1
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Morimoto M, Takano M, Sato T, Makino S. Combination treatment with paclitaxel, carboplatin and cetuximab in maxillary sinus cancer: A case report. Oncol Lett 2024; 27:93. [PMID: 38288039 PMCID: PMC10823329 DOI: 10.3892/ol.2024.14226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/17/2023] [Indexed: 01/31/2024] Open
Abstract
The standard treatment for maxillary sinus cancer is surgery; however, surgery for advanced cases often leads to significant aesthetic and functional disability. Combination treatment (induction chemotherapy) with paclitaxel, carboplatin and cetuximab (PCE) can be effective in head and neck cancer. The present study describes the case of a patient with advanced maxillary sinus cancer that was successfully treated using the PCE regimen. A 69-year-old man presented to the Department of Dentistry and Oral Surgery, Hokuto Hospital (Obihiro, Japan) with left buccal swelling and an irregular mass on the left maxillary gingiva. The lesion filled the ethmoid and maxillary sinus, and destroyed the pterygoid process. Numerous lymph node metastases were suspected in the bilateral cervical region. The patient was diagnosed with left maxillary sinus cancer T4aN2cM0 and treated with PCE. The size of the tumor was markedly reduced after the initial treatment. After six cycles of PCE, bioradiotherapy (BRT; 66 Gy/33 Fr) was performed for the remaining lesion, and a complete response was achieved. Ten months after BRT, the tumor recurred in the anterior wall of the left maxillary sinus, which was treated by partial maxillary resection and split-thickness skin grafting. No local or cervical recurrence was observed 2 years after the surgery. These findings suggested that PCE could be considered as the first step for the treatment of highly advanced malignant tumors in the head and neck.
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Affiliation(s)
- Masahiro Morimoto
- Department of Oral Diagnosis and Medicine, Hokkaido University Faculty of Dental Medicine, Sapporo, Hokkaido 060-8586, Japan
| | - Masashi Takano
- Department of Dentistry and Oral Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan
| | - Takehiko Sato
- Department of Dentistry and Oral Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan
| | - Shujiroh Makino
- Department of Dentistry and Oral Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan
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2
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Li Q, Tie Y, Alu A, Ma X, Shi H. Targeted therapy for head and neck cancer: signaling pathways and clinical studies. Signal Transduct Target Ther 2023; 8:31. [PMID: 36646686 PMCID: PMC9842704 DOI: 10.1038/s41392-022-01297-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/27/2022] [Accepted: 12/13/2022] [Indexed: 01/17/2023] Open
Abstract
Head and neck cancer (HNC) is malignant, genetically complex and difficult to treat and is the sixth most frequent cancer, with tobacco, alcohol and human papillomavirus being major risk factors. Based on epigenetic data, HNC is remarkably heterogeneous, and treatment remains challenging. There is a lack of significant improvement in survival and quality of life in patients with HNC. Over half of HNC patients experience locoregional recurrence or distal metastasis despite the current multiple traditional therapeutic strategies and immunotherapy. In addition, resistance to chemotherapy, radiotherapy and some targeted therapies is common. Therefore, it is urgent to explore more effective and tolerable targeted therapies to improve the clinical outcomes of HNC patients. Recent targeted therapy studies have focused on identifying promising biomarkers and developing more effective targeted therapies. A well understanding of the pathogenesis of HNC contributes to learning more about its inner association, which provides novel insight into the development of small molecule inhibitors. In this review, we summarized the vital signaling pathways and discussed the current potential therapeutic targets against critical molecules in HNC, as well as presenting preclinical animal models and ongoing or completed clinical studies about targeted therapy, which may contribute to a more favorable prognosis of HNC. Targeted therapy in combination with other therapies and its limitations were also discussed.
