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Fu JY, Yue XH, Dong MJ, Li J, Zhang CP. Assessment of neoadjuvant chemotherapy with docetaxel, cisplatin, and fluorouracil in patients with oral cavity cancer. Cancer Med 2023; 12:2417-2426. [PMID: 35880556 PMCID: PMC9939210 DOI: 10.1002/cam4.5075] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chemotherapy with docetaxel, cisplatin, and fluorouracil (TPF) has been studied in patients with head and neck cancer. Its impact on patients with oral cavity cancer was not specified. METHODS We consecutively reviewed medical files of patients with untreated oral cavity cancer who received neoadjuvant TPF chemotherapy in our department from January 2017 to April 2020. Outcomes included the objective response to TPF chemotherapy, factors associated with the response, and progression and survival in different response groups. RESULTS A total of 167 patients were included, with half of stage IV disease. Complete or partial response was observed in 51 patients. A total of 91 patients had stable disease, and 25 patients had progressive disease. The response was not associated with age, sex, anatomic subsite, and the tumor's T stage. It was related with N stage (p < 0.001) and clinical stage (p = 0.004). Most patients with bulky nodes or nodes with obvious necrosis showed low response or even progressed after neoadjuvant TPF chemotherapy. The planned surgery was conducted in 159 patients. Disease relapse mostly occurred in 2 years after treatment. The 2-year overall survival and the progression-free survival were 89.0% and 85.2% for patients with complete or partial response, 62.4% and 55.6% for patients with stable disease, and 12.5% and 4.2% for patients with progressive disease, respectively. CONCLUSIONS The response of neoadjuvant TPF chemotherapy in patients with oral cavity cancer is related to disease stage, especially the nodal stage. Patients with complete or partial response developed less progression events and better survival.
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Affiliation(s)
- Jin Ye Fu
- Department of Oral & Maxillofacial – Head & Neck Oncology, Shanghai Ninth People's HospitalCollege of Stomatology, Shanghai Jiao Tong University School of MedicineShanghaiChina
- National Clinical Research Center for Oral Diseases & National Center for StomatologyShanghaiChina
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of StomatologyShanghaiChina
| | - Xiu Hui Yue
- Department of RadiologyShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Min Jun Dong
- Department of RadiologyShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jiang Li
- National Clinical Research Center for Oral Diseases & National Center for StomatologyShanghaiChina
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of StomatologyShanghaiChina
- Department of Oral PathologyShanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Chen Ping Zhang
- Department of Oral & Maxillofacial – Head & Neck Oncology, Shanghai Ninth People's HospitalCollege of Stomatology, Shanghai Jiao Tong University School of MedicineShanghaiChina
- National Clinical Research Center for Oral Diseases & National Center for StomatologyShanghaiChina
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of StomatologyShanghaiChina
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Griso AB, Acero-Riaguas L, Castelo B, Cebrián-Carretero JL, Sastre-Perona A. Mechanisms of Cisplatin Resistance in HPV Negative Head and Neck Squamous Cell Carcinomas. Cells 2022; 11:561. [PMID: 35159370 PMCID: PMC8834318 DOI: 10.3390/cells11030561] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Head and neck squamous cell carcinomas (HNSCCs) are the eighth most common cancers worldwide. While promising new therapies are emerging, cisplatin-based chemotherapy remains the gold standard for advanced HNSCCs, although most of the patients relapse due to the development of resistance. This review aims to condense the different mechanisms involved in the development of cisplatin resistance in HNSCCs and highlight future perspectives intended to overcome its related complications. Classical resistance mechanisms include drug import and export, DNA repair and oxidative stress control. Emerging research identified the prevalence of these mechanisms in populations of cancer stem cells (CSC), which are the cells mainly contributing to cisplatin resistance. The use of old and new CSC markers has enabled the identification of the characteristics within HNSCC CSCs predisposing them to treatment resistance, such as cell quiescence, increased self-renewal capacity, low reactive oxygen species levels or the acquisition of epithelial to mesenchymal transcriptional programs. In the present review, we will discuss how cell intrinsic and extrinsic cues alter the phenotype of CSCs and how they influence resistance to cisplatin treatment. In addition, we will assess how the stromal composition and the tumor microenvironment affect drug resistance and the acquisition of CSCs' characteristics through a complex interplay between extracellular matrix content as well as immune and non-immune cell characteristics. Finally, we will describe how alterations in epigenetic modifiers or other signaling pathways can alter tumor behavior and cell plasticity to induce chemotherapy resistance. The data generated in recent years open up a wide range of promising strategies to optimize cisplatin therapy, with the potential to personalize HNSCC patient treatment strategies.
