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Mahdavi H. Induction chemotherapy in locally advanced head and neck cancers, is there a best choice? Crit Rev Oncol Hematol 2023; 186:103986. [PMID: 37059273 DOI: 10.1016/j.critrevonc.2023.103986] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/25/2023] [Accepted: 04/11/2023] [Indexed: 04/16/2023] Open
Abstract
Locally advanced stages of squamous cancers of the head and neck (LAHNCs) acquire high propensity for local and systemic relapse. Addition of systemic therapy as an induction (IC) to the standard concurrent chemoradiotherapy (CCRT) has become an approach of many practitioners. This strategy has shown to reduce metastases but did not affect survival in unselected populations. Meanwhile, the induction regimen including docetaxel, cisplatin, 5-FU (TPF) has shown superiority over other combinations, however, a survival advantage was not detected when compared to CCRT alone. This may be attributed to its high toxicity profile, inducing treatment delay, resistance, or variations in tumor sites and responses. Currently, newer systemic therapy combinations are being tested and indicators of benefit are being identified. The focus of this review is on the development of the choice of combination regimen for induction. Subsequently, proposed alternatives and strategies for patient selection will be introduced.
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Affiliation(s)
- Hoda Mahdavi
- Department of Radiation Oncology, School of Medicine, Iran University of Medical Sciences,Tehran, Iran; Department of Radiation Oncology, Firoozgar General Hospital, Beh-Afarin St., Karimkhan-e-Zand Ave., Vali-e-Asr Sq., Tehran, Iran.
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2
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Xie QH, Wang WM, Yang JG, Xia HF, Xiao BL, Chen GH, Huang J, Li RF, Chen G. ALIX promotes cell migration and invasion of head and neck squamous cell carcinoma by regulating the expression of MMP9, MMP14, VEGF-C. Arch Oral Biol 2023; 151:105696. [PMID: 37086494 DOI: 10.1016/j.archoralbio.2023.105696] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVE The poor survival rate of head and neck squamous cell carcinoma (HNSCC), one of the most prevalent human cancer, is attributed to frequent locoregional recurrence and lymph node metastases. Though it is reported that the expression of ALG-2 interacting protein X (ALIX) closely correlates with the progression of various tumors, its role in HNSCC remains unclear. The present study aims to investigate the role of ALIX in the development of HNSCC. DESIGN With immunohistochemical staining, the expression levels of ALIX and series of related functional proteins were compared in normal mucosal (n = 18), HNSCC tissues (n = 54), and metastatic lymph nodes (n = 11). Further, the correlation analysis was performed among the proteins detected. By knocking down ALIX in HNSCC cell lines, the correlation of ALIX with the proteins was verified in vitro. The role of ALIX in proliferation, migration, and invasion of HNSCC cells was further studied by flow cytometry, wounding healing, and transwell assays, respectively. RESULTS Higher expression level of ALIX was revealed in HNSCC samples, especially in metastatic lymph nodes, than in normal mucosal tissues. Accordingly, increasing levels of MMP9, MMP14, and VEGF-C were also discovered in metastatic lymph nodes and significantly correlated with the expression of ALIX. In vitro assays demonstrated that the knockdown of ALIX reduced both the transcriptional and protein levels of MMP9, MMP14, and VEGF-C, together with suppressed migration and weakened invasion of HNSCC cell lines. CONCLUSIONS ALIX up-regulated the expression of MMP9, MMP14 and VEGF-C, and promoted migration and invasion of HNSCC cells.
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Affiliation(s)
- Qi-Hui Xie
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Wei-Ming Wang
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jie-Gang Yang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Hou-Fu Xia
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Bo-Lin Xiao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Gao-Hong Chen
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jue Huang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Rui-Fang Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
| | - Gang Chen
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China; TaiKang Center for Life and Medical Sciences, Wuhan University, Wuhan 430071, China; Frontier Science Center for Immunology and Metabolism, Wuhan University, Wuhan, China.
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3
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Taylor MH, Betts CB, Maloney L, Nadler E, Algazi A, Guarino MJ, Nemunaitis J, Jimeno A, Patel P, Munugalavadla V, Tao L, Adkins D, Goldschmidt JH, Cohen EE, Coussens LM. Safety and Efficacy of Pembrolizumab in Combination with Acalabrutinib in Advanced Head and Neck Squamous Cell Carcinoma: Phase 2 Proof-of-Concept Study. Clin Cancer Res 2022; 28:903-914. [PMID: 34862248 PMCID: PMC9311322 DOI: 10.1158/1078-0432.ccr-21-2547] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/12/2021] [Accepted: 11/30/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE Programmed cell death-1 (PD-1) receptor inhibitors have shown efficacy in head and neck squamous cell carcinoma (HNSCC), but treatment failure or secondary resistance occurs in most patients. In preclinical murine carcinoma models, inhibition of Bruton's tyrosine kinase (BTK) induces myeloid cell reprogramming that subsequently bolsters CD8+ T cell responses, resulting in enhanced antitumor activity. This phase 2, multicenter, open-label, randomized study evaluated pembrolizumab (anti-PD-1 monoclonal antibody) plus acalabrutinib (BTK inhibitor) in recurrent or metastatic HNSCC. PATIENTS AND METHODS Patients received pembrolizumab 200 mg intravenously every 3 weeks, alone or in combination with acalabrutinib 100 mg orally twice daily. Safety and overall response rate (ORR) were co-primary objectives. The secondary objectives were progression-free survival (PFS) and overall survival. RESULTS Seventy-six patients were evaluated (pembrolizumab, n = 39; pembrolizumab + acalabrutinib, n = 37). Higher frequencies of grade 3-4 treatment-emergent adverse events (AE; 65% vs. 39%) and serious AEs (68% vs. 31%) were observed with combination therapy versus monotherapy. ORR was 18% with monotherapy versus 14% with combination therapy. Median PFS was 2.7 [95% confidence interval (CI), 1.4-6.8] months in the combination arm and 1.7 (95% CI, 1.4-4.0) months in the monotherapy arm. The study was terminated due to lack of clinical benefit with combination treatment. To assess how tumor immune contexture was affected by therapy in patients with pre- and post-treatment biopsies, spatial proteomic analyses were conducted that revealed a trend toward increased CD45+ leukocyte infiltration of tumors from baseline at day 43 with pembrolizumab (monotherapy, n = 5; combination, n = 2), which appeared to be higher in combination-treated patients; however, definitive conclusions could not be drawn due to limited sample size. CONCLUSIONS Despite lack of clinical efficacy, immune subset analyses suggest that there are additive effects of this combination; however, the associated toxicity limits the feasibility of combination treatment with pembrolizumab and acalabrutinib in patients with recurrent or metastatic HNSCC.
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Affiliation(s)
- Matthew H. Taylor
- Division of Hematology and Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.,Corresponding Authors: Lisa M. Coussens, Knight Cancer Institute, Oregon Health and Science University, 2720 S Moody Avenue, Portland, OR 97201. Phone: 503–494–7811; Fax: 503–494–4253; E-mail: ; and Matthew H. Taylor, Earle A. Chiles Research Institute 4805 NE Glisan Street, 2N140, Portland, Oregon 97213. Phone: 503-215-6614; Fax: 503-215-6841; E-mail:
| | - Courtney B. Betts
- Department of Cell, Developmental, and Cancer Biology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Lauren Maloney
- Division of Hematology and Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.,Department of Cell, Developmental, and Cancer Biology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Eric Nadler
- Baylor University Medical Center, Dallas, Texas
| | - Alain Algazi
- University of California San Francisco, San Francisco, California
| | | | - John Nemunaitis
- University of Toledo College of Medicine and Life Sciences, and ProMedica Health System, Toledo, Ohio
| | | | - Priti Patel
- AstraZeneca, South San Francisco, California
| | | | - Lin Tao
- AstraZeneca, South San Francisco, California
| | - Douglas Adkins
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Ezra E.W. Cohen
- University of California San Diego, Moores Cancer Center, La Jolla, California
| | - Lisa M. Coussens
- Department of Cell, Developmental, and Cancer Biology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.,Corresponding Authors: Lisa M. Coussens, Knight Cancer Institute, Oregon Health and Science University, 2720 S Moody Avenue, Portland, OR 97201. Phone: 503–494–7811; Fax: 503–494–4253; E-mail: ; and Matthew H. Taylor, Earle A. Chiles Research Institute 4805 NE Glisan Street, 2N140, Portland, Oregon 97213. Phone: 503-215-6614; Fax: 503-215-6841; E-mail:
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Xu Y, Hong M, Kong D, Deng J, Zhong Z, Liang J. Ferroptosis-associated DNA methylation signature predicts overall survival in patients with head and neck squamous cell carcinoma. BMC Genomics 2022; 23:63. [PMID: 35042463 PMCID: PMC8767683 DOI: 10.1186/s12864-022-08296-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 01/05/2022] [Indexed: 01/12/2023] Open
Abstract
Background Head and neck squamous cell carcinoma (HNSCC) is a common cancer characterized by late diagnosis and poor prognosis. The aim of this study was to identify a novel ferroptosis-related DNA methylation signature as an alternative diagnosis index for patients with HNSCC. Methods Methylome and transcriptome data of 499 HNSCC patients, including 275 oral squamous cell carcinoma (OSCC) samples, were obtained from The Cancer Genome Atlas (TCGA). An additional independent methylation dataset of 50 OSCC patients from the NCBI Gene Expression Omnibus (GEO) database was used for validation. As an index of ferroptosis activity, the ferroptosis score (FS) of each patient was inferred from the transcriptome data using single-sample gene set enrichment analysis. Univariate, multivariate, and LASSO Cox regression analyses were used to select CpG sites for the construction of a ferroptosis-related DNA methylation signature for diagnosis of patients. Results We initially inferred the FS of each TCGA HNSCC patient and divided the samples into high- and low-FS subgroups. Results showed that the high-FS subgroup displayed poor overall survival. Moreover, 378 differentially methylated CpG sites (DMCs) were identified between the two HNSCC subgroups, with 16 selected to construct a 16-DNA methylation signature for risk prediction in HNSCC patients using the LASSO and multivariate Cox regression models. Relative operating characteristic (ROC) curve analysis showed great predictive efficiency for 1-, 3-, and 5-year HNSCC survival using the 16-DNA methylation signature. Its predictive efficiency was also observed in OSCC patients from the TCGA and GEO databases. In addition, we found that the signature was associated with the fractions of immune types in the tumor immune microenvironment (TIME), suggesting potential interactions between ferroptosis and TIME in HNSCC progression. Conclusions We established a novel ferroptosis-related 16-DNA methylation signature that could be applied as an alternative tool to predict prognosis outcome in patients with HNSCC, including OSCC. Supplementary Information The online version contains supplementary material available at 10.1186/s12864-022-08296-z.