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Affiliation(s)
- Qingfang Li
- grid.13291.380000 0001 0807 1581Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Tie
- grid.13291.380000 0001 0807 1581Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Aqu Alu
- grid.13291.380000 0001 0807 1581Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Huashan Shi
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
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3
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Fernandes GMDM, Serafim Junior V, Galbiatti-Dias ALS, Ferreira LAM, Castanhole-Nunes MMU, Kawasaki-Oyama RS, Maniglia JV, Pavarino EC, Goloni-Bertollo EM. Treatment effects of the EGFR pathway drugs on head and neck cancer stem cells. Am J Cancer Res 2022; 12:4196-4210. [PMID: 36225637 PMCID: PMC9548020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/18/2022] [Indexed: 06/16/2023] Open
Abstract
(1) Head and neck cancer (HNC) is the sixth most common cancer worldwide and show low survival rates and drug resistance, which can be due to the presence of cancer stem cells (CSCs), a small cell population with metastatic potential, invasion and self-renewal ability. (2) Here, seven tumor cells were sorted as CD44+/CD117+/CD133+ or ALDH+, considered as HNC stem cells (HNCSCs), and as CD44-/CD117-/CD133- or ALDH-, considered non-HNCSCs after both cells sorted criteria was compared to evaluate cell migration, invasion, and colony forming assays. These subpopulations were treated with Cetuximab, Paclitaxel, or a combination of both drugs and evaluated for cell viability. Quantitative PCR and western blot were performed to evaluate EGFR, TRKB, KRAS and HIF-1α gene and protein expression. (3) HNCSCs presented more colonies and appeared to be more sensitive to the drug combination when compared with non-HNCSCs, regardless cells sorted criteria and primary tumor subsite. The EGFR, TRKB, KRAS and HIF-1α genes and proteins were upregulated in CSCs compared with non-HNCSCs, thus explaining the drug resistance. (4) This study contributes to the better development of specific therapeutic protocols based on Cetuximab and Paclitaxel drugs in the treatment of HNC in the presence of CSCs and cell proliferation biomarkers.
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Affiliation(s)
- Glaucia Maria de Mendonça Fernandes
- Molecular Biology Department, Genetics and Molecular Biology Research Unit (UPGEM), Faculdade de Medicina de São José do Rio Preto (FAMERP)São José do Rio Preto, São Paulo, Brazil
| | - Vilson Serafim Junior
- Molecular Biology Department, Genetics and Molecular Biology Research Unit (UPGEM), Faculdade de Medicina de São José do Rio Preto (FAMERP)São José do Rio Preto, São Paulo, Brazil
| | - Ana Lívia Silva Galbiatti-Dias
- Molecular Biology Department, Genetics and Molecular Biology Research Unit (UPGEM), Faculdade de Medicina de São José do Rio Preto (FAMERP)São José do Rio Preto, São Paulo, Brazil
| | - Leticia Antunes Muniz Ferreira
- Molecular Biology Department, Genetics and Molecular Biology Research Unit (UPGEM), Faculdade de Medicina de São José do Rio Preto (FAMERP)São José do Rio Preto, São Paulo, Brazil
| | - Márcia Maria Urbanin Castanhole-Nunes
- Molecular Biology Department, Genetics and Molecular Biology Research Unit (UPGEM), Faculdade de Medicina de São José do Rio Preto (FAMERP)São José do Rio Preto, São Paulo, Brazil
| | - Rosa Sayoko Kawasaki-Oyama
- Molecular Biology Department, Genetics and Molecular Biology Research Unit (UPGEM), Faculdade de Medicina de São José do Rio Preto (FAMERP)São José do Rio Preto, São Paulo, Brazil
| | - José Victor Maniglia
- Department of Otolaryngology and Head and Neck Surgery, Faculdade de Medicina de São José do Rio Preto (FAMERP)São José do Rio Preto, São Paulo, Brazil
| | - Erika Cristina Pavarino
- Molecular Biology Department, Genetics and Molecular Biology Research Unit (UPGEM), Faculdade de Medicina de São José do Rio Preto (FAMERP)São José do Rio Preto, São Paulo, Brazil
| | - Eny Maria Goloni-Bertollo
- Molecular Biology Department, Genetics and Molecular Biology Research Unit (UPGEM), Faculdade de Medicina de São José do Rio Preto (FAMERP)São José do Rio Preto, São Paulo, Brazil
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4
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Oksen D, Prince P, Boutmy E, Garry EM, Ellers-Lenz B, Estrin A, Johne A, Verpillat P, Gatto NM. Treatment effectiveness in a rare oncology indication: Lessons from an external control cohort study. Clin Transl Sci 2022; 15:1990-1998. [PMID: 35661422 PMCID: PMC9372419 DOI: 10.1111/cts.13315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/04/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022] Open
Abstract
Real-world data (RWD) reflecting patient treatment in routine clinical practice can be used to develop external control groups for single-arm trials. External controls can provide valuable benchmark results on potential comparator drug effectiveness, particularly in rare indications when randomized controlled trials are either infeasible or unethical. This paper describes lessons learned from a descriptive real-world external control cohort study conducted to provide benchmark data for a single-arm clinical trial in a rare oncology biomarker driven disease. Conducting external control cohort studies to evaluate treatment effectiveness in rare indications likely will present with data and analysis challenges as seen in the example study. However, there are mitigating measures that can be applied in the study design, identification of RWD sources, and data analysis. The lessons learned and reported here with a proposal of an external control study framework can provide guidance for future research in this area, and may be applicable as well in other rare indications. Taking these learnings into consideration, the use of real-world external controls to contextualize treatment effectiveness in rare indications is a valuable approach and warrants further application in the future.
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Affiliation(s)
- Dina Oksen
- Global Biostatistics, Epidemiology & Medical Writing (GBEM), The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | | | - Emmanuelle Boutmy
- Global Biostatistics, Epidemiology & Medical Writing (GBEM), The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | | | - Barbara Ellers-Lenz
- Global Biostatistics, Epidemiology & Medical Writing (GBEM), The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | | | - Andreas Johne
- Global Clinical Development, The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Patrice Verpillat
- Global Biostatistics, Epidemiology & Medical Writing (GBEM), The Healthcare Business of Merck KGaA, Darmstadt, Germany
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Forman R, Deshpande H, Burtness B, Bhatia AK. Efficacy and toxicity of weekly paclitaxel, carboplatin, and cetuximab as induction chemotherapy or in cases of metastases or relapse for head and neck cancer with a focus on elderly or frail patients. Head Neck 2022; 44:1777-1786. [PMID: 35488876 DOI: 10.1002/hed.27077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/26/2022] [Accepted: 04/22/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Paclitaxel, carboplatin, and cetuximab (PCC) has shown promise as induction chemotherapy and in patients with metastatic/recurrent head and neck cancer (HNC). Given its tolerability, the regimen is used in frail and elderly patients. METHODS Software generated the cohort of adult patients with HNC treated with PCC in 2014-2019. Modified RECIST response rate (RR), progression-free survival (PFS), and overall survival (OS) were calculated for the metastatic/recurrent group, and successful induction rate and RR for the induction group. These were also calculated in the elderly/frail subset (EF): age ≥75, performance status ≥2, albumin <3.5. RESULTS Fifty-two percent of patients experienced ≥grade 3 toxicities. For metastatic/recurrent disease (N = 58), RR was 22%, mean PFS was 7.1 months. Mean OS was 15.2 months. In the induction cohort (N = 22), 86% reached their endpoint. The RR was 64%. There were no significant differences for EF. CONCLUSIONS PCC is well-tolerated with good induction success rate and reasonable PFS/OS in metastatic/recurrent disease.
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Affiliation(s)
- Rebecca Forman
- Department of Internal Medicine, Section of Medical Oncology, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Hari Deshpande
- Department of Internal Medicine, Section of Medical Oncology, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Barbara Burtness
- Department of Internal Medicine, Section of Medical Oncology, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Aarti K Bhatia
- Department of Internal Medicine, Section of Medical Oncology, Yale New Haven Hospital, New Haven, Connecticut, USA
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6
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Application of Approved Cisplatin Derivatives in Combination Therapy against Different Cancer Diseases. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27082466. [PMID: 35458666 PMCID: PMC9031877 DOI: 10.3390/molecules27082466] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 02/03/2023]
Abstract
The problems with anticancer therapy are resistance and toxicity. From 3000 Cisplatin derivatives tested as antitumor agents, most of them have been rejected, due to toxicity. The aim of current study is the comparison of therapeutic combinations of the currently applied in clinical practice: Cisplatin, Carboplatin, Oxaliplatin, Nedaplatin, Lobaplatin, Heptaplatin, and Satraplatin. The literature data show that the strategies for the development of platinum anticancer agents and bypassing of resistance to Cisplatin derivatives and their toxicity are: combination therapy, Pt IV prodrugs, the targeted nanocarriers. The very important strategy for the improvement of the antitumor effect against different cancers is synergistic combination of Cisplatin derivatives with: (1) anticancer agents—Fluorouracil, Gemcitabine, Cytarabine, Fludarabine, Pemetrexed, Ifosfamide, Irinotecan, Topotecan, Etoposide, Amrubicin, Doxorubicin, Epirubicin, Vinorelbine, Docetaxel, Paclitaxel, Nab-Paclitaxel; (2) modulators of resistant mechanisms; (3) signaling protein inhibitors—Erlotinib; Bortezomib; Everolimus; (4) and immunotherapeutic drugs—Atezolizumab, Avelumab, Bevacizumab, Cemiplimab, Cetuximab, Durvalumab, Erlotinib, Imatinib, Necitumumab, Nimotuzumab, Nivolumab, Onartuzumab, Panitumumab, Pembrolizumab, Rilotumumab, Trastuzumab, Tremelimumab, and Sintilimab. An important approach for overcoming the drug resistance and reduction of toxicity of Cisplatin derivatives is the application of nanocarriers (polymers and liposomes), which provide improved targeted delivery, increased intracellular penetration, selective accumulation in tumor tissue, and enhanced therapeutic efficacy. The advantages of combination therapy are maximum removal of tumor cells in different phases; prevention of resistance; inhibition of the adaptation of tumor cells and their mutations; and reduction of toxicity.
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7
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Sheth S, Gilbert J, Deal AM, Chera B, Murphy B, Woods J, Miller K, Weissler M, Hackman T, Liao JJ, Olson JG, Hayes DN, Weiss J. Mature follow up of induction chemotherapy with carboplatin, nab-paclitaxel, cetuximab in head and neck squamous cell carcinoma. Oral Oncol 2022; 127:105807. [DOI: 10.1016/j.oraloncology.2022.105807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/24/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
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Hu A, Zhang JW, Yang LY, Qiao PP, Lu D. AHRR contributes to inflammatory lymphangiogenesis by activating the EPAS1/VEGFD signaling axis in head and neck cancer. Am J Cancer Res 2022; 12:537-548. [PMID: 35261785 PMCID: PMC8899997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023] Open
Abstract
Lymph node metastasis (LNM) is associated with poor survival in patients with Head and Neck cancer (HNC). Aryl hydrocarbon receptor repressor (AHRR) is thought to be responsible for increased lymphangiogenesis and LNM. AHRR and endothelial PAS domain-containing protein 1 (EPAS1) are basic helix-loop-helix/per-arnt-sim family transcription factors, however, its central role in lymphangiogenesis remains to be explored. In this study, we explored that EPAS1 dimerizes with HIF-1β during lymphangiogenes and tumor growth, inducing expression of many genes, including vascular endothelial growth factor-d (VEGFD). AHRR wild-type (Ahrr +/+) transgenic carcinoma of the mice develop tumors with greater frequency than AHRR-null (Ahrr -/-) mice, even though prevalence of squamous epithelial hyperplasia is not inhibited. Hypoxia induced VEGFD protein in a genotype-dependent fashion in Ahrr +/+, Ahrr +/- and Ahrr -/- HNC. However, hypoxia induced upstream proteins in the phosphatidylinositol 3-kinase-signaling cascade to a similar extent in HNC of each Ahrr genotype, evidenced by Akt phosphorylation. These findings suggest that AHRR induces HIF-1β expression, increasing interaction with EPAS1 enhancing VEGFD production and lymphangiogenesis in HNC.
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Affiliation(s)
- An Hu
- Department of Otolaryngology-Head and Neck Surgery, Gongli Hospital, Second Military Medical UniversityPudong New Area, Shanghai 200135, China
| | - Jian-Wei Zhang
- Department of Otolaryngology-Head and Neck Surgery, Gongli Hospital, Second Military Medical UniversityPudong New Area, Shanghai 200135, China
| | - Li-Yun Yang
- Department of Otolaryngology-Head and Neck Surgery, Gongli Hospital, Second Military Medical UniversityPudong New Area, Shanghai 200135, China
| | - Pei-Pei Qiao
- Department of Otolaryngology-Head and Neck Surgery, Gongli Hospital, Second Military Medical UniversityPudong New Area, Shanghai 200135, China
- The Graduate School, Ningxia Medical UniversityYinchuan 750004, Ningxia, China
| | - Dan Lu
- Department of Otolaryngology-Head and Neck Surgery, Gongli Hospital, Second Military Medical UniversityPudong New Area, Shanghai 200135, China
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9
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Carinato H, Burgy M, Ferry R, Fischbach C, Kalish M, Guihard S, Brahimi Y, Flesch H, Bronner G, Schultz P, Frasie V, Thiéry A, Demarchi M, Petit T, Jung AC, Wagner P, Coliat P, Borel C. Weekly Paclitaxel, Carboplatin, and Cetuximab as First-Line Treatment of Recurrent and/or Metastatic Head and Neck Squamous Cell Carcinoma for Patients Ineligible to Cisplatin-Based Chemotherapy: A Retrospective Monocentric Study in 60 Patients. Front Oncol 2021; 11:714551. [PMID: 34778031 PMCID: PMC8580328 DOI: 10.3389/fonc.2021.714551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/17/2021] [Indexed: 12/02/2022] Open
Abstract
Objective For most patients suffering from recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC), chemotherapy is the main option after considering surgery and reirradiation. Cetuximab combined with a platinum-fluorouracil regimen (EXTREME) has been the standard of care for over a decade. Nevertheless, a significant number of patients remain unfit for this regimen because of age, severe comorbidities, or poor performance status. The aim of this study is to investigate an alternative regimen with sufficient efficacy and safety. Methods We reviewed retrospectively the medical charts of all patients treated with paclitaxel, carboplatin, and cetuximab (PCC) at our institution. Eligibility criteria were as follows: first-line R/M-HNSCC of the oral cavity, oropharynx, hypopharynx, or larynx not suitable for local therapy, cisplatin, and/or 5-FU ineligibility, ECOG-PS: 0–2. PCC consisted of paclitaxel 80 mg/m2, carboplatin AUC 2, and cetuximab at an initial dose of 400 mg/m2 then 250 mg/m2, for 16 weekly administrations followed by cetuximab maintenance for patients for whom a disease control was obtained. The primary endpoint was overall survival (OS), and secondary endpoints were overall response rate (ORR), progression free survival (PFS), and safety. Results We identified 60 consecutive patients treated with PCC between 2010 and 2016 at our institution. Thirty-one patients (52%) were ECOG-PS 2. Fifty-five patients (92%) were cisplatin ineligible. ORR was 43.3% (95% CI, 30.8–55.8), and disease control rate was 65% (95% CI, 52.9–77.1). With a median follow-up of 35.7 months (IQR 28.6–48.8), median PFS was 5.8 months (95% CI, 4.5–7.2), and median OS was 11.7 months (95% CI, 7.5-14.8). For ECOG-PS 0–1 patients, median OS was 14.8 months (95% CI, 12.2–21.7) while it was only 7.5 months (95%CI: 5.5-12.7) for ECOG-PS 2 patients (p < 0.04). Grades III–IV toxicities occurred in 30 patients (50%). Most toxicities were hematologic. Six patients (10%) had febrile neutropenia. Nonhematologic toxicities were reported such as cutaneous toxicities, neuropathy, infusion-related reactions, or electrolyte disorders. Conclusion The weekly PCC regimen seems to be an interesting option in cisplatin-unfit patients. This study shows favorable PFS and OS when compared with what is achieved with the EXTREME regimen and a high controlled disease rate with predictable and manageable toxicities even in the more fragile population.
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Affiliation(s)
- Hélène Carinato
- Institut de Cancérologie Strasbourg Europe, Department of Medical Oncology, Strasbourg, France
| | - Mickaël Burgy
- Institut de Cancérologie Strasbourg Europe, Department of Medical Oncology, Strasbourg, France
| | - Régine Ferry
- Centre Paul Strauss, Department of Medical Oncology, Strasbourg, France
| | - Cathie Fischbach
- Institut de Cancérologie Strasbourg Europe, Department of Medical Oncology, Strasbourg, France
| | - Michal Kalish
- Institut de Cancérologie Strasbourg Europe, Department of Medical Oncology, Strasbourg, France
| | - Sébastien Guihard
- Institut de Cancérologie Strasbourg Europe, Department of Radiation Oncology, Strasbourg, France
| | - Youssef Brahimi
- Institut de Cancérologie Strasbourg Europe, Department of Radiation Oncology, Strasbourg, France
| | - Henri Flesch
- Clinique Sainte Barbe, Head and Neck Surgery Unit, Strasbourg, France
| | - Guy Bronner
- Clinique Sainte Barbe, Head and Neck Surgery Unit, Strasbourg, France
| | - Philippe Schultz
- Hôpitaux Universitaires de Strasbourg, Department of Otorhinolaryngology and Head and Neck Surgery, Strasbourg, France
| | - Véronique Frasie
- Institut de Cancérologie Strasbourg Europe, Supportive Care Unit, Strasbourg, France
| | - Alicia Thiéry
- Institut de Cancérologie Strasbourg Europe, Department of Biostatistics, Strasbourg, France
| | - Martin Demarchi
- Institut de Cancérologie Strasbourg Europe, Department of Medical Oncology, Strasbourg, France
| | - Thierry Petit
- Institut de Cancérologie Strasbourg Europe, Department of Medical Oncology, Strasbourg, France
| | - Alain C Jung
- Institut de Cancérologie Strasbourg Europe, Laboratoire de Biologie Tumorale, Strasbourg, France.,Université de Strasbourg, Inserm, UMR_S1113, Strasbourg, France
| | - Pierre Wagner
- Centre Paul Strauss, Department of Radiology, Strasbourg, France
| | - Pierre Coliat
- Institut de Cancérologie Strasbourg Europe, Pharmacy Department, Strasbourg, France
| | - Christian Borel
- Institut de Cancérologie Strasbourg Europe, Department of Medical Oncology, Strasbourg, France
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10
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Guo TW, Saiyed F, Yao CMKL, Kiong KL, Martinez J, Sacks R, Lee JJ, Moreno AC, Frank SJ, Rosenthal DI, Glisson BS, Ferrarotto R, Mott FE, Johnson FM, Myers JN. Outcomes of patients with oropharyngeal squamous cell carcinoma treated with induction chemotherapy followed by concurrent chemoradiation compared with those treated with concurrent chemoradiation. Cancer 2021; 127:2916-2925. [PMID: 33873251 DOI: 10.1002/cncr.33491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/23/2020] [Accepted: 01/18/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Induction chemotherapy (IC) has been associated with a decreased risk of distant metastasis in locally advanced head and neck squamous cell carcinoma. However, its role in the treatment of oropharyngeal squamous cell carcinoma (OPSCC) is not well established. METHODS The outcomes of patients with OPSCC treated with IC followed by concurrent chemoradiation (CRT) were compared with the outcomes of those treated with CRT alone. The primary outcome was overall survival (OS), and the secondary end points were the times to locoregional and distant recurrence. RESULTS In an existing database, 585 patients met the inclusion criteria: 137 received IC plus CRT, and 448 received CRT. Most patients were positive for human papillomavirus (HPV; 90.9%). Patients receiving IC were more likely to present with a higher T stage, a higher N stage, and low neck disease. The 3-year OS rate was significantly lower in patients receiving IC (75.7%) versus CRT alone (92.9%). In a multicovariate analysis, receipt of IC (adjusted hazard ratio [aHR], 3.4; P < .001), HPV tumor status (aHR, 0.36; P = .002), and receipt of concurrent cetuximab (aHR, 2.7; P = .002) were independently associated with OS. The risk of distant metastasis was also significantly higher in IC patients (aHR, 2.8; P = .001), whereas an HPV-positive tumor status (aHR, 0.44; P = .032) and completion of therapy (aHR, 0.51; P = .034) were associated with a lower risk of distant metastasis. In HPV-positive patients, IC remained associated with distant metastatic progression (aHR, 2.6; P = .004) but not OS. CONCLUSIONS In contrast to prior studies, IC was independently associated with worse OS and a higher risk of distant metastasis in patients with OPSCC. Future studies are needed to validate these findings.
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Affiliation(s)
- Theresa W Guo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, California
| | - Faiez Saiyed
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Christopher M K L Yao
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kimberley L Kiong
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Julian Martinez
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ruth Sacks
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Jack Lee
- Department of Biostatistics, Division of Basic Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amy C Moreno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bonnie S Glisson
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Renata Ferrarotto
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Frank E Mott
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Faye M Johnson
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Graduate School of Biomedical Sciences, University of Texas, Houston, Texas
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Graduate School of Biomedical Sciences, University of Texas, Houston, Texas
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11
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Shirasu H, Yokota T, Kawakami T, Hamauchi S, Onozawa Y, Ogawa H, Onoe T, Mori K, Onitsuka T. Efficacy and feasibility of induction chemotherapy with paclitaxel, carboplatin and cetuximab for locally advanced unresectable head and neck cancer patients ineligible for combination treatment with docetaxel, cisplatin, and 5-fluorouracil. Int J Clin Oncol 2020; 25:1914-1920. [PMID: 32648132 DOI: 10.1007/s10147-020-01742-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/26/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Docetaxel, cisplatin, and 5-fluorouracil (TPF) induction chemotherapy (ICT) is a treatment option for locally advanced unresectable head and neck squamous cell carcinoma (LA-HNSCC). However, patients with advanced age, or renal, cardiac or neurogenic dysfunction are ineligible for ICT-TPF. METHODS We retrospectively assessed 24 unresectable LA-HNSCC patients who received paclitaxel, carboplatin and cetuximab (PCE) as ICT at the Shizuoka Cancer Center between April 2013 and October 2018. RESULTS Patient characteristics were as follows: median age, 72 years (range 60-81); 0, 1, and 2 performance status (PS), 1, 15, and 8 patients, respectively, and creatinine clearance ≥ 60 mL/min or < 60 mL/min, 8 and 16 patients, respectively. The main reasons for PCE selection were renal impairment, older age, cardiac dysfunction, poor PS, and cerebral infarction. Twenty-two patients (92%) completed two or three cycles of ICT-PCE. After ICT-PCE, one patient (4%) and 20 patients (83%) achieved a complete response and partial response, respectively. Twenty-one patients (87%) advanced to definitive locoregional treatment. Median observation period was 25.2 months. The 12-month progression-free and overall survival rates were 75 and 92%, respectively. Median progression-free survival and overall survival were 29.4 and 34.8 months, respectively. Grade 3 or 4 toxicities included neutropenia (58%), oral mucositis (8%), and febrile neutropenia (4%). CONCLUSIONS ICT-PCE may be a tolerable and potential option for unresectable LA-HNSCC patients ineligible for TPF.
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Affiliation(s)
- Hiromichi Shirasu
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho Sunto-gun, Shizuoka, 411-8777, Japan
| | - Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Takeshi Kawakami
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho Sunto-gun, Shizuoka, 411-8777, Japan
| | - Satoshi Hamauchi
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yusuke Onozawa
- Division of Medical Oncology, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Hirofumi Ogawa
- Division of Radiation Oncology and Proton Therapy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Tsuyoshi Onoe
- Division of Radiation Oncology and Proton Therapy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Keita Mori
- Clinical Research Center, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Tetsuro Onitsuka
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
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12
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An Analysis and Comparison of Survival and Functional Outcomes in Oropharyngeal Squamous Cell Carcinoma Patients Treated with Concurrent Chemoradiation Therapy within City of Hope Cancer Center Sites. J Clin Med 2020; 9:jcm9103083. [PMID: 32987866 PMCID: PMC7601157 DOI: 10.3390/jcm9103083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 12/02/2022] Open
Abstract
Oropharyngeal squamous cell carcinoma (OPSCC) is a subset of head and neck cancers that can arise due to human papillomavirus (HPV) infection. We designed a retrospective analysis to determine differences in outcomes of OPSCC patients treated at City of Hope (COH) Cancer Center’s main campus versus selected satellite sites with COH-associated faculty and facilities. Patients diagnosed with OPSCC and treated with concurrent chemoradiation therapy (n = 94) were identified and included in the study. Patients underwent treatment at the COH main campus site (n = 50) or satellite sites (n = 44). The majority of patients were Caucasian, male, and diagnosed with p16 positive stage IV locally advanced OPSCC by AJCC 7th edition. Most patients completed their prescribed cumulative radiation therapy dose and had a complete response to treatment. No significant difference in overall survival and progression-free survival was observed between the main campus and the satellite sites. Our study demonstrates successful treatment completion rates as well as comparable recurrence rates between the main campus and COH-associated satellite sites. A trend toward significant difference in feeding tube dependency at 6-months was observed. Differences in feeding tube placement and dependency rates could be addressed by the establishment of on-site supportive services in satellite sites.
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13
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Enokida T, Ogawa T, Homma A, Okami K, Minami S, Nakanome A, Shimizu Y, Maki D, Ueda Y, Fujisawa T, Motegi A, Ohkoshi A, Taguchi J, Ebisumoto K, Nomura S, Okano S, Tahara M. A multicenter phase II trial of paclitaxel, carboplatin, and cetuximab followed by chemoradiotherapy in patients with unresectable locally advanced squamous cell carcinoma of the head and neck. Cancer Med 2020; 9:1671-1682. [PMID: 31943834 PMCID: PMC7050099 DOI: 10.1002/cam4.2852] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/19/2019] [Accepted: 01/03/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Induction chemotherapy (IC) in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) often compromises compliance with subsequent chemoradiotherapy (CRT), which negatively affects outcomes. Here, we assessed the combination of paclitaxel (PTX), carboplatin (CBDCA), and cetuximab (Cmab) as IC for unresectable LA-SCCHN. METHODS Induction chemotherapy consisted of weekly CBDCA area under the plasma concentration-time curve = 1.5, PTX 80 mg/m2 and Cmab with an initial dose of 400 mg/m2 followed by 250 mg/m2 for 8 weeks. Following IC, CDDP (20 mg/m2 , 4 days × 3 cycles) and concurrent radiotherapy (70 Gy/35 fr) were started. Primary endpoint was the proportion of CRT completion (%CRT completion). PCE was planned to be deemed effective if the Bayesian posterior probability (PP), defined as the probability that %CRT completion was larger than the threshold value of 65%, exceeded 84%. RESULTS Thirty-five patients were enrolled. Cases were hypopharynx/oropharynx/larynx in 17/17/1 patients, all at Stage IV. Of 35 patients, 34 (97%) completed IC and 32 received CRT and met the criteria of full analysis set (FAS). In FAS, the %CRT completion was 96.9%, and PP was 99.9%, exceeding the prespecified boundary of 84%. Mean cumulative dose and relative to dose intensity of CDDP in CRT was 232.5 mg/m2 and 100%, respectively. Response rate was 88.6% by IC and 93.8% in the CRT phase. Three year overall survival was 83.5%. Main grade 3 toxicities included neutropenia (11.4%) and skin rash (5.7%) during IC; and oral mucositis (31.3%) and neutropenia (12.5%) during CRT. No grade 4 toxicity or treatment-related death was seen. CONCLUSIONS PCE as IC was feasible, with promising efficacy and no effect on compliance with subsequent CRT in unresectable LA-SCCHN.
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Affiliation(s)
- Tomohiro Enokida
- Department of Head and Neck Medical OncologyNational Cancer Center Hospital EastChibaJapan
| | - Takenori Ogawa
- Department of Otolaryngology – Head and Neck SurgeryTohoku University School of MedicineMiyagiJapan
| | - Akihiro Homma
- Department of Otolaryngology, Head & Neck SurgeryHokkaido University Graduate School of MedicineSapporoJapan
| | - Kenji Okami
- Department of Otolaryngology – Head Neck SurgeryTokai UniversityKanagawaJapan
| | - Shujiro Minami
- Department of OtorhinolaryngologyNational Hospital Organization Tokyo Medical CenterTokyoJapan
| | - Ayako Nakanome
- Department of Otolaryngology – Head and Neck SurgeryTohoku University School of MedicineMiyagiJapan
| | - Yasushi Shimizu
- Department of Medical OncologyHokkaido University HospitalSapporoJapan
| | - Daisuke Maki
- Department of Otolaryngology – Head Neck SurgeryTokai UniversityKanagawaJapan
| | - Yuri Ueda
- Department of Head and Neck Medical OncologyNational Cancer Center Hospital EastChibaJapan
| | - Takao Fujisawa
- Department of Head and Neck Medical OncologyNational Cancer Center Hospital EastChibaJapan
| | - Atsushi Motegi
- Division of Radiation Oncology and Particle TherapyNational Cancer Center Hospital EastChibaJapan
| | - Akira Ohkoshi
- Department of Otolaryngology – Head and Neck SurgeryTohoku University School of MedicineMiyagiJapan
| | - Jun Taguchi
- Department of Medical OncologyHokkaido University HospitalSapporoJapan
| | - Koji Ebisumