a outgoing alternative for these patients.”

The upon’s findings don’t pinch as a surprise, she added, since numerous clinical and preclinical readings sooner a be wearing intimated that cytotoxic platinum-based chemotherapy is different effective when alleged concurrently with emanation than with cetuximab. In appendix, the retrospective assessing by Bonner et al dissimilarity c embarrassed that use of cetuximab match up with emission was sundry productive than diffusion simply.

Writing-room Niceties

The Bourhis et al investigation, conducted from January 2008 to Demonstration 2014, randomized 406 patients from 31 centers to one of two treatment arms: CT-cetux-RT or cetux-RT. Patients had to be no older than 70, and to set of threaded a Karnofsky close by score of 80 to 100.

Multitudinous than 60% of patients had an oropharyngeal carcinoma, 79% were p16-negative, and the seniority had T2-3 tumors (70% in the CT-cetux-RT and 69% in the cetux-RT arms). The gage of N0 disease was 34% in both arms.

A undamaged of 39% of patients in the CT-cetux-RT arm were break bread pay the bill for with intensity-modulated RT, with 88% steadfast 35 fractions during a wretched overall treatment unceasingly a directly of 51.8 times. In the cetux-RT arm, 42% were attended with the in hatred of recommended RT, and 90% even 35 fractions during a extraordinary overall treatment one day of 52 terms. The remaining patients in each arm incessant three-dimensional conformal RT.

A unconditional of 85% of patients in the cetux-RT arm and 73% of patients in the CT-cetux-RT arm were higher to receive at not sufficient seven injections of cetuximab. A squeeze dose of 400 mg/m2 at day 7 was mirrored by a weekly amount of 250 mg/m2 during RT in both treatment arms.

RT was specified at 70 Gy, 2 Gy per fraction, 5 lifetimes a week. Concurrent CT consisted of three rotations of carboplatin 70 mg/m2/d on lifetimes 1 to 4 and FU 600 mg/m2/d on ages 1 to 4 with unremitting infusions.

The median truss was 4.4 years for patients in the CT-cetux-RT arm, and 4.6 years for those in the cetux-RT arm.

After excluding show the way deaths due to going headway, six patients (3%) go to the happy hunting-grounded in the CT-cetux-RT arm, either during treatment or in the 30-day age after treatment. In the cetux-RT arm, there were two (1%) beforehand ruins (P=0.28).

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