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Lan YY, Chen YH, Liu C, Tung KL, Wu YT, Lin SC, Wu CH, Chang HY, Chen YC, Huang BM. Role of JNK activation in paclitaxel-induced apoptosis in human head and neck squamous cell carcinoma. Oncol Lett 2021; 22:705. [PMID: 34457060 PMCID: PMC8358625 DOI: 10.3892/ol.2021.12966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022] Open
Abstract
It has been reported that paclitaxel activates cell cycle arrest and increases caspase protein expression to induce apoptosis in head and neck squamous cell carcinoma (HNSCC) cell lines. However, the potential signaling pathway regulating this apoptotic phenomenon remains unclear. The present study used OEC-M1 cells to investigate the underlying molecular mechanism of paclitaxel-induced apoptosis. Following treatment with paclitaxel, cell viability was assessed via the MTT assay. Necrosis, apoptosis, cell cycle and mitochondrial membrane potential (∆Ψm) were analyzed via flow cytometric analyses, respectively. Western blot analysis was performed to detect the expression levels of proteins associated with the MAPK and caspase signaling pathways. The results demonstrated that low-dose paclitaxel (50 nM) induced apoptosis but not necrosis in HNSCC cells. In addition, paclitaxel activated the c-Jun N-terminal kinase (JNK), but not extracellular signal-regulated kinase or p38 mitogen-activated protein kinase. The paclitaxel-activated JNK contributed to paclitaxel-induced apoptosis, activation of caspase-3, -6, -7, -8 and -9, and reduction of ∆Ψm. In addition, caspase-8 and -9 inhibitors, respectively, significantly decreased paclitaxel-induced apoptosis. Notably, Bid was truncated following treatment with paclitaxel. Taken together, the results of the present study suggest that paclitaxel-activated JNK is required for caspase activation and loss of ∆Ψm, which results in apoptosis of HNSCC cells. These results may provide mechanistic basis for designing more effective paclitaxel-combining regimens to treat HNSCC.
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Affiliation(s)
- Yu-Yan Lan
- Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung 82144, Taiwan, R.O.C
| | - Ying-Hui Chen
- Department of Anesthesia, Chi-Mei Medical Center, Liouying, Tainan 73657, Taiwan, R.O.C
| | - Cheng Liu
- Department of Optometry, Shu-Zen Junior College of Medicine and Management, Kaohsiung 82144, Taiwan, R.O.C.,Department of Health and Beauty, Shu-Zen Junior College of Medicine and Management, Kaohsiung 82144, Taiwan, R.O.C
| | - Kuo-Lung Tung
- Department of Optometry, Shu-Zen Junior College of Medicine and Management, Kaohsiung 82144, Taiwan, R.O.C
| | - Yen-Ting Wu
- Department of Pathology, Golden Hospital, Pingtung 90049, Taiwan, R.O.C
| | - Sheng-Chieh Lin
- Department of Optometry, Shu-Zen Junior College of Medicine and Management, Kaohsiung 82144, Taiwan, R.O.C
| | - Chin-Han Wu
- Department of Optometry, Shu-Zen Junior College of Medicine and Management, Kaohsiung 82144, Taiwan, R.O.C
| | - Hong-Yi Chang
- Department of Biotechnology and Food Technology, College of Engineering, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan, R.O.C
| | - Yung-Chia Chen
- Department of Anatomy, School of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan, R.O.C
| | - Bu-Miin Huang
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan, R.O.C.,Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan, R.O.C
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Bahig H, Lambert L, Filion E, Soulières D, Guertin L, Ayad T, Christopoulos A, Bissada E, Alizadeh M, Bélair M, Nguyen-Tan PF. Phase II study of de-intensified intensity-modulated radiotherapy and concurrent carboplatin/5-fluorouracil in lateralized p16-associated oropharyngeal carcinoma. Head Neck 2020; 42:3479-3489. [PMID: 32866313 DOI: 10.1002/hed.26401] [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: 11/11/2019] [Revised: 06/16/2020] [Accepted: 07/14/2020] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess cancer control and patient-reported outcomes (PROs) after de-intensified intensity-modulated radiotherapy (IMRT) in lateralized p16-associated oropharyngeal cancer (p16-OPC). METHODS Lateralized p16-OPC treated with radiotherapy and concurrent Carboplatin/5-fluorouracil between 2011 and 2014 were enrolled. De-intensified IMRT consisted in elective neck dose of 43.2 Gy/24 fractions and omission of contralateral retropharyngeal/level IV nodes. PROs were assessed using the EORTC QLC-C30 and QLQ-HN35 scales. RESULTS Twenty-nine patients were included. Median follow-up was 44 months. As per AJCC 7th Ed, 7%, 83% and 10% of patients had stage III, IVa and IVb. 5-year locoregional control and overall survival rates were 100% and 100%, respectively. Rates of acute were 52% and 35%, respectively. At 2 years post-treatment, 50% and 14% of patients had grade 1 xerostomia and dysgueusia, respectively. Most PROs scores returned to baseline within 8 months post-treatment. CONCLUSION De-intensified IMRT was associated with excellent cancer outcomes, and rapid recovery of PROs in lateralized p16-OPC.
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Affiliation(s)
- Houda Bahig
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Louise Lambert
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Edith Filion
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Denis Soulières
- Medical Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Louis Guertin
- Otolaryngology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Tareck Ayad
- Otolaryngology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Apostolos Christopoulos
- Otolaryngology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Eric Bissada
- Otolaryngology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Moein Alizadeh
- Radiation Oncology Department, Centre Intégré de Cancérologie de la Cité de la Santé à Laval, Montreal, Québec, Canada
| | - Manon Bélair
- Radiology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Phuc Felix Nguyen-Tan
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
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Pai SI, Cohen EEW, Lin D, Fountzilas G, Kim ES, Mehlhorn H, Baste N, Clayburgh D, Lipworth L, Resteghini C, Shara N, Fujii T, Zhang J, Stokes M, Wang H, Twumasi-Ankrah P, Wildsmith S, Khaliq A, Melillo G, Shire N. SUPREME-HN: a retrospective biomarker study assessing the prognostic value of PD-L1 expression in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck. J Transl Med 2019; 17:429. [PMID: 31878938 PMCID: PMC6933901 DOI: 10.1186/s12967-019-02182-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/18/2019] [Indexed: 12/17/2022] Open
Abstract
Background Programmed cell death ligand-1 (PD-L1) expression on tumor cells (TCs) is associated with improved survival in patients with head and neck squamous cell carcinoma (HNSCC) treated with immunotherapy, although its role as a prognostic factor is controversial. This study investigates whether tumoral expression of PD-L1 is a prognostic marker in patients with recurrent and/or metastatic (R/M) HNSCC treated with standard chemotherapy. Methods This retrospective, multicenter, noninterventional study assessed PD-L1 expression on archival R/M HNSCC tissue samples using the VENTANA PD-L1 (SP263) Assay. PD-L1 high was defined as PD-L1 staining of ≥ 25% TC, with exploratory scoring at TC ≥ 10% and TC ≥ 50%. The primary objective of this study was to estimate the prognostic value of PD-L1 status in terms of overall survival (OS) in patients with R/M HNSCC. Results 412 patients (median age, 62.0 years; 79.9% male; 88.2% Caucasian) were included from 19 sites in seven countries. 132 patients (32.0%) had TC ≥ 25% PD-L1 expression; 199 patients (48.3%) and 85 patients (20.6%) had TC ≥ 10% and ≥ 50%, respectively. OS did not differ significantly across PD-L1 expression (at TC ≥ 25% cutoff median OS: 8.2 months vs TC < 25%, 10.1 months, P = 0.55) or the ≥ 10% and ≥ 50% cutoffs (at TC ≥ 10%, median OS: 9.6 months vs TC < 10%, 9.4 months, P = 0.32, and at TC ≥ 50%, median OS 7.9 vs TC < 50%, 10.0 months, P = 0.39, respectively). Conclusions PD-L1 expression, assessed using the VENTANA PD-L1 (SP263) Assay, was not prognostic of OS in patients with R/M HNSCC treated with standard of care chemotherapies. Trial registration ClinicalTrials.gov, NCT02543476. Registered September 4, 2015.
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Affiliation(s)
- Sara I Pai
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, GRJ 9-904G, Boston, MA, 02114, USA.
| | - Ezra E W Cohen
- UC San Diego Health System, Moores Cancer Center, La Jolla, CA, USA
| | - Derrick Lin
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, GRJ 9-904G, Boston, MA, 02114, USA.,Massachusetts Eye and Ear, Boston, MA, USA
| | | | - Edward S Kim
- Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Holger Mehlhorn
- Universitaetsklinikum Leipzig, Klinik und Poliklinik fur HNO-Heilkunde, Leipzig, Germany
| | - Neus Baste
- Department of Oncology, Hospital Universitari Vall d'Hebron & Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Loren Lipworth
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Nawar Shara
- MedStar Health Research Institute, Hyattsville, MD, USA
| | | | - Jun Zhang
- Baylor College of Medicine, Houston, TX, USA
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Siu LL, Even C, Mesía R, Remenar E, Daste A, Delord JP, Krauss J, Saba NF, Nabell L, Ready NE, Braña I, Kotecki N, Zandberg DP, Gilbert J, Mehanna H, Bonomi M, Jarkowski A, Melillo G, Armstrong JM, Wildsmith S, Fayette J. Safety and Efficacy of Durvalumab With or Without Tremelimumab in Patients With PD-L1-Low/Negative Recurrent or Metastatic HNSCC: The Phase 2 CONDOR Randomized Clinical Trial. JAMA Oncol 2019; 5:195-203. [PMID: 30383184 PMCID: PMC6439564 DOI: 10.1001/jamaoncol.2018.4628] [Citation(s) in RCA: 209] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Dual blockade of programmed death ligand 1 (PD-L1) and cytotoxic T-lymphocyte associated protein 4 (CTLA-4) may overcome immune checkpoint inhibition. It is unknown whether dual blockade can potentiate antitumor activity without compromising safety in patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) and low or no PD-L1 tumor cell expression. Objective To assess safety and objective response rate of durvalumab combined with tremelimumab. Design, Setting, and Participants The CONDOR study was a phase 2, randomized, open-label study of Durvalumab, Tremelimumab, and Durvalumab in Combination With Tremelimumab in Patients With R/M HNSCC. Eligibility criteria included PD-L1-low/negative disease that had progressed after 1 platinum-containing regimen in the R/M setting. Patients were randomized (N = 267) from April 15, 2015, to March 16, 2016, at 127 sites in North America, Europe, and Asia Pacific. Interventions Durvalumab (20 mg/kg every 4 weeks) + tremelimumab (1 mg/kg every 4 weeks) for 4 cycles, followed by durvalumab (10 mg/kg every 2 weeks), or durvalumab (10 mg/kg every 2 weeks) monotherapy, or tremelimumab (10 mg/kg every 4 weeks for 7 doses then every 12 weeks for 2 doses) monotherapy. Main Outcomes and Measures Safety and tolerability and efficacy measured by objective response rate. Results Among the 267 patients (220 men [82.4%]), median age (range) of patients was 61.0 (23-82) years. Grade 3/4 treatment-related adverse events occurred in 21 patients (15.8%) treated with durvalumab + tremelimumab, 8 (12.3%) treated with durvalumab, and 11 (16.9%) treated with tremelimumab. Grade 3/4 immune-mediated adverse events occurred in 8 patients (6.0%) in the combination arm only. Objective response rate (95% CI) was 7.8% (3.78%-13.79%) in the combination arm (n = 129), 9.2% (3.46%-19.02%) for durvalumab monotherapy (n = 65), and 1.6% (0.04%-8.53%) for tremelimumab monotherapy (n = 63); median overall survival (95% CI) for all patients treated was 7.6 (4.9-10.6), 6.0 (4.0-11.3), and 5.5 (3.9-7.0) months, respectively. Conclusions and Relevance In patients with R/M HNSCC and low or no PD-L1 tumor cell expression, all 3 regimens exhibited a manageable toxicity profile. Durvalumab and durvalumab + tremelimumab resulted in clinical benefit, with minimal observed difference between the two. A phase 3 study is under way. Trial Registration clinicaltrials.gov Identifier: NCT02319044.