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Affiliation(s)
- Ana Belén Griso
- Laboratory of Experimental Therapies and Biomarkers in Cancer, IdiPAZ, 28046 Madrid, Spain; (A.B.G.); (L.A.-R.)
| | - Lucía Acero-Riaguas
- Laboratory of Experimental Therapies and Biomarkers in Cancer, IdiPAZ, 28046 Madrid, Spain; (A.B.G.); (L.A.-R.)
| | - Beatriz Castelo
- Medical Oncology Department, University Hospital La Paz, 28046 Madrid, Spain;
| | | | - Ana Sastre-Perona
- Laboratory of Experimental Therapies and Biomarkers in Cancer, IdiPAZ, 28046 Madrid, Spain; (A.B.G.); (L.A.-R.)
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3
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Yokota T, Shibata M, Hamauchi S, Shirasu H, Onozawa Y, Ogawa H, Onoe T, Kawakami T, Furuta M, Inoue H, Fushiki K, Onitsuka T. Feasibility and efficacy of chemoradiotherapy with concurrent split-dose cisplatin after induction chemotherapy with docetaxel/cisplatin/5-fluorouracil for locally advanced head and neck cancer. Mol Clin Oncol 2020; 13:35. [PMID: 32802331 DOI: 10.3892/mco.2020.2105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/12/2020] [Indexed: 11/06/2022] Open
Abstract
Chemoradiotherapy (CRT) with concurrent high-dose cisplatin (CDDP) is a standard treatment for locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). Docetaxel plus CDDP and 5-fluorouracil (TPF) induction chemotherapy (ICT) prior to CRT is considered for patients at high risk of distant metastases. The purpose of the current study was to evaluate the feasibility and efficacy of CRT with split-dose CDDP after TPF-ICT for LA-SCCHN. A total of 21 LA-SCCHN patients treated with TPF-ICT followed by concurrent CRT with split-dose CDDP between January 2011 and December 2017 were retrospectively analysed. The patients' characteristics were i) median age 66 years (48-75 years); ii) male/female, 21/0; iii) performance status 0-1/2, 20/1; iv) larynx/hypopharynx/oropharynx/oral cavity, 4/8/8/1 and v) clinical stage III/IV, 3/18. The numbers of TPF-ICT cycles 1/2/3 were 2/3/16. Median cumulative doses of CDDP in TPF-ICT and CRT were 180.0 and 206.7 mg/m2, respectively. All patients completed 70 Gy RT. The complete response rate was 76.2%. At a median follow-up of 51.5 months, median PFS and OS were not reached and 65.5 months, respectively. The most common grade 3 or worse toxicities during CRT-ICT were stomatitis (48%), dysphagia (21%), anorexia (17%) and leukopenia (14%). However, no grade 2 or worse nephrotoxicity, neurotoxicity or ototoxicity was observed. The results demonstrated that concurrent CRT with split-dose CDDP after TPF-ICT is feasible and effective for LA-SCCHN.
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Affiliation(s)
- Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
| | - Masayuki Shibata
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
| | - Satoshi Hamauchi
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
| | - Hiromichi Shirasu
- Division of Medical Oncology, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
| | - Yusuke Onozawa
- Division of Medical Oncology, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
| | - Hirofumi Ogawa
- Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
| | - Tsuyoshi Onoe
- Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
| | - Takeshi Kawakami
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
| | - Mitsuhiro Furuta
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
| | - Hiroto Inoue
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
| | - Kunihiro Fushiki
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
| | - Tetsuro Onitsuka
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
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4
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Enokida T, Ogawa T, Homma A, Okami K, Minami S, Nakanome A, Shimizu Y, Maki D, Ueda Y, Fujisawa T, Motegi A, Ohkoshi A, Taguchi J, Ebisumoto K, Nomura S, Okano S, Tahara M. A multicenter phase II trial of paclitaxel, carboplatin, and cetuximab followed by chemoradiotherapy in patients with unresectable locally advanced squamous cell carcinoma of the head and neck. Cancer Med 2020; 9:1671-1682. [PMID: 31943834 PMCID: PMC7050099 DOI: 10.1002/cam4.2852] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/19/2019] [Accepted: 01/03/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Induction chemotherapy (IC) in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) often compromises compliance with subsequent chemoradiotherapy (CRT), which negatively affects outcomes. Here, we assessed the combination of paclitaxel (PTX), carboplatin (CBDCA), and cetuximab (Cmab) as IC for unresectable LA-SCCHN. METHODS Induction chemotherapy consisted of weekly CBDCA area under the plasma concentration-time curve = 1.5, PTX 80 mg/m2 and Cmab with an initial dose of 400 mg/m2 followed by 250 mg/m2 for 8 weeks. Following IC, CDDP (20 mg/m2 , 4 days × 3 cycles) and concurrent radiotherapy (70 Gy/35 fr) were started. Primary endpoint was the proportion of CRT completion (%CRT completion). PCE was planned to be deemed effective if the Bayesian posterior probability (PP), defined as the probability that %CRT completion was larger than the threshold value of 65%, exceeded 84%. RESULTS Thirty-five patients were enrolled. Cases were hypopharynx/oropharynx/larynx in 17/17/1 patients, all at Stage IV. Of 35 patients, 34 (97%) completed IC and 32 received CRT and met the criteria of full analysis set (FAS). In FAS, the %CRT completion was 96.9%, and PP was 99.9%, exceeding the prespecified boundary of 84%. Mean cumulative dose and relative to dose intensity of CDDP in CRT was 232.5 mg/m2 and 100%, respectively. Response rate was 88.6% by IC and 93.8% in the CRT phase. Three year overall survival was 83.5%. Main grade 3 toxicities included neutropenia (11.4%) and skin rash (5.7%) during IC; and oral mucositis (31.3%) and neutropenia (12.5%) during CRT. No grade 4 toxicity or treatment-related death was seen. CONCLUSIONS PCE as IC was feasible, with promising efficacy and no effect on compliance with subsequent CRT in unresectable LA-SCCHN.
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Affiliation(s)
- Tomohiro Enokida
- Department of Head and Neck Medical OncologyNational Cancer Center Hospital EastChibaJapan
| | - Takenori Ogawa
- Department of Otolaryngology – Head and Neck SurgeryTohoku University School of MedicineMiyagiJapan
| | - Akihiro Homma
- Department of Otolaryngology, Head & Neck SurgeryHokkaido University Graduate School of MedicineSapporoJapan
| | - Kenji Okami
- Department of Otolaryngology – Head Neck SurgeryTokai UniversityKanagawaJapan
| | - Shujiro Minami
- Department of OtorhinolaryngologyNational Hospital Organization Tokyo Medical CenterTokyoJapan
| | - Ayako Nakanome
- Department of Otolaryngology – Head and Neck SurgeryTohoku University School of MedicineMiyagiJapan
| | - Yasushi Shimizu
- Department of Medical OncologyHokkaido University HospitalSapporoJapan
| | - Daisuke Maki
- Department of Otolaryngology – Head Neck SurgeryTokai UniversityKanagawaJapan
| | - Yuri Ueda
- Department of Head and Neck Medical OncologyNational Cancer Center Hospital EastChibaJapan
| | - Takao Fujisawa
- Department of Head and Neck Medical OncologyNational Cancer Center Hospital EastChibaJapan
| | - Atsushi Motegi
- Division of Radiation Oncology and Particle TherapyNational Cancer Center Hospital EastChibaJapan
| | - Akira Ohkoshi
- Department of Otolaryngology – Head and Neck SurgeryTohoku University School of MedicineMiyagiJapan
| | - Jun Taguchi
- Department of Medical OncologyHokkaido University HospitalSapporoJapan
| | - Koji Ebisumoto
- Department of Otolaryngology – Head Neck SurgeryTokai UniversityKanagawaJapan
| | - Shogo Nomura
- Biostatistics DivisionCenter for Research Administration and SupportNational Cancer CenterChibaJapan
| | - Susumu Okano
- Department of Head and Neck Medical OncologyNational Cancer Center Hospital EastChibaJapan
| | - Makoto Tahara
- Department of Head and Neck Medical OncologyNational Cancer Center Hospital EastChibaJapan
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5
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Xu J, Zang Y, Cao S, Lei D, Pan X. Aberrant expression of PAFAH1B3 associates with poor prognosis and affects proliferation and aggressiveness in hypopharyngeal squamous cell carcinoma. Onco Targets Ther 2019; 12:2799-2808. [PMID: 31043794 PMCID: PMC6469483 DOI: 10.2147/ott.s196324] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Hypopharyngeal squamous cell carcinoma (HSCC) is among the most lethal tumors encountered in the head and neck, and currently lacks satisfactory therapeutic targets. Platelet activating factor acetylhydrolase 1B3 (PAFAH1B3), a cancer-relevant metabolic driver, is reported to play a critical role in controlling tumorigenesis and aggressiveness in several types of cancers. However, the role of PAFAH1B3 in HSCC progression has not yet been identified. Methods The expression pattern of PAFAH1B3 was examined using immunohistochemistry in 83 HSCC tumor tissues and 44 paired adjacent non-tumor samples. Univariate and multivariate analyses were conducted to explore its association with prognosis of HSCC. In vitro loss-of-function assays were performed to explore the impact of PAFAH1B3 knockdown on the biological phenotype of the human HSCC cell line, ie, FaDu cells. Results PAFAH1B3 was overly expressed in the HSCC tumor tissues compared with the adjacent non-tumor samples. Moreover, high expression of PAFAH1B3 was positively correlated with cervical lymph node metastasis. PAFAH1B3 overexpression was associated with poor outcome in HSCC, but it was not an independent prognostic indicator. Furthermore, in vitro loss-of function experiments demonstrated that PAFAH1B3 knockdown suppressed cell proliferation by inducing apoptosis and disrupting cell cycle process, and the migratory and invasive capacities were also attenuated in the absence of PAFAH1B3. Conclusion This study for the first time demonstrated the clinical value and the role of PAFAH1B3 in the biological function of HSCC. This work suggested that PAFAH1B3 might serve as a potential therapeutic target for HSCC patients.
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Affiliation(s)
- Jianing Xu
- Department of Otorhinolaryngology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, People's Republic of China, .,NHC Key Laboratory of Otorhinolaryngology, Shandong University, Jinan, Shandong 250012, People's Republic of China,
| | - Yuanwei Zang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, China
| | - Shengda Cao
- Department of Otorhinolaryngology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, People's Republic of China, .,NHC Key Laboratory of Otorhinolaryngology, Shandong University, Jinan, Shandong 250012, People's Republic of China,
| | - Dapeng Lei
- Department of Otorhinolaryngology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, People's Republic of China, .,NHC Key Laboratory of Otorhinolaryngology, Shandong University, Jinan, Shandong 250012, People's Republic of China,
| | - Xinliang Pan
- Department of Otorhinolaryngology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, People's Republic of China, .,NHC Key Laboratory of Otorhinolaryngology, Shandong University, Jinan, Shandong 250012, People's Republic of China,
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Nakahara S, Kitamura K, Honma K, Yamamoto Y, Takenaka Y, Yasui T, Hanamoto A, Morii E, Inohara H. [A Case of Nasopharyngeal Cancer with Febrile Neutropenia Followed by Death during Adjuvant Chemotherapy]. ACTA ACUST UNITED AC 2015; 118:763-9. [PMID: 26336750 DOI: 10.3950/jibiinkoka.118.763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Chemotherapy-related death can occur, but is rarely experienced in the case of head and neck cancer. In this report, we present the case of a 55-year-old male who died of a severe febrile neutropenia during adjuvant chemotherapy. He was initially diagnosed as having nasopharyngeal carcinoma (cT2N0M0), and concurrent chemoradiotherapy was used as a primary treatment. He did not show any critical side effects during that therapy. After residual disease was proven by biopsy, docetaxel, cisplatin and 5-fluorouracil (TPF) therapy was introduced as adjuvant chemotherapy. The patient developed a high fever with a decreased neutrophil count on day 8, and went into a state of shock on day 9. He underwent immediate systemic management, but methicillin-resistant Staphylococcus aureus (MRSA) pneumonia and enteritis were uncontrolled, resulting in death on day 43. The autopsy findings suggested that the main cause of death was acute respiratory distress syndrome (ARDS), but cytomegalovirus (CMV) infection was also noted in multiple organs. . Since it is assumed from literature that the mortality rate in TPF therapy is about 2-4%, it was considered that prior sufficient explanations and informed consent should be required before this therapy.
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Feasibility and efficacy of induction docetaxel, cisplatin, and 5-fluorouracil chemotherapy combined with concurrent weekly cisplatin chemoradiotherapy for locally advanced head and neck squamous cell carcinoma. Int J Clin Oncol 2014; 20:431-7. [PMID: 24993675 DOI: 10.1007/s10147-014-0726-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 06/21/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the feasibility of induction docetaxel, cisplatin, and 5-fluorouracil chemotherapy followed by concurrent weekly cisplatin chemoradiotherapy for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). METHODS Between 2010 and 2013, 30 patients with Stage IV HNSCC were treated in Hokkaido University Hospital with three cycles of induction chemotherapy (docetaxel 75 mg/m(2) and cisplatin 75 mg/m(2), day 1; and 5-fluorouracil 750 mg/m(2)/day 120 h continuous infusion, every 3 weeks) followed by concurrent weekly cisplatin (40 mg/m(2), on weeks 1, 2, 3, 5, 6 and 7) chemoradiotherapy. RESULTS Three courses of induction chemotherapy were performed in 25 patients (83%) with grade 3-4 toxicities during induction chemotherapy observed in 22 patients (73%). The major toxicities were hematologic, with 22 cases (73%) showing grade 3-4 neutropenia. Radiotherapy was completed (70 Gy) in 29 patients (97%), while a total of 19 patients (63%) completed five (13 patients) or six (6 patients) courses of chemotherapy. During concurrent chemoradiotherapy, no grade 4 hematological toxicities were observed. Grade 4 dermatitis was observed in one patient, and grade 3 mucositis was observed in 12 patients. There were no treatment-related deaths during the induction chemotherapy or concurrent chemoradiotherapy. The 1- and 2-year progression-free survival rates and the 1- and 2-year overall survival rates were 86%, 72%, and 89%, 81%, respectively. CONCLUSION Sequential therapy composed of induction chemotherapy followed by concurrent weekly cisplatin chemoradiotherapy is feasible, showing encouraging results in patients with locally advanced HNSCC. Concurrent weekly cisplatin chemoradiotherapy following induction chemotherapy appears to be a suitable alternative to three-weekly high-dose cisplatin therapy.
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Gold KA, Neskey M, William WN. The role of systemic treatment before, during, and after definitive treatment. Otolaryngol Clin North Am 2013; 46:645-56. [PMID: 23910475 DOI: 10.1016/j.otc.2013.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In locoregionally advanced head and neck squamous cell carcinomas, outcomes using single-modality therapy are usually poor. Although chemotherapy alone is not considered a curative therapy, the addition of chemotherapy to other modalities can lead to improved outcomes. Discussed here is the use of chemotherapy for oropharyngeal and/or oral cavity squamous cell carcinomas in 3 settings: in combination with radiation as definitive therapy, as induction treatment before definitive therapy, and in combination with radiation therapy as adjuvant treatment following surgical resection. The role of the targeted agent cetuximab in combination with radiation therapy for locally advanced disease is also discussed.
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Affiliation(s)
- Kathryn A Gold
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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BAUMAN JESSICA, LANGER COREY, QUON HARRY, ALGAZY KENNETH, LIN ALEXANDER, DESAI ARATI, MUTALE FAITH, WEISS JARED. Induction chemotherapy with cetuximab, carboplatin and paclitaxel for the treatment of locally advanced squamous cell carcinoma of the head and neck. Exp Ther Med 2013; 5:1247-1253. [PMID: 23599744 PMCID: PMC3628719 DOI: 10.3892/etm.2013.948] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 01/25/2013] [Indexed: 12/19/2022] Open
Abstract
Although controversy exists in the management of locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN), clinicians often use induction chemotherapy for treatment of the most advanced cases. One promising regimen combines weekly cetuximab (400 mg/m2 loading dose followed by 250 mg/m2) with carboplatin (AUC of 2) and paclitaxel (90 mg/m2). We retrospectively evaluated patients treated with this regimen prior to definitive chemoradiation or surgery between May 2008 and December 2011. The primary endpoint used for this retrospective analysis was feasibility. Thirty consecutive, unselected patients were included. Median follow-up was 13.7 months (range, 5.0-38.7 months). All but one patient had stage IV SCCHN. Dose intensity was high for carboplatin (92%), paclitaxel (93%) and cetuximab (85%). Grade 3-4 toxicities occurred in <7% of the study population and were limited to rash, neutropenia and infusion reactions. Response rate (RR) to induction chemotherapy was 97% (30% complete response, 67% partial response). All patients completed subsequent chemoradiotherapy or surgery. Nineteen patients (63%) demonstrated a complete response and 11 patients (37%) demonstrated a partial response. Median overall survival and progression-free survival data are not yet mature. The RR to therapy in our off-protocol experience is at least comparable to that observed in the two phase II studies of this regimen and appears superior to that observed with docetaxel, cisplatin and fluorouracil (TPF).
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Affiliation(s)
- JESSICA BAUMAN
- Division of Hematology and Oncology, Dana-Farber Cancer Institute, Boston, MA 02215
| | - COREY LANGER
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA 19104
| | - HARRY QUON
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD 21205
| | - KENNETH ALGAZY
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA 19104
| | - ALEXANDER LIN
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104
| | - ARATI DESAI
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA 19104
| | - FAITH MUTALE
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA 19104
| | - JARED WEISS
- Division of Hematology and Oncology, University of North Carolina, Chapel Hill, NC 27599,
USA
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10
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Adkins D, Ley J, Trinkaus K, Thorstad W, Lewis J, Wildes T, Siegel BA, Dehdashti F, Gay H, Mehan P, Nussenbaum B. A phase 2 trial of induction nab-paclitaxel and cetuximab given with cisplatin and 5-fluorouracil followed by concurrent cisplatin and radiation for locally advanced squamous cell carcinoma of the head and neck. Cancer 2012; 119:766-73. [PMID: 22991252 DOI: 10.1002/cncr.27741] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 06/13/2012] [Accepted: 06/18/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND Complete response (CR) at the primary tumor site as assessed by clinical examination following induction chemotherapy with PF (cisplatin and 5-fluorouracil [5-FU]) is a favorable predictive factor for overall survival and disease control in patients with locally advanced squamous cell carcinoma of the head and neck. In most series, the rate of CR at the primary site after induction PF was 20% to 30%. This study evaluated the efficacy and feasibility of induction nab-paclitaxel and cetuximab given with PF (ACPF) followed by definitive chemoradiation (CRT) in a phase 2 trial. METHODS Patients with squamous cell carcinoma of the head and neck were treated with ACPF (nab-paclitaxel 100 mg/m(2) /week; cetuximab 250 mg/m(2) /week; cisplatin 75 mg/m(2) on day 1; 5-FU 750 mg/m(2) /day on days 1 through 3) every 21 days for 3 cycles followed by CRT (cisplatin 100 mg/m(2) on days 1, 22, and 43 of radiation therapy [RT]). CR at the primary tumor site after 2 cycles of ACPF was the primary endpoint. RESULTS Thirty patients were enrolled, of which 22 (73%) had large (T3/T4) primary tumors. The CR rate at the primary tumor site after 2 cycles of ACPF was 53% and the overall response rate was 100%. Twenty-nine (96%) patients completed 3 cycles of ACPF, 26 (90%) completed definitive RT per protocol, and 22 of the 27 evaluable patients (81%) received > 2 of the 3 planned doses of cisplatin with RT. The estimated 2-year overall and progression-free survival rates were 84% and 65%, respectively. CONCLUSIONS Induction ACPF resulted in a high CR rate (53%) at the primary tumor site even in large tumors and did not adversely affect delivery of definitive CRT. Further investigation of ACPF is warranted.
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Affiliation(s)
- Douglas Adkins
- Division of Medical Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
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11
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Brizel D. Management of human papillomavirus-induced oropharynx cancer. Am Soc Clin Oncol Educ Book 2012:368-71. [PMID: 24451765 DOI: 10.14694/edbook_am.2012.32.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Oropharynx cancer (OPC) constitutes the most common location for squamous-cell head and neck cancer, and most OPC is caused by the human papilloma virus (HPV). Early-stage (American Joint Committee on Cancer [AJCC] stage I and II) disease should be treated with single modality surgery or radiotherapy whenever possible. More advanced presentations generally require combined-modality therapy with various combinations of surgery, radiotherapy, and chemotherapy or molecularly targeted therapy. All of these approaches expose patients to a substantial risk of serious long-term functional morbidity. HPV-induced OPC has a very favorable prognosis compared with its HPV-negative counterpart irrespective of the treatment platform that is used. Current clinical trials are investigating the concept of therapeutic deintensification with the dual objectives of decreasing toxicity and maintaining efficacy.
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Affiliation(s)
- David Brizel
- From the Duke University Cancer Institute, Durham, NC
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12
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Keereweer S, Kerrebijn JDF, Al-Mamgani A, Sewnaik A, Baatenburg de Jong RJ, van Meerten E. Chemoradiation for advanced hypopharyngeal carcinoma: a retrospective study on efficacy, morbidity and quality of life. Eur Arch Otorhinolaryngol 2011; 269:939-46. [PMID: 21739092 PMCID: PMC3275723 DOI: 10.1007/s00405-011-1694-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 06/24/2011] [Indexed: 12/19/2022]
Abstract
Chemoradiation (CRT) is a valuable treatment option for advanced hypopharyngeal squamous cell cancer (HSCC). However, long-term toxicity and quality of life (QOL) is scarcely reported. Therefore, efficacy, acute and long-term toxic effects, and long-term QOL of CRT for advanced HSCC were evaluated,using retrospective study and post-treatment quality of life questionnaires. in a tertiary hospital setting. Analysis was performed of 73 patients that had been treated with CRT. Toxicity was rated using the CTCAE score list. QOL questionnaires EORTC QLQ-C30, QLQ-H&N35, and VHI were analyzed. The most common acute toxic effects were dysphagia and mucositis. Dysphagia and xerostomia remained problematic during long-term follow-up. After 3 years, the disease-specific survival was 41%, local disease control was 71%, and regional disease control was 97%. The results indicated that CRT for advanced HSCC is associated with high locoregional control and disease-specific survival. However, significant acute and long-term toxic effects occur, and organ preservation appears not necessarily equivalent to preservation of function and better QOL.
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Affiliation(s)
- Stijn Keereweer
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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13
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Wilken R, Veena MS, Wang MB, Srivatsan ES. Curcumin: A review of anti-cancer properties and therapeutic activity in head and neck squamous cell carcinoma. Mol Cancer 2011; 10:12. [PMID: 21299897 PMCID: PMC3055228 DOI: 10.1186/1476-4598-10-12] [Citation(s) in RCA: 621] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 02/07/2011] [Indexed: 12/21/2022] Open
Abstract
Curcumin (diferuloylmethane) is a polyphenol derived from the Curcuma longa plant, commonly known as turmeric. Curcumin has been used extensively in Ayurvedic medicine for centuries, as it is nontoxic and has a variety of therapeutic properties including anti-oxidant, analgesic, anti-inflammatory and antiseptic activity. More recently curcumin has been found to possess anti-cancer activities via its effect on a variety of biological pathways involved in mutagenesis, oncogene expression, cell cycle regulation, apoptosis, tumorigenesis and metastasis. Curcumin has shown anti-proliferative effect in multiple cancers, and is an inhibitor of the transcription factor NF-κB and downstream gene products (including c-myc, Bcl-2, COX-2, NOS, Cyclin D1, TNF-α, interleukins and MMP-9). In addition, curcumin affects a variety of growth factor receptors and cell adhesion molecules involved in tumor growth, angiogenesis and metastasis. Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide and treatment protocols include disfiguring surgery, platinum-based chemotherapy and radiation, all of which may result in tremendous patient morbidity. As a result, there is significant interest in developing adjuvant chemotherapies to augment currently available treatment protocols, which may allow decreased side effects and toxicity without compromising therapeutic efficacy. Curcumin is one such potential candidate, and this review presents an overview of the current in vitro and in vivo data supporting its therapeutic activity in head and neck cancer as well as some of the challenges concerning its development as an adjuvant chemotherapeutic agent.
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Affiliation(s)
- Reason Wilken
- Department of Surgery, VA Greater Los Angeles Healthcare System, West Los Angeles, CA, USA
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14
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Feasibility, toxicity, and efficacy of short induction chemotherapy of docetaxel plus cisplatin or carboplatin (TP) followed by concurrent chemoradio-therapy for organ preservation in advanced cancer of the hypopharynx, larynx, and base of tongue. Early results. Strahlenther Onkol 2010; 187:15-22. [PMID: 21234526 DOI: 10.1007/s00066-010-2178-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 09/29/2010] [Indexed: 12/14/2022]
Abstract
PURPOSE Concurrent chemoradiotherapy (CRT) is standard treatment for advanced head and neck cancer. Whether short induction chemotherapy (ICT) provides additional benefit or, in particular, predictive benefit for the response to chemoradiotherapy is an open question. The present study aimed to assess the feasibility, toxicity, and efficacy of induction with docetaxel and platinum salt (TP) and subsequent CRT. PATIENTS AND METHODS A total of 25 patients with functionally inoperable cancer of the base of the tongue, hypopharynx, or larynx received 1 cycle of docetaxel (75 mg/m², day 1) combined with either cisplatin (30 mg/m², days 1-3; n = 23) or carboplatin (AUC 1.5 days 1-3; n = 2). Responders (n = 22, >30% tumor reduction, graded by endoscopy) and 1 non-responder received CRT (target dose: 69-72 Gy) with cisplatin/paclitaxel, carboplatin/paclitaxel, or cisplatin/docetaxel. RESULTS All patients completed ICT with acceptable toxicity (leukocytopenia grade 4: 8%). The remission rate of the primary tumor was 88% (22/25 patients). There was no need to delay CRT due to toxicity in any case. Each patient received the full radiation dose. Of the patients, 56% received >80% of the chemotherapy. The acute toxicity of CRT was moderate, no grade 4 toxicities occurred, while grade 3 toxicities included the following: infection (39%), dermatitis (13%), leukocytopenia (30%), and thrombocytopenia (4%). The local control rate was 84.6% ± 8.5% and the survival rate was 89.6% ± 7.2% at 12 months. Organ preservation was possible in 22/23 (95%) cases. CONCLUSION Short induction with a TP regimen and subsequent CRT with a taxan is feasible and associated with an encouraging local control rate.
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15
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Argiris A, Heron DE, Smith RP, Kim S, Gibson MK, Lai SY, Branstetter BF, Posluszny DM, Wang L, Seethala RR, Dacic S, Gooding W, Grandis JR, Johnson JT, Ferris RL. Induction docetaxel, cisplatin, and cetuximab followed by concurrent radiotherapy, cisplatin, and cetuximab and maintenance cetuximab in patients with locally advanced head and neck cancer. J Clin Oncol 2010; 28:5294-300. [PMID: 21079141 DOI: 10.1200/jco.2010.30.6423] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE We incorporated cetuximab, a chimeric monoclonal antibody against the epidermal growth factor receptor (EGFR), into the induction therapy and subsequent chemoradiotherapy of head and neck cancer (HNC). PATIENTS AND METHODS Patients with locally advanced HNC, including squamous and undifferentiated histologies, were treated with docetaxel 75 mg/m2 day 1, cisplatin 75 mg/m2 day 1, and cetuximab 250 mg/m2 days 1, 8, and 15 (after an initial loading dose of 400 mg/m2), termed TPE, repeated every 21 days for three cycles, followed by radiotherapy with concurrent cisplatin 30 mg/m2 and cetuximab weekly (XPE), and maintenance cetuximab for 6 months. Quality of life (QOL) was assessed using Functional Assessment of Cancer Therapy-Head and Neck. In situ hybridization (ISH) for human papillomavirus (HPV), immunohistochemistry for p16, and fluorescence ISH for EGFR gene copy number were performed on tissue microarrays. RESULTS Of 39 enrolled patients, 36 had stage IV disease and 23 an oropharyngeal primary. Acute toxicities during TPE included neutropenic fever (10%) and during XPE, grade 3 or 4 oral mucositis (54%) and hypomagnesemia (39%). With a median follow-up of 36 months, 3-year progression-free survival and overall survival were 70% and 74%, respectively. Eight patients progressed in locoregional sites, three in distant, and one in both. HPV positivity was not associated with treatment efficacy. No progression-free patient remained G-tube dependent. The H&N subscale QOL scores showed a significant decrement at 3 months after XPE, which normalized at 1 year. CONCLUSION This cetuximab-containing regimen resulted in excellent long-term survival and safety, and warrants further evaluation in both HPV-positive and -negative HNC.
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Affiliation(s)
- Athanassios Argiris
- University of Pittsburgh Medical Center Cancer Pavilion, 5th Floor, Pittsburgh, PA 15232, USA.
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Engineering of self-assembled nanoparticle platform for precisely controlled combination drug therapy. Proc Natl Acad Sci U S A 2010; 107:17939-44. [PMID: 20921363 DOI: 10.1073/pnas.1011368107] [Citation(s) in RCA: 422] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The genomic revolution has identified therapeutic targets for a plethora of diseases, creating a need to develop robust technologies for combination drug therapy. In the present work, we describe a self-assembled polymeric nanoparticle (NP) platform to target and control precisely the codelivery of drugs with varying physicochemical properties to cancer cells. As proof of concept, we codelivered cisplatin and docetaxel (Dtxl) to prostate cancer cells with synergistic cytotoxicity. A polylactide (PLA) derivative with pendant hydroxyl groups was prepared and conjugated to a platinum(IV) [Pt(IV)] prodrug, c,t,c-[Pt(NH(3))(2)(O(2)CCH(2)CH(2)COOH)(OH)Cl(2)] [PLA-Pt(IV)]. A blend of PLA-Pt(IV) functionalized polymer and carboxyl-terminated poly(D,L-lactic-co-glycolic acid)-block-poly(ethylene glycol) copolymer in the presence or absence of Dtxl, was converted, in microfluidic channels, to NPs with a diameter of ∼100 nm. This process resulted in excellent encapsulation efficiency (EE) and high loading of both hydrophilic platinum prodrug and hydrophobic Dtxl with reproducible EEs and loadings. The surface of the NPs was derivatized with the A10 aptamer, which binds to the prostate-specific membrane antigen (PSMA) on prostate cancer cells. These NPs undergo controlled release of both drugs over a period of 48-72 h. Targeted NPs were internalized by the PSMA-expressing LNCaP cells via endocytosis, and formation of cisplatin 1,2-d(GpG) intrastrand cross-links on nuclear DNA was verified. In vitro toxicities demonstrated superiority of the targeted dual-drug combination NPs over NPs with single drug or nontargeted NPs. This work reveals the potential of a single, programmable nanoparticle to blend and deliver a combination of drugs for cancer treatment.
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Fury MG, Shah JP. Induction chemotherapy in the management of head and neck cancer. J Surg Oncol 2010; 101:292-8. [PMID: 20187068 DOI: 10.1002/jso.21438] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The strategy of induction chemotherapy prior to planned definitive local therapy for head and neck squamous cell carcinoma has been studied for over 30 years, and appears to have a role in select clinical situations. Here we review landmark studies regarding induction chemotherapy, both in the pre-taxane era and in the current taxane era, and we address some of the unresolved questions regarding the role of induction chemotherapy in head and neck cancer.
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Affiliation(s)
- Matthew G Fury
- Head and Neck Medical Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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