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Cohen EEW, Karrison TG, Kocherginsky M, Mueller J, Egan R, Huang CH, Brockstein BE, Agulnik MB, Mittal BB, Yunus F, Samant S, Raez LE, Mehra R, Kumar P, Ondrey F, Marchand P, Braegas B, Seiwert TY, Villaflor VM, Haraf DJ, Vokes EE. Phase III randomized trial of induction chemotherapy in patients with N2 or N3 locally advanced head and neck cancer. J Clin Oncol 2014; 32:2735-43. [PMID: 25049329 DOI: 10.1200/jco.2013.54.6309] [Citation(s) in RCA: 345] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Induction chemotherapy (IC) before radiotherapy lowers distant failure (DF) rates in locally advanced squamous cell carcinoma of the head and neck (SCCHN). The goal of this phase III trial was to determine whether IC before chemoradiotherapy (CRT) further improves survival compared with CRT alone in patients with N2 or N3 disease. PATIENTS AND METHODS Treatment-naive patients with nonmetastatic N2 or N3 SCCHN were randomly assigned to CRT alone (CRT arm; docetaxel, fluorouracil, and hydroxyurea plus radiotherapy 0.15 Gy twice per day every other week) versus two 21-day cycles of IC (docetaxel 75 mg/m(2) on day 1, cisplatin 75 mg/m(2) on day 1, and fluorouracil 750 mg/m(2) on days 1 to 5) followed by the same CRT regimen (IC + CRT arm). The primary end point was overall survival (OS). Secondary end points included DF-free survival, failure pattern, and recurrence-free survival (RFS). RESULTS A total of 285 patients were randomly assigned. The most common grade 3 to 4 toxicities during IC were febrile neutropenia (11%) and mucositis (9%); during CRT (both arms combined), they were mucositis (49%), dermatitis (21%), and leukopenia (18%). Serious adverse events were more common in the IC arm (47% v 28%; P = .002). With a minimum follow-up of 30 months, there were no statistically significant differences in OS (hazard ratio, 0.91; 95% CI, 0.59 to 1.41), RFS, or DF-free survival. CONCLUSION IC did not translate into improved OS compared with CRT alone. However, the study was underpowered because it did not meet the planned accrual target, and OS was higher than predicted in both arms. IC cannot be recommended routinely in patients with N2 or N3 locally advanced SCCHN.
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Affiliation(s)
- Ezra E W Cohen
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France.
| | - Theodore G Karrison
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Masha Kocherginsky
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Jeffrey Mueller
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Robyn Egan
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Chao H Huang
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Bruce E Brockstein
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Mark B Agulnik
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Bharat B Mittal
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Furhan Yunus
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Sandeep Samant
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Luis E Raez
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Ranee Mehra
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Priya Kumar
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Frank Ondrey
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Patrice Marchand
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Bettina Braegas
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Tanguy Y Seiwert
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Victoria M Villaflor
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Daniel J Haraf
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Everett E Vokes
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
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