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Affiliation(s)
- Lillian L Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Caroline Even
- Department of Head and Neck Cancer, Gustave Roussy, Villejuif, France
| | - Ricard Mesía
- Medical Oncology Department, Catalan Institute of Oncology-Badalona, University of Barcelona, IDIBELL, Barcelona, Spain
| | - Eva Remenar
- Fej-nyak Állcsont, Rekonstrukciós Plasztikai Sebészeti és Laser Sebészeti Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - Amaury Daste
- Department of Medical Oncology, Hôpital Saint André, Bordeaux, France
| | - Jean-Pierre Delord
- Département d'Oncologie Médicale, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Jürgen Krauss
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg, Germany
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Lisle Nabell
- Department of Medical Oncology, University of Alabama at Birmingham, Comprehensive Cancer Center, Birmingham
| | - Neal E Ready
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Irene Braña
- Medical Oncology Department, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Spain
| | - Nuria Kotecki
- Département de Cancérologie Cervico-Faciale, Centre de Lutte Contre le Cancer-Centre Oscar Lambret, Lille, France
| | - Dan P Zandberg
- University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Jill Gilbert
- Department of Hematology and Oncology, Henry-Joyce Cancer Clinic, Nashville, Tennessee
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, United Kingdom
| | - Marcelo Bonomi
- Department of Medical Oncology, The Ohio State University, Columbus, Ohio
| | - Anthony Jarkowski
- AstraZeneca, Gaithersburg, Maryland.,Now with Bristol-Myers Squibb, New Brunswick, New Jersey
| | | | | | - Sophie Wildsmith
- Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Jérôme Fayette
- Clinical Oncology, Cancer Center Centre Léon Bérard, University of Lyon, Lyon, France
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9
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Mizuno H, Miyai H, Yokoi A, Kobayashi T, Inabu C, Maruyama T, Ekuni D, Mizukawa N, Kariya S, Nishizaki K, Kimata Y, Morita M. Relationship Between Renal Dysfunction and Oral Mucositis in Patients Undergoing Concurrent Chemoradiotherapy for Pharyngeal Cancer: A Retrospective Cohort Study. In Vivo 2019; 33:183-189. [PMID: 30587621 DOI: 10.21873/invivo.11457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/21/2018] [Accepted: 09/28/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND/AIM The aim of this retrospective cohort study was to investigate the association between renal dysfunction (RD) and the development of oral mucositis (OM) in patients undergoing concurrent chemoradiotherapy (CCRT) for pharyngeal cancer including radiation to the oral cavity. PATIENTS AND METHODS Of 130 patients diagnosed as having pharyngeal cancer who received CCRT at the Okayama University Hospital Head and Neck Cancer Center, 44 were finally selected. RESULTS During the observation period, 24 (54.5%) patients experienced severe OM (grade 3). The Cox proportional hazards regression model demonstrated that RD (hazard ratio(HR)=2.45, 95% confidence interval(CI)=1.067-6.116, p=0.035) and nasopharynx/oropharynx as center of the irradiated area (HR=2.56, 95% CI=1.072-5.604, p=0.034) were significantly associated with the incidence of severe OM (grade 3). CONCLUSION In patients with pharyngeal cancer treated with CCRT including radiation to the oral cavity, RD at baseline can be a risk factor for developing severe OM.
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Affiliation(s)
- Hirofumi Mizuno
- Sasaki Dental Clinic, Komaki, Japan.,Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hisataka Miyai
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Aya Yokoi
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Terumasa Kobayashi
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | - Takayuki Maruyama
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Daisuke Ekuni
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuyoshi Mizukawa
- Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Hospital, Okayama, Japan
| | - Shin Kariya
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazunori Nishizaki
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihiro Kimata
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Manabu Morita
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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10
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Gao P, Gong L, Wang X. Induction chemotherapy in patients with resectable laryngeal cancer: A meta-analysis. Mol Clin Oncol 2018; 9:155-162. [PMID: 30101013 PMCID: PMC6083427 DOI: 10.3892/mco.2018.1645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/06/2018] [Indexed: 01/18/2023] Open
Abstract
Head and neck squamous cell carcinoma (SCC) ranks 6th among the most frequently diagnosed carcinomas globally. Laryngeal carcinoma is quite common, and 95% of the cases are SCCs. Since the introduction of larynx-preserving surgery, induction chemotherapy (IC) has played a substantial role. The aim of IC is to shrink or downstage primary laryngeal carcinomas, increasing the chances of complete surgical removal, particularly in cases with advanced but potentially resectable lesions. The aim of the present study was to investigate the value of IC in patients with resectable laryngeal cancer. A meta-analysis was performed of randomized controlled trials (1985-2017) investigating the effect of IC on survival, disease control, larynx-preserving surgery and disease-free survival. Engauge-Digitizer software was used to construct Kaplan-Meier curves and RevMan software was used for the analysis of the data. A total of 12 trials (4,320 patients) were included. There was no significant difference in local recurrence or locoregional control between patients receiving and those not receiving IC (P>0.05). However, the experimental group (IC) exhibited a lower propensity for distant metastasis by 11.7% (95% confidence interval: 10.3-13.3%, P=0.02) compared with the control group (no IC). Among patients with laryngeal cancer, larynx preservation was possible in those who responded well to IC, without a significant decrease in survival compared with radical surgery (P<0.05). Taking into consideration these findings, IC confers an advantage in terms of lowering the risk of distant metastasis in patients with resectable laryngeal carcinoma, and enables laryngeal preservation in responders. Moreover, IC increases the overall survival rate in patients with locally advanced but resectable LC.
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Affiliation(s)
- Pei Gao
- Department of Otolaryngology, Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Liang Gong
- Department of Otolaryngology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Xuefeng Wang
- Department of Otolaryngology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
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11
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Tiasto V, Mikhailova V, Gulaia V, Vikhareva V, Zorin B, Kalitnik A, Kagansky A. Esophageal cancer research today and tomorrow: Lessons from algae and other perspectives. AIMS GENETICS 2018; 5:75-90. [PMID: 31435514 PMCID: PMC6690251 DOI: 10.3934/genet.2018.1.75] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 03/01/2018] [Indexed: 12/16/2022]
Abstract
Esophageal cancer is an increasing concern due to poor prognosis, aggressive disease modalities, and a lack of efficient therapeutics. The two types of esophageal cancer: esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) are responsible for an estimated 450,000 annual deaths, with over 457,000 new patients diagnosed in 2015, making it the eighth most prevalent and the 10th most fatal cancer worldwide. As esophageal cancer prevalence continues to increase, and so does the pressing need for the development of new and effective strategies for the early diagnostics, prevention, and treatment of this cancer, as well for building the innovative research tools to understand the affected molecular mechanisms. This short review summarizes the current statistics and recent research of the problems and solutions related to the esophageal cancer, and offer a brief overview of its epidemiology, molecular alterations, and existing biomedical tools. We will discuss currently available research tools and discuss selected approaches we deem relevant to find new model systems and therapies for the future with the special focus on novel opportunities presented by the unique molecules found in algae, namely carbohydrates and lipids. Their remarkable chemical variability is connected to their striking structural and functional properties, which combined with the relative novelty of these compounds to cancer biology, warrants interest of the wide biomedical community to these molecules, especially in the esophageal cancer theory and practice.
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Affiliation(s)
- Vladlena Tiasto
- Centre for Genomic and Regenerative Medicine, School of Biomedicine, FEFU, 8 Sukhanova str, Vladivostok, Primorsky region, 690950, Russian Federation
| | - Valeriia Mikhailova
- Centre for Genomic and Regenerative Medicine, School of Biomedicine, FEFU, 8 Sukhanova str, Vladivostok, Primorsky region, 690950, Russian Federation
| | - Valeriia Gulaia
- Centre for Genomic and Regenerative Medicine, School of Biomedicine, FEFU, 8 Sukhanova str, Vladivostok, Primorsky region, 690950, Russian Federation
| | - Valeriia Vikhareva
- Laboratory of Pharmacology and Bioassays, School of Biomedicine, FEFU, 8 Sukhanova str, Vladivostok, Primorsky region, 690950, Russian Federation
| | - Boris Zorin
- Microalgal Biotechnology Laboratory, The French Associates Institute for Agriculture and Biotechnology for Drylands, The J. Blaustein Institutes for Desert Research, Ben-Gurion University of the Negev, Sede-Boqer Campus, Midreshet Ben-Gurion 8499000, Israel
| | - Alexandra Kalitnik
- Laboratory of Pharmacology and Bioassays, School of Biomedicine, FEFU, 8 Sukhanova str, Vladivostok, Primorsky region, 690950, Russian Federation
| | - Alexander Kagansky
- Centre for Genomic and Regenerative Medicine, School of Biomedicine, FEFU, 8 Sukhanova str, Vladivostok, Primorsky region, 690950, Russian Federation
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12
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Feng L, Qi S, Lin M. Efficacy and survival rate of intensity-modulated radiotherapy combined with chemotherapy for elderly patients with locally advanced oropharyngeal cancer. Exp Ther Med 2018; 15:2475-2479. [PMID: 29467849 PMCID: PMC5792795 DOI: 10.3892/etm.2017.5682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 12/12/2017] [Indexed: 02/02/2023] Open
Abstract
The efficacy of intensity-modulated radiotherapy (IMRT) combined with chemotherapy in the treatment of elderly patients with locally advanced oropharyngeal cancer and its effect on survival rate were studied. Elderly patients (n=150) diagnosed with locally advanced oropharyngeal cancer by histopathology were selected and randomly divided into the observation group (n=75) and the control group (n=75). Patients in the observation group were treated with IMRT combined with chemotherapy, while those in the control group were treated with conventional radiotherapy and chemotherapy. The two groups were treated with docetaxel + cisplatin (TP regimen). All patients received 1 to 2 cycles of docetaxel + cisplatin-induced chemotherapy, and after the radiotherapy began, the chemotherapy with docetaxel was synchronously conducted. The recent efficacy (tumor regression condition was observed at 3 months after the treatment), 1-year, 3-year and 5-year overall survival (OS), local-regional control (LRC), progression-free survival (PFS), disease-free survival (DFS) and the incidence rate of adverse reactions of patients in the two groups were compared. In the observation group, 73 patients completed the radiotherapy and chemotherapy, while all the patients in the control group completed the treatments. The 1-year OS of the observation group and the control group was 97.3 and 85.3%, respectively. In the observation group, the 3-year LRC, OS, PFS and DFS of the observation group was 94.5, 91.8, 90.4 and 87.7%, respectively; the 5-year LRC, OS, PFS and DFS was 64.4, 56.2, 56.2 and 54.8%, respectively. In the control group, the 3-year LRC, OS, PFS and DFS was 86.7, 73.3, 82.7 and 68.0%, respectively; the 5-year LRC, OS, PFS and DFS were 54.7, 45.3, 44.0 and 56.7%, respectively. The differences were statistically significant (P<0.05). In the observation group, the number of leukocytes was decreased, and the incidence rates of acute oropharyngeal mucosa reaction and radiation dermatitis were significantly lower than those in the control group. The differences were statistically significant (P<0.05). In conclusion, IMRT combined with chemotherapy can improve the OS and the 3-year and 5-year LRC, PFS and DFS of elderly patients with locally advanced oropharyngeal cancer, reduce toxic and side effects, and improve patients' quality of life.
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Affiliation(s)
- Li Feng
- Customer Service Management Office, Shandong University Affiliated Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
| | - Shummei Qi
- Department of Stomatology, Jinan Maternity and Child Health Care Hospital, Jinan, Shandong 250001, P.R. China
| | - Ming Lin
- Department of Stomatology, Shandong University Affiliated Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
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13
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Leduc C, Adam J, Louvet E, Sourisseau T, Dorvault N, Bernard M, Maingot E, Faivre L, Cassin-Kuo MS, Boissier E, Dessoliers MC, Robin A, Casiraghi O, Even C, Temam S, Olaussen KA, Soria JC, Postel-Vinay S. TPF induction chemotherapy increases PD-L1 expression in tumour cells and immune cells in head and neck squamous cell carcinoma. ESMO Open 2018; 3:e000257. [PMID: 29344407 PMCID: PMC5761289 DOI: 10.1136/esmoopen-2017-000257] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 01/05/2023] Open
Abstract
Background Antiprogrammed cell death-1/programmed cell death-ligand 1 (PD-1/PD-L1) therapies have demonstrated promising activity in advanced head and neck squamous cell carcinoma (HNSCC), with overall response rates of approximately 20% in unselected populations and survival benefit. Whether induction docetaxel, platinum and fluorouracil (TPF) modifies PD-L1 expression or tumour immune infiltrates is unknown. Patients and methods Patients with locally advanced HNSCC treated at Gustave Roussy (Villejuif, France) between 2006 and 2013 by induction TPF followed by surgery were retrospectively considered. Patients with paired samples (pre-TPF and post-TPF) were kept for further analysis. PD-L1 expression was quantified by immunohistochemistry according to a validated protocol. The objective of the study was to compare PD-L1 expression on tumour cells (TC) and immune cells (IC) (positivity threshold of ≥5%) before and after TPF. CD8+ and Foxp3+ lymphocytes densities before and after TPF were also quantified. Results Out of 313 patients receiving induction TPF, 86 underwent surgery; paired samples were available for 21 of them. Baseline PD-L1 expression was ≥5% in two and five samples for TC and IC, respectively. A significant increase of PD-L1 expression was observed after TPF, with 15 samples (71%) presenting a positive staining in IC after induction chemotherapy (P=0.003; Wilcoxon rank-sum test) and eight samples (38%) in TC (P=0.005; Wilcoxon rank-sum test). Tumour-infiltrating CD8+ mean densities also significantly increased post-TPF (P=0.01). There was no significant difference in Foxp3+ expression, CD8/Foxp3 ratio or correlation with outcome. Conclusion TPF induction chemotherapy in advanced HNSCC increases PD-L1 positivity on tumour-infiltrating ICs, as well as CD8+ lymphocytes density. These results warrant independent validation on larger datasets and might help therapeutic strategy in advanced HNSCC.
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Affiliation(s)
- Charlotte Leduc
- INSERM, UMR981, F-94805, Villejuif, France, Paris Sud University, Gustave Roussy, Villejuif, France.,Department of Pathology, Gustave Roussy, Villejuif, France.,Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France.,INSERM U1018, Paris Sud University, Gustave Roussy, Villejuif, France.,Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France.,Drug development unit (DITEP), Gustave Roussy Cancer Campus, Paris-Saclay University, F-94805, Villejuif, France, Gustave Roussy, France
| | - Julien Adam
- INSERM, UMR981, F-94805, Villejuif, France, Paris Sud University, Gustave Roussy, Villejuif, France.,Department of Pathology, Gustave Roussy, Villejuif, France
| | - Emilie Louvet
- INSERM, UMR981, F-94805, Villejuif, France, Paris Sud University, Gustave Roussy, Villejuif, France
| | - Tony Sourisseau
- INSERM, UMR981, F-94805, Villejuif, France, Paris Sud University, Gustave Roussy, Villejuif, France
| | - Nicolas Dorvault
- INSERM, UMR981, F-94805, Villejuif, France, Paris Sud University, Gustave Roussy, Villejuif, France
| | - Marine Bernard
- INSERM, UMR981, F-94805, Villejuif, France, Paris Sud University, Gustave Roussy, Villejuif, France
| | - Elodie Maingot
- INSERM, UMR981, F-94805, Villejuif, France, Paris Sud University, Gustave Roussy, Villejuif, France
| | - Laura Faivre
- Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France.,INSERM U1018, Paris Sud University, Gustave Roussy, Villejuif, France
| | - Mei-Shiue Cassin-Kuo
- INSERM, UMR981, F-94805, Villejuif, France, Paris Sud University, Gustave Roussy, Villejuif, France
| | - Emilie Boissier
- INSERM, UMR981, F-94805, Villejuif, France, Paris Sud University, Gustave Roussy, Villejuif, France
| | | | - Angélique Robin
- INSERM, UMR981, F-94805, Villejuif, France, Paris Sud University, Gustave Roussy, Villejuif, France
| | | | - Caroline Even
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
| | - Stéphane Temam
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
| | - Ken A Olaussen
- INSERM, UMR981, F-94805, Villejuif, France, Paris Sud University, Gustave Roussy, Villejuif, France
| | - Jean-Charles Soria
- INSERM, UMR981, F-94805, Villejuif, France, Paris Sud University, Gustave Roussy, Villejuif, France.,Drug development unit (DITEP), Gustave Roussy Cancer Campus, Paris-Saclay University, F-94805, Villejuif, France, Gustave Roussy, France
| | - Sophie Postel-Vinay
- INSERM, UMR981, F-94805, Villejuif, France, Paris Sud University, Gustave Roussy, Villejuif, France.,Drug development unit (DITEP), Gustave Roussy Cancer Campus, Paris-Saclay University, F-94805, Villejuif, France, Gustave Roussy, France
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14
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Laryngeal cancer: United Kingdom National Multidisciplinary guidelines. The Journal of Laryngology & Otology 2017; 130:S75-S82. [PMID: 27841116 PMCID: PMC4873912 DOI: 10.1017/s0022215116000487] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Significantly new data have been published on laryngeal cancer management since the last edition of the guidelines. This paper discusses the evidence base pertaining to the management of laryngeal cancer and provides updated recommendations on management for this group of patients receiving cancer care.
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15
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Arnold SM, Kudrimoti M, Dressler EV, Gleason JF, Silver NL, Regine WF, Valentino J. Using low-dose radiation to potentiate the effect of induction chemotherapy in head and neck cancer: Results of a prospective phase 2 trial. Adv Radiat Oncol 2016; 1:252-259. [PMID: 28740895 PMCID: PMC5514161 DOI: 10.1016/j.adro.2016.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 11/08/2022] Open
Abstract
Purpose Low-dose fractionated radiation therapy (LDFRT) induces effective cell killing through hyperradiation sensitivity and potentiates effects of chemotherapy. We report our second investigation of LDFRT as a potentiator of the chemotherapeutic effect of induction carboplatin and paclitaxel in locally advanced squamous cell cancer of the head and neck (SCCHN). Experimental design Two cycles of induction therapy were given every 21 days: paclitaxel (75 mg/m2) on days 1, 8, and 15; carboplatin (area under the curve 6) day 1; and LDFRT 50 cGy fractions (2 each on days 1, 2, 8, and 15). Objectives included primary site complete response rate; secondary included overall survival, progression-free survival (PFS), disease-specific survival, and toxicity. Results A total of 24 evaluable patients were enrolled. Primary sites included oropharynx (62.5%), larynx (20.8%), oral cavity (8.3%), and hypopharynx (8.3%). Grade 3/4 toxicities included neutropenia (20%), leukopenia (32%), dehydration/hypotension (8%), anemia (4%), infection (4%), pulmonary/allergic rhinitis (4%), and diarrhea (4%). Primary site response rate was 23/24 (95.8%): 15/24 (62.5%) complete response, 8/24 (33.3%) partial response, and 1/24 (4.2%) stable disease. With median follow-up of 7.75 years, 9-year rates for overall survival were 49.4% (95% confidence interval [CI], 30.5-79.9), PFS was 72.2% (CI, 55.3-94.3), and disease-specific survival was 65.4% (44.3-96.4). Conclusion Chemopotentiating LDFRT combined with paclitaxel and carboplatin is effective in SCCHN and provided an excellent median overall survival of 107.2 months, with median PFS not yet reached in this locally advanced SCCHN cohort. This compares favorably to prior investigations and caused fewer grade 3 and 4 toxicities than more intensive, 3-drug induction regimens. This trial demonstrates the innovative use of LDFRT as a potentiator of chemotherapy.
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Affiliation(s)
- Susanne M Arnold
- Department of Internal Medicine, Division of Medical Oncology, University of Kentucky, Markey Cancer Center, Lexington, Kentucky
| | - Mahesh Kudrimoti
- Department of Radiation Medicine, University of Kentucky, Markey Cancer Center, Lexington, Kentucky
| | - Emily V Dressler
- Division of Cancer Biostatistics, University of Kentucky, Markey Cancer Center, Lexington, Kentucky
| | | | | | - William F Regine
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland
| | - Joseph Valentino
- Department of Otolaryngology Head and Neck Surgery, University of Kentucky, Markey Cancer Center, Lexington, Kentucky
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16
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Chhatui B, Devleena, Roy S, Maji T, Lahiri D, Biswas J. Immunomodulated anterior chemotherapy followed by concurrent chemoradiotherapy in locally advanced tongue cancer: An Institutional experience. Indian J Med Paediatr Oncol 2015; 36:43-8. [PMID: 25810574 PMCID: PMC4363850 DOI: 10.4103/0971-5851.151782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Context: Sequential induction chemotherapy with cisplatin and 5-fluorouracil (PF) along with interferon-alpha2b and concurrent chemoradiation offers superior loco-regional control for locally advanced carcinoma of oral tongue. Aims: The study was designed to evaluate the beneficial role of induction PF chemotherapy and interferon-alpha2b followed by chemoradiation over definitive chemoradiation only for patients with locally advanced carcinoma of oral tongue. Settings and Design: Phase II randomized, prospective, open-labeled, single-institutional study. Methods and Material: Fifty patients were randomized into 2 arms. Arm A patients were treated with induction chemotherapy with PF regimen for 3 cycles and interferon alpha 2b, 3MU biweekly for 6 such followed by chemoradiation with cisplatin 30 mg/ m2/ week and external radiotherapy. Arm B patients received chemoradiation only, in the same dose schedule as in Arm A. Statistical analysis used: Chi-square test was done to find out the statistical correlation between the two arms. For plotting the disease-free survival (DFS) and overall survival (OS) for the two arms, Kaplan-Meier method was used. Results: The loco-regional response rate of patients treated with interferon containing induction chemotherapy followed by concurrent chemoradiation was superior to concurrent chemoradiation only. However the toxicities and treatment interruption were more in patients treated with induction chemotherapy. Conclusions: In locally advanced carcinoma of oral tongue, induction chemotherapy with cisplatin and 5-fluorouracil (PF) along with interferon alpha 2b followed by concurrent chemoradiation may produce superior loco-regional control with manageable toxicities that needs to be validated by more randomized trials with adequate number of patients.
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Affiliation(s)
- Bappaditya Chhatui
- Department of Radiotherapy, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Devleena
- Department of Radiotherapy, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Sanjoy Roy
- Department of Radiotherapy, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Tapas Maji
- Department of Radiotherapy, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Debarshi Lahiri
- Department of Radiotherapy, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Jaydip Biswas
- Department of Radiotherapy, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
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17
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Baer AH, Hoff BA, Srinivasan A, Galbán CJ, Mukherji SK. Feasibility analysis of the parametric response map as an early predictor of treatment efficacy in head and neck cancer. AJNR Am J Neuroradiol 2015; 36:757-62. [PMID: 25792532 DOI: 10.3174/ajnr.a4296] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/16/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE Estimating changes in the volume transfer constant, normalized area under the contrast-enhancement time curve at 60 seconds, and fractional blood plasma volume by using dynamic contrast-enhanced MR imaging may be useful in predicting tumor response to chemoradiation. We hypothesized that the parametric response map, a voxel-by-voxel analysis of quantitative dynamic contrast-enhanced MR imaging maps, predicts survival in patients with head and neck cancer. MATERIALS AND METHODS Ten patients with locoregionally advanced head and neck squamous cell carcinoma underwent definitive concurrent chemoradiation therapy. For each patient, dynamic contrast-enhanced MR imaging data were collected before and 2 weeks after treatment initiation. Change in perfusion parameters within the primary tumor volume with time was analyzed by parametric response mapping and by whole-tumor mean percentage change. Outcome was defined as overall survival. The perfusion parameter and metric most predictive of outcome were identified. Overall survival was estimated by the log-rank test and Kaplan-Meier survival curve. RESULTS The volume transfer constant and normalized area under the contrast-enhancement time curve at 60 seconds were predictive of survival both in parametric response map analysis (volume transfer constant, P = .002; normalized area under the contrast-enhancement time curve at 60 seconds, P = .02) and in the percentage change analysis (volume transfer constant, P = .04; normalized area under the contrast-enhancement time curve at 60 seconds, P = .02). Blood plasma volume predicted survival in neither analysis. CONCLUSIONS Parametric response mapping of MR perfusion biomarkers could potentially guide treatment modification in patients with predicted treatment failure. Larger studies are needed to determine whether parametric response map analysis or percentage signal change in these perfusion parameters is the stronger predictor of survival.
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Affiliation(s)
- A H Baer
- From the Department of Radiology (A.H.B., B.A.H., A.S., C.J.G.), University of Michigan Health System, Ann Arbor, Michigan
| | - B A Hoff
- From the Department of Radiology (A.H.B., B.A.H., A.S., C.J.G.), University of Michigan Health System, Ann Arbor, Michigan
| | - A Srinivasan
- From the Department of Radiology (A.H.B., B.A.H., A.S., C.J.G.), University of Michigan Health System, Ann Arbor, Michigan
| | - C J Galbán
- From the Department of Radiology (A.H.B., B.A.H., A.S., C.J.G.), University of Michigan Health System, Ann Arbor, Michigan
| | - S K Mukherji
- Department of Radiology (S.K.M.), Michigan State University, East Lansing, Michigan
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18
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Peddi P, Shi R, Nair B, Ampil F, Mills GM, Jafri SH. Cisplatin, cetuximab, and radiation in locally advanced head and neck squamous cell cancer: a retrospective review. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2015; 9:1-7. [PMID: 25628515 PMCID: PMC4283547 DOI: 10.4137/cmo.s18682] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/29/2014] [Accepted: 10/01/2014] [Indexed: 01/06/2023]
Abstract
Efficacy of cisplatin versus cetuximab with radiation in locally advanced head and neck cancer (LAHNC) was evaluated. A total of 96 patients with newly diagnosed LAHNC treated at our institution between 2006 and 2011 with concurrent radiation and cisplatin (group A, n = 45), cetuximab (group B, n = 24), or started with cisplatin but switched to cetuximab because of toxicity (group C, n = 27) were reviewed. Chi-square test, analysis of variance, and log-rank test were used for analysis. The three groups had similar baseline characteristics, except for median age, T stage, albumin levels, hemoglobin levels, performance status, and comorbidities. A complete response (CR) was seen in 77%, 17%, and 67% of patients (P < 0.001), respectively. There was no significant difference in median overall survival (OS) between groups A and C. The median OS for groups A and C was not reached (>65 months), even though it was significantly longer than median OS for group B (11.6 months; P ≤ 0.001). The 2-year OS in groups A and C is significantly higher than that in group B (70% for groups A and C, 22% for group B). There is no significant difference in progression-free survival (PFS) between groups A and C. The median PFS for these groups was not reached (>62 months), and is significantly longer than that for group B (4.3 months; P ≤ 0.001). The 2-year PFS of group A (67%) and group C (76%) was significantly longer than that of group B (20%). Cisplatin with radiation appears to be more efficacious even in suboptimal dosing than cetuximab with radiation in LAHNC but the two groups were not well matched.
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Affiliation(s)
- Prakash Peddi
- Department of Medicine, Division of Hematology/Oncology, Louisiana State University Health, Shreveport, LA, USA. ; Feist-Weiller Cancer Center, Shreveport, LA, USA
| | - Runhua Shi
- Department of Medicine, Division of Hematology/Oncology, Louisiana State University Health, Shreveport, LA, USA. ; Feist-Weiller Cancer Center, Shreveport, LA, USA
| | - Binu Nair
- Department of Medicine, Division of Hematology/Oncology, Louisiana State University Health, Shreveport, LA, USA. ; Feist-Weiller Cancer Center, Shreveport, LA, USA
| | - Fred Ampil
- Department of Medicine, Division of Hematology/Oncology, Louisiana State University Health, Shreveport, LA, USA. ; Feist-Weiller Cancer Center, Shreveport, LA, USA
| | - Glenn M Mills
- Department of Medicine, Division of Hematology/Oncology, Louisiana State University Health, Shreveport, LA, USA. ; Feist-Weiller Cancer Center, Shreveport, LA, USA
| | - Syed H Jafri
- Department of Internal Medicine, Division of Oncology, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Komatsu M, Shiono O, Taguchi T, Sakuma Y, Nishimura G, Sano D, Sakuma N, Yabuki K, Arai Y, Takahashi M, Isitoya J, Oridate N. Concurrent chemoradiotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF) in patients with locally advanced squamous cell carcinoma of the head and neck. Jpn J Clin Oncol 2014; 44:416-21. [PMID: 24688084 DOI: 10.1093/jjco/hyu026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Compared with radiotherapy alone, concurrent chemoradiotherapy significantly improves survival rates for patients with squamous cell carcinoma of the head and neck. The aim of this study was to retrospectively evaluate the efficacy, toxicity and long-term prognosis of concurrent chemoradiotherapy with docetaxel, cisplatin and 5-fluorouracil chemotherapy. METHODS A total of 140 patients were enrolled and evaluated. Patients were received two cycles of docetaxel, cisplatin and 5-fluorouracil chemotherapy (docetaxel [50 mg/m(2): Day 1], cisplatin [60 mg/m(2): Day 4] and continuous 5-fluorouracil [600 mg/m(2)/day: Days 1-5]) during definitive radiotherapy. RESULTS The overall response rate was 97.1%. The 3 and 5-year overall survival rates were 83.3 and 79.2%, respectively. The 3 and 5-year disease-specific survival rates were 84.2 and 80.0%, respectively. Among patients with laryngeal or hypopharyngeal carcinoma, the 5-year laryngectomy-free survival rate was 64.9%. CONCLUSIONS Concurrent chemoradiotherapy with docetaxel, cisplatin and 5-fluorouracil showed excellent survival and organ preservation rates for the patients with locally advanced squamous cell carcinoma of the head and neck.
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Affiliation(s)
- Masanori Komatsu
- *Department of Otorhinolaryngology and Head and Neck Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Yokohama 236-0004, Japan.
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Current attitudes of head and neck oncologists in the United Kingdom to induction chemotherapy for locally advanced head and neck cancer: A survey of centres participating in a national randomised controlled trial. Oral Oncol 2014; 50:141-6. [DOI: 10.1016/j.oraloncology.2013.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/15/2013] [Accepted: 10/17/2013] [Indexed: 11/22/2022]
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Merlano M, Mattiot VP. Future chemotherapy and radiotherapy options in head and neck cancer. Expert Rev Anticancer Ther 2014; 6:395-403. [PMID: 16503856 DOI: 10.1586/14737140.6.3.395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chemoradiation is a standard approach to advanced unresectable head and neck cancer, although the optimum combination regimen remains controversial. However, in the past few years, chemoradiation has been successfully extended from the treatment of unresectable disease to the postsurgical therapy of high-risk patients and its value as an organ preservation procedure is under evaluation. More recently, molecular-targeted therapies have emerged, which interfere with mechanisms of chemo- and radioresistance, and preliminary data are promising. Their use in the combined treatment of head and neck cancer will hopefully further improve the value of chemoradiation in the clinical setting.
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Affiliation(s)
- Marco Merlano
- Department of Clinical Oncology, S. Croce General Hospital, Via M. Coppino 26, 12100 Cuneo, Italy.
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22
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Doornaert P, Dahele M, Verbakel WFAR, Bohoudi O, Slotman BJ, Langendijk JA. The effect of induction chemotherapy on tumor volume and organ-at-risk doses in patients with locally advanced oropharyngeal cancer. Radiother Oncol 2013; 109:269-74. [PMID: 24252276 DOI: 10.1016/j.radonc.2013.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 07/18/2013] [Accepted: 07/24/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To retrospectively report changes in gross tumor volume (GTV) and organ-at-risk (OAR) doses after induction chemotherapy (IC) in oropharyngeal cancer using different contouring strategies. MATERIALS AND METHODS GTV and OARs were delineated on pre- and post-IC planning CT. Two post-IC GTV contours were made: (1) a 'consensus set' using published guidelines (GTVconsensus), and (2) 'visible set', delineating only visible post-IC GTV (GTVvisible). Pre-IC interactively optimized volumetric modulated arc therapy plans were generated. The pre-IC planning constraints served as the starting point for both post-IC plans. Results reflect pooled data from all 10 patients. RESULTS Mean reduction in volume post-IC was 24% and 47% for consensus and visible primary tumor and 57% and 60% for consensus and visible nodes. Compared to pre-IC plans, average mean OAR dose for post-IC GTVconsensus plans was significantly lower for CL parotid. For GTVvisible plans both parotids, upper/lower larynx, inferior pharyngeal constrictor and cricopharyngeal muscles were significantly lower. However reductions compared with post-IC GTVconsensus plans were modest (1.6/1.5/1.2/3.7/5.9/2.6Gy, respectively). CONCLUSION IC in patients with oropharyngeal carcinoma results in substantial reductions in GTVs. If post-IC GTVs are used, which is contrary to current consensus, statistically significant but relatively small OAR dose reductions are observed.
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Affiliation(s)
- Patricia Doornaert
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
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Abstract
Despite advances in multimodality therapies for the treatment of squamous cell carcinoma of the head and neck (SCCHN), survival rates, functional outcomes and toxicities of therapy remain poor. The recognition of the prognostic value of human papillomavirus (HPV) status, and the advent of biologically targeted therapies with potential for decreased toxicities and increased selectivity, represent significant developments in our understanding of SCCHN. Targeted agents currently approved or under investigation for SCCHN include epidermal growth factor receptor (EGFR) monoclonal antibodies (cetuximab, panitumumab, zalutumumab, nimotuzumab), EGFR tyrosine kinase inhibitors (gefitinib, erlotinib, lapatinib, afatanib, dacomitinib), vascular endothelial growth factor receptor (VEGFR) inhibitors (bevacizumab, sorafenib, sunitinib, vandetanib) and various inhibitors of other pathways and targets, including phosphatidylinositol 3' kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR), MET and insulin-like growth factor receptor (IGF-1R). On-going clinical trials are evaluating these emerging agents and their combinations in the treatment of SCCHN.
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Affiliation(s)
- Kelly Dorsey
- Robert H. Lurie Comprehensive Cancer Center and Division of Hematology/Oncology, Northwestern University, 676 N. St. Clair, Suite 850, Chicago, IL 60611, USA
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Fujii M. [Progress in chemotherapy of head and neck cancers]. NIHON JIBIINKOKA GAKKAI KAIHO 2013; 116:767-778. [PMID: 24052970 DOI: 10.3950/jibiinkoka.116.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Ma J, Liu Y, Yang X, Zhang CP, Zhang ZY, Zhong LP. Induction chemotherapy in patients with resectable head and neck squamous cell carcinoma: a meta-analysis. World J Surg Oncol 2013; 11:67. [PMID: 23497185 PMCID: PMC3601969 DOI: 10.1186/1477-7819-11-67] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 02/23/2013] [Indexed: 01/22/2023] Open
Abstract
Background Induction chemotherapy has been investigated as a possible strategy to shrink or downstage locally advanced head and neck cancers, providing opportunity to remove the lesions completely after induction chemotherapy, especially in the patients with resectable advanced disease. The aim of this study was to investigate the definitive effect of induction chemotherapy in patients with resectable head and neck squamous cell carcinoma. Methods A meta-analysis of randomized trials (1965–2011) was performed on the impact of induction chemotherapy on survival, disease control, and toxicity in this population of patients. Kaplan-Meier curves were read by Engauge-Digitizer. Data combining was performed using RevMan. Results Fourteen trials (2099 patients) were involved in this analysis. There was no significant difference on overall survival, disease free survival, or locoregional recurrence between the patients treated with and without induction chemotherapy (P >0.05). However, the patients treated with induction chemotherapy had a lower rate of distant metastasis by 8% (95% confidence interval 1%–16%, P = 0.02) than those treated without induction chemotherapy. In patients with laryngeal cancer, comparing to radical surgery, the larynx could be preserved in responders to induction chemotherapy without survival decease (P >0.05). Induction chemotherapy-associated death was 0%–5%. Conclusions Based on the results above, there is a significant benefit of induction chemotherapy on decreasing distant metastasis in patients with resectable head and neck squamous cell carcinoma. In patients with laryngeal cancer, induction chemotherapy provides larynx preservation in responders to induction chemotherapy.
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Affiliation(s)
- Jie Ma
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, No,639 Zhizaoju Rd, Shanghai, 200011, China
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Zhang XR, Liu ZM, Liu XK, Wang FH, Li Q, Li H, Li QL, Guo ZM, Zeng ZY. Influence of pathologic complete response to neoadjuvant chemotherapy on long-term survival of patients with advanced head and neck squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:218-23. [DOI: 10.1016/j.oooo.2012.09.084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 09/21/2012] [Accepted: 09/28/2012] [Indexed: 11/27/2022]
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Bhide SA, Gulliford S, Schick U, Miah A, Zaidi S, Newbold K, Nutting CM, Harrington KJ. Dose-response analysis of acute oral mucositis and pharyngeal dysphagia in patients receiving induction chemotherapy followed by concomitant chemo-IMRT for head and neck cancer. Radiother Oncol 2012; 103:88-91. [PMID: 22280809 DOI: 10.1016/j.radonc.2011.12.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 12/14/2011] [Accepted: 12/28/2011] [Indexed: 01/24/2023]
Abstract
Dose-response curves (DRCs) and the quantitative parameters describing these curves were generated for grade 3 oral mucositis and dysphagia in 144 patients using individual patient DVHs. Curve fits to the oral mucositis clinical data yielded parameter values of mean dose in 2 Gy equivalent, MD(50) = 51 Gy (95% CI 40-61), slope of the curve, k = 1(95% CI 0.6-1.5). R(2) value for the goodness of fit was 0.80. Fits to the grade 3 dysphagia clinical data yielded parameter values of MD(50) = 44.5 Gy (95% CI 36-53), k = 2.6 (95% CI 0.8-4.5). R(2) value for the goodness of fit was 0.65. This is the first study to derive DRCs in patients receiving induction chemotherapy followed by chemo-radiation (IC-C-IMRT) for head and neck cancer. The dose-response model described in this study could be useful for comparing acute mucositis rates for different dose-fractionation schedules when using IMRT for head and neck cancer.
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Tsukuda M. [New development in the treatment of head and neck cancer--with special reference to non-surgical approach. Treatment of progressive head and neck cancers for functional preservation: simultaneous chemo-radiotherapy]. NIHON JIBIINKOKA GAKKAI KAIHO 2011; 114:897-904. [PMID: 22442864 DOI: 10.3950/jibiinkoka.114.897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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PD28. Induction chemotherapy (ICT) and sequential therapy (ST) in locoregionally advanced head and neck cancer. Oral Oncol 2011. [DOI: 10.1016/j.oraloncology.2011.06.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
The addition of chemotherapy to radiotherapy in the treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN) patients improves survival. Meta-analyses of randomized trials have indicated that the benefit of this approach is associated with the timing of chemotherapy administration. It has been demonstrated that the greatest survival benefit over locoregional treatment alone is seen with the concurrent administration of chemotherapy and radiotherapy. However, sequential chemotherapy administration, in the form of induction chemotherapy followed by radiotherapy or concurrent chemoradiotherapy, has been successful as a strategy for organ function preservation in patients with potentially resectable SCCHN. In addition, a meta-analysis of trials using platinum and 5-fluorouracil (PF)-containing induction regimens demonstrated a significant survival benefit for this approach over locoregional treatment alone in locally advanced disease. In recent years, the introduction of the taxanes into induction chemotherapy has provided physicians with more active regimens. The triplet combination induction regimen of docetaxel, cisplatin, and 5-fluorouracil has been shown to be more effective in prolonging survival than the doublet PF. Current trials are testing whether the addition of induction chemotherapy to standard concomitant chemoradiotherapy is superior to concomitant chemoradiotherapy alone.
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Affiliation(s)
- Everett E Vokes
- Department of Medicine and Cancer Research Center, The University of Chicago Medical Center, Chicago, Illinois 60637, USA.
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Nemunaitis J, Nemunaitis J. Head and neck cancer: response to p53-based therapeutics. Head Neck 2011; 33:131-4. [PMID: 20222046 DOI: 10.1002/hed.21364] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Limited options are available for patients with advanced stage head and neck cancer. The p53 gene is known as the "guardian of the genome." Mutations of the p53 gene predispose to carcinogenesis. The p53 mutations are common in head and neck cancer. Replacement of p53 gene function in preclinical models demonstrates cancer regression and improved survival. Clinical data with an adenoviral based p53 gene delivery product (Advexin) supports safety and clinical response after direct intratumoral injection. We summarize p53-related therapeutics in this review.
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Byers LA, Holsinger FC, Kies MS, William WN, El-Naggar AK, Lee JJ, Hu J, Lopez A, Tran HT, Yan S, Du Z, Ang KK, Glisson BS, Raso MG, Wistuba II, Myers JN, Hong WK, Papadimitrakopoulou V, Lippman SM, Heymach JV. Serum signature of hypoxia-regulated factors is associated with progression after induction therapy in head and neck squamous cell cancer. Mol Cancer Ther 2010; 9:1755-63. [PMID: 20530716 DOI: 10.1158/1535-7163.mct-09-1047] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tumor hypoxia regulates many cytokines and angiogenic factors (CAF) and is associated with worse prognosis in head and neck squamous cell cancer (HNSCC). Serum CAF profiling may provide information regarding the biology of the host and tumor, prognosis, and response to therapy. We investigated 38 CAFs in HNSCC patients receiving induction therapy on a phase II trial of carboplatin, paclitaxel, and cetuximab. CAFs were measured by multiplex bead assay and enzyme-linked immunosorbent assay in 32 patients. Baseline and postinduction CAF levels were correlated with disease progression (PD) and human papilloma virus (HPV) status by Wilcoxon rank sum test. Baseline levels of eight hypoxia-regulated CAFs (the "high-risk signature" including vascular endothelial growth factor, interleukins 4 and 8, osteopontin, growth-related oncogene-alpha, eotaxin, granulocyte-colony stimulating factor, and stromal cell-derived factor-1alpha) were associated with subsequent PD. Elevation in >or=6 of 8 factors was strongly associated with shorter time to progression (P = 0.001) and was 73% specific and 100% sensitive for PD. Increasing growth-related oncogene-alpha from baseline to week 6 was also associated with PD. Progression-free and overall survival were shorter in patients with HPV-negative tumors (P = 0.012 and 0.046, respectively), but no individual CAF was associated with HPV status. However, among 14 HPV-negative patients, the high-risk CAF signature was seen in all 6 patients with PD, but only 2 of 14 without PD. In conclusion, serum CAF profiling, particularly in HPV-negative patients, may be useful for identifying those at highest risk for recurrence.
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Affiliation(s)
- Lauren Averett Byers
- Division of Cancer Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
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Advances in chemotherapy for head and neck cancer. Oral Oncol 2010; 46:436-8. [DOI: 10.1016/j.oraloncology.2010.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 03/04/2010] [Indexed: 11/21/2022]
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Won HS, Chun SH, Kim BS, Chung SR, Yoo IR, Jung CK, Kim YS, Sun DI, Kim MS, Kang JH. Treatment outcome of maxillary sinus cancer. Rare Tumors 2009; 1:e36. [PMID: 21139915 PMCID: PMC2994449 DOI: 10.4081/rt.2009.e36] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 09/16/2009] [Accepted: 09/17/2009] [Indexed: 11/24/2022] Open
Abstract
The standard treatment in the early stage of maxillary sinus cancer is surgical resection followed by postoperative radiation therapy. However, for locally advanced maxillary sinus cancer, a multimodality treatment approach is strongly recommended to improve the survival rate and quality of life of the patient. We determined the treatment outcomes of induction chemotherapy, concurrent chemoradiation therapy, and surgical resection for locally advanced maxillary sinus cancer. Forty-four patients with locally advanced maxillary sinus cancer, who had been treated between January 1990 and April 2008 at Kangnam St. Mary's Hospital, were retrospectively analyzed. The objective response rates were 70%, 53%, and 57% in the intra-arterial induction chemotherapy, intravenous induction chemotherapy, and concurrent chemoradiation therapy groups, respectively. The orbital preservation rates were 83%, 100%, and 75% in the intra-arterial induction chemotherapy, intravenous induction chemotherapy, and surgical resection groups, respectively. In seven of nine patients in whom the orbit could be preserved after induction chemotherapy, the primary tumors were removed completely. However, although the orbits were preserved in three patients who underwent surgical resection as a primary treatment, all three cases were confirmed to be incomplete resections. We found that active induction chemotherapy for locally advanced cancer of the maxillary sinus increased the possibility of complete resection with orbital preservation as well as tumor down-staging.
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Affiliation(s)
- Hye Sung Won
- Head and Neck Cancer Interdisciplinary Team, Departments of
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Randomized controlled phase II comparison study of concurrent chemoradiotherapy with docetaxel, cisplatin, and 5-fluorouracil versus CCRT with cisplatin, 5-fluorouracil, methotrexate and leucovorin in patients with locally advanced squamous cell carcinoma of the head and neck. Cancer Chemother Pharmacol 2009; 66:729-36. [DOI: 10.1007/s00280-009-1217-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 12/09/2009] [Indexed: 10/20/2022]
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Kies MS, Holsinger FC, Lee JJ, William WN, Glisson BS, Lin HY, Lewin JS, Ginsberg LE, Gillaspy KA, Massarelli E, Byers L, Lippman SM, Hong WK, El-Naggar AK, Garden AS, Papadimitrakopoulou V. Induction chemotherapy and cetuximab for locally advanced squamous cell carcinoma of the head and neck: results from a phase II prospective trial. J Clin Oncol 2009; 28:8-14. [PMID: 19917840 DOI: 10.1200/jco.2009.23.0425] [Citation(s) in RCA: 177] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the potential efficacy of combining cetuximab with chemotherapy in patients with advanced nodal disease, we conducted a phase II trial with induction chemotherapy (ICT) consisting of six weekly cycles of paclitaxel 135 mg/m(2) and carboplatin (area under the curve = 2) with cetuximab 400 mg/m(2) in week 1 and then 250 mg/m(2) (PCC). PATIENTS AND METHODS Forty-seven previously untreated patients (41 with oropharynx primaries; 33 men, 14 women; median age, 53 years; performance status of 0 or 1) with squamous cell carcinoma of the head and neck (SCCHN; T1-4, N2b/c/3) were treated and evaluated for clinical and radiographic response. After ICT, patients underwent risk-based local therapy, which consisted of either radiation, concomitant chemoradiotherapy, or surgery, based on tumor stage and site at diagnosis. Results After induction PCC, nine patients (19%) achieved a complete response, and 36 patients (77%) achieved a partial response. The most common grade 3 or 4 toxicity was skin rash (45%), followed by neutropenia (21%) without fever. At a median follow-up time of 33 months, locoregional or systemic disease progression was observed in six patients. The 3-year progression-free survival (PFS) and overall survival (OS) rates were 87% (95% CI, 78% to 97%) and 91% (95% CI, 84% to 99%), respectively. Human papillomavirus (HPV) 16, found in 12 (46%) of 26 biopsies, was associated with improved PFS (P = .012) and OS (P = .046). CONCLUSION ICT with weekly PCC followed by risk-based local therapy seems to be feasible, effective, and well tolerated. PFS is promising, and this sequential treatment strategy should be further investigated. Patients with HPV-positive tumors have an excellent prognosis.
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Affiliation(s)
- Merrill S Kies
- Departments of Thoracic/Head and Neck Medical Oncology, Head and Neck Surgery, Radiation Oncology, Biostatistics, Radiology, and Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
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Abstract
OBJECTIVES To discuss current clinical recommendations for treatment of squamous cell carcinoma of the head and neck (SCCHN), to identify common toxicities associated with combined chemoradiotherapy or chemotherapy alone, and describe strategies for management of the most common treatment-related toxicities. DATA SOURCES Current research, published literature, National Comprehensive Cancer Network Clinical Practice Guidelines, American Society of Clinical Oncology, and Oncology Nursing Society. CONCLUSION Advances in options for systemic therapy for SCCHN have provided hope for patients with this disease. However, effective management of these patients requires a proactive and persistent multidisciplinary treatment approach, including toxicity management. IMPLICATIONS FOR NURSING PRACTICE Careful evaluation of each patient before initiating treatment with the goals of therapy reviewed by the multidisciplinary team, the patient, and the caregivers, will allow selection of the most appropriate treatment plan. The goals of therapy should provide guidance in balancing tumor response, toxicity (both acute and late effects), survival, and quality of life.
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Barringer DA, Hutcheson KA, Sturgis EM, Kies MS, Lewin JS. Effect of induction chemotherapy on speech and swallowing function in patients with oral tongue cancer. Head Neck 2009; 31:611-7. [PMID: 19107949 DOI: 10.1002/hed.20989] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Swallowing physiology, diet, and patient-reported outcomes were evaluated after induction chemotherapy for oral tongue cancer. METHODS Fifteen of 23 patients enrolled in a phase II clinical trial of induction chemotherapy followed by surgical resection for oral tongue cancer underwent instrumental and perceptual analysis of speech and swallowing. Oropharyngeal swallow efficiency (OPSE) was calculated. Patient-reported outcomes were collected. We compared pre- and postchemotherapy results. RESULTS OPSE scores were not significantly different (p > .05) after induction chemotherapy; however, patient-reported swallowing and diet levels were significantly higher (p < .001 and p = .015, respectively). Diet levels improved from soft-chewable to full diet in most patients. Speech intelligibility did not change (p = .328). CONCLUSION It appears that induction chemotherapy has a negligible effect on speech and swallowing physiology but may provide symptomatic improvement of pain and swallowing after treatment. Further investigations are needed to corroborate these findings.
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Affiliation(s)
- Denise A Barringer
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Abstract
Despite recent advances, the prognosis of oral squamous cell carcinoma is still poor. Therapeutic options such as radiotherapy, chemotherapy, surgery and the novel treatment option gene therapy are being investigated in animal models. Diverse models have been studied to induce oral squamous cell carcinomas. The carcinogenic 4-nitroquinoline-1-oxide (4NQO) model has proven to be successful although until now it is unknown at what time point the established tumor is a representative squamous cell carcinoma and has a suitable volume for scientific treatment. For this end we applied 4NQO 3 times a week during 16 weeks and measured the volume of tumor tissue each week until the end of the experiment at 40 weeks. Concurrent histopathology at different time points up to the end of the experiment revealed that all mice bearing oral tumors were diagnosed with squamous cell carcinoma. Immunohistochemistry with markers cyclin D1 and E-cadherin revealed that the generated mouse oral tumors showed strong similarities with the described immunopathology in human oral tumors. The 4NQO model is a suitable alternative for preclinical gene therapy experiments with primary oral tumors. Future survey of therapeutic options in the carcinogenic 4NQO model should be conducted around 40 weeks after the start of the treatment.
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41
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Haugen H, Johansson KA, Ejnell H, Edström S, Mercke C. Accelerated radiotherapy for advanced laryngeal cancer. Acta Oncol 2009; 44:481-9. [PMID: 16118082 DOI: 10.1080/02841860510029950] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to evaluate a single institution's outcome for patients with advanced laryngeal cancer treated with accelerated radiotherapy (RT). Fifty-eight patients with advanced laryngeal cancer (T3/T4N0/N + M0) were treated with curative intent with accelerated RT during the period 1990-1998. Patients received radiotherapy alone or with induction chemotherapy. The 5-year local control (LC) and loco-regional control (LRC) probabilities were both 49% for T3 and 75% for T4 tumors. The 5-year disease-free survival probability was 46% and 68% and overall survival probability was 30% and 39% for T3 and T4 tumors respectively. No significant statistical difference in outcome was found, either between T3 and T4 tumors, or between patients who received induction chemotherapy and those who did not. The treatment results for advanced laryngeal cancer at this institution were comparable to those reported in the literature. The results for T3 and T4 were similar. T4 classification alone should not be an exclusion criterion for larynx preservation. Overall survival was poor, partly because of a high incidence of deaths from intercurrent diseases.
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Affiliation(s)
- Hedda Haugen
- Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden
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42
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Ho KF, Swindell R, Brammer CV. Dose intensity comparison between weekly and 3-weekly Cisplatin delivered concurrently with radical radiotherapy for head and neck cancer: a retrospective comparison from New Cross Hospital, Wolverhampton, UK. Acta Oncol 2009; 47:1513-8. [PMID: 18607863 DOI: 10.1080/02841860701846160] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS In this retrospective comparison, we describe the differences in dose intensity, delays and toxicity between weekly Cisplatin and 3-weekly Cisplatin given concurrently to patients with locally advanced squamous head and neck cancer (SCCHN) at New Cross Hospital, Wolverhampton. MATERIALS AND METHODS Fifty-one patients received radical Cisplatin based chemoradiotherapy for stage 4a SCCHN of the head and neck between September 2000 and December 2004. Twenty-seven patients were treated with 3-weekly inpatient Cisplatin for 3 cycles (20 patients-80 mg/m(2); 7 patients-100 mg/m(2)) concomitantly with radiotherapy (66-70 Gy/33-35 fractions). Twenty-four patients received a similar radiotherapy schedule but received weekly Cisplatin 33-40 mg/m(2). RESULTS More patients received a higher cumulative dose of at least 240 mg/m(2) if given weekly Cisplatin 40 mg/m(2) or 3-weekly Cisplatin 80 mg/m(2) compared with those receiving Cisplatin 3-weekly 100 mg/m(2) (p=0.04). Maximum cumulative dose achievable in the latter group was only 200 mg/m(2) and none achieved the full 3 cycles. Mean Cisplatin dose in the weekly Cisplatin 40 mg/m(2) regime (mean 202 mg/m(2)) and 3-weekly arm of 80 mg/m(2) (mean 203 mg/m(2)) was higher than that reached if given 3-weekly Cisplatin 100 mg/m(2) (mean 180 mg/m(2)) although statistically insignificant (p=0.39) due to the small number of patients. More delays (29% vs. 41%) and omission of chemotherapy (5.6% vs. 17.4%) occurred in the 3-weekly compared with the weekly regime. Toxicity, radiotherapy overall treatment time and delays were similar between the two groups. CONCLUSION Delivery of 100 mg/m(2) Cisplatin 3-weekly with radiotherapy was less tolerated than 40 mg/m(2) weekly and resulted in less patients achieving cumulative dose beyond 200 mg/m(2), potentially lowering chemotherapy dose intensity.
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43
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Salama JK, Haddad RI, Kies MS, Busse PM, Dong L, Brizel DM, Eisbruch A, Tishler RB, Trotti AM, Garden AS. Clinical practice guidance for radiotherapy planning after induction chemotherapy in locoregionally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2009; 75:725-33. [PMID: 19362781 DOI: 10.1016/j.ijrobp.2008.11.059] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 11/14/2008] [Accepted: 11/21/2008] [Indexed: 11/29/2022]
Abstract
PURPOSE The use of induction chemotherapy (IC) for locoregionally advanced head-and-neck cancer is increasing. The response to IC often causes significant alterations in tumor volume and location and shifts in normal anatomy. Proper determination of the radiotherapy (RT) targets after IC becomes challenging, especially with the use of conformal and precision RT techniques. Therefore, a consensus conference was convened to discuss issues related to RT planning and coordination of care for patients receiving IC. METHODS AND MATERIALS Ten participants with special expertise in the various aspects of integration of IC and RT for the treatment of locoregionally advanced head-and-neck cancer, including radiation oncologists, medical oncologists, and a medical physicist, participated. The individual members were assigned topics for focused, didactic presentations. Discussion was encouraged after each presentation, and recommendations were formulated. RESULTS Recommendations and guidelines emerged that emphasize up-front evaluation by all members of the head-and-neck management team, high-quality baseline and postinduction planning scans with the patient in the treatment position, the use of preinduction target volumes, and the use of full-dose RT, even in the face of a complete response. CONCLUSION A multidisciplinary approach is strongly encouraged. Although these recommendations were provided primarily for patients treated with IC, many of these same principles apply to concurrent chemoradiotherapy without IC. A rapid response during RT is quite common, requiring the development of two or more plans in a sizeable fraction of patients, and suggesting the need for similar guidance in the rapidly evolving area of adaptive RT.
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Affiliation(s)
- Joseph K Salama
- Department of Radiationand Cellular Oncology, University of Chicago, 5758 S. Maryland Ave., Chicago, IL 60637, USA.
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44
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Induction chemotherapy in locally advanced head and neck cancer: a new standard of care? Hematol Oncol Clin North Am 2009; 22:1155-63, viii. [PMID: 19010265 DOI: 10.1016/j.hoc.2008.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Locally advanced squamous cell cancer of the head and neck is a major contributor to morbidity and mortality worldwide. Despite progress through the use of multimodality treatment involving surgery, radiotherapy, and chemotherapy in recent years, the survival remains poor, and treatment-related morbidity-mainly caused by radiation-induced effects such as soft tissue scarring, esophageal stenosis, xerostomia, dental decay, and osteoradionecrosis-is a major problem in long-term survivors. Data from early trials and encouraging results from meta-analyses have revived interest in the use of neoadjuvant or induction chemotherapy before definitive local treatment. Recent randomized trials have demonstrated marked improvements in survival with the addition of the taxane docetaxel (Taxotere) to the traditional induction regimen consisting of cisplatin and 5FU (TPF) compared with cisplatin and 5FU (PF) alone and have established a new standard of care. The newer TPF induction chemotherapy regimens also appear to be tolerated better than PF when accompanied by adequate supportive measures. Studies to enhance the efficacy of TPF induction chemotherapy by adding new targeted agents, such as the EGF-R inhibitors cetuximab and panitumumab, are underway.
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45
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Bhide SA, Ahmed M, Rengarajan V, Powell C, Miah A, Newbold K, Nutting CM, Harrington KJ. Anemia During Sequential Induction Chemotherapy and Chemoradiation for Head and Neck Cancer: The Impact of Blood Transfusion on Treatment Outcome. Int J Radiat Oncol Biol Phys 2009; 73:391-8. [DOI: 10.1016/j.ijrobp.2008.04.052] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 04/07/2008] [Accepted: 04/11/2008] [Indexed: 11/30/2022]
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46
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Abstract
The intensification of radiation, induction chemotherapy, and concomitant chemoradiotherapy has been extensively investigated over the past 2 decades for the nonsurgical management of locally advanced, nonmetastatic squamous cell head and neck cancer (HNC). Concurrent chemoradiation has emerged as the standard of care, with the majority of its benefit resulting from improvements in locoregional disease control. Distant failure has become a more prominent problem in conjunction with these improvements. Concurrent chemotherapy provides suboptimal adjuvant treatment for distant disease. Multiagent induction chemotherapy holds more promise especially with the use of taxane-based regimens. Induction chemotherapy followed by concurrent chemoradiation (sequential chemoradiation) is now under investigation. The rationale and evidence supporting the choice to use or not to use a sequential program are discussed.
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Affiliation(s)
- David M Brizel
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
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47
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Hu K, Harrison LB. Cancer of the Oral Cavity and Oropharynx. Radiat Oncol 2008. [DOI: 10.1007/978-3-540-77385-6_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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48
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Giralt J, Benavente S. Controversies surrounding the use of neoadjuvant chemotherapy in locally advanced head and neck cancer. Expert Rev Anticancer Ther 2008; 8:1359-63. [PMID: 18759687 DOI: 10.1586/14737140.8.9.1359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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49
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Bernier J, Vrieling C. Docetaxel in the management of patients with head and neck squamous cell carcinoma. Expert Rev Anticancer Ther 2008; 8:1023-32. [PMID: 18588449 DOI: 10.1586/14737140.8.7.1023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The taxanes play a significant role in the treatment of various solid tumors of epithelial origin. Docetaxel is the most extensively studied taxane in prospective head and neck cancer trials and has been investigated as induction chemotherapy or in combination with radiotherapy in locally advanced squamous cell carcinomas of the head and neck (HNSCC) and as palliation in recurrent or metastatic disease. The data in locally advanced disease are particularly compelling. Three recently reported randomized trials, carried out in patients with locally advanced disease who were receiving induction chemotherapy followed by radiotherapy or chemoradiotherapy, demonstrated that adding docetaxel to the standard induction regimen of cisplatin/5-fluorouracil (PF) significantly improved survival compared with PF alone, without significantly increasing toxicity. On the basis of these trials, docetaxel/PF (TPF) has become the current standard induction regimen and TPF-based sequential therapy can be considered a standard treatment alternative to chemoradiotherapy alone in patients with locally advanced HNSCC. This review article discusses the current developments of docetaxel-based chemotherapy and the optimal use of this agent in patients with HNSCC.
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Affiliation(s)
- Jacques Bernier
- Genolier Swiss Medical Network, Department of Radio-Oncology, CH-1272 Genolier, Switzerland.
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50
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Posner M, Vermorken JB. Induction therapy in the modern era of combined-modality therapy for locally advanced head and neck cancer. Semin Oncol 2008; 35:221-8. [PMID: 18544437 DOI: 10.1053/j.seminoncol.2008.03.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As therapy for locoregionally advanced head and neck cancer (HNC) has evolved, treatment has become increasingly aggressive and cure rates have risen. However, survival still remains poor. The evolving standard of care has focused on the concurrent use of chemotherapy with more aggressive radiotherapy; however, patients continue to recur locally and/or regionally, albeit at a diminished rate, and distant metastases have become a major site of fatal recurrence, while long-term local and acute systemic toxicities have increased. As a result of these changes in outcomes and a re-evaluation of earlier historical data by meta-analyses, interest in cisplatin and 5-fluorouracil (PF) induction chemotherapy has re-emerged and evolved. Most recently randomized studies comparing PF with PF plus a taxane, in particular docetaxel (TPF regimen), have demonstrated markedly superior survival with the three-drug regimens. TPF is now considered the standard of care for induction chemotherapy. Induction chemotherapy followed by chemoradiotherapy, known as sequential therapy, has been shown to be safe and effective. This approach is promising and may have a survival advantage over chemoradiotherapy alone. Both TPF induction and sequential therapy are considered appropriate platforms upon which the new molecularly targeted agents can be tested.
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Affiliation(s)
- Marshall Posner
- Head and Neck Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.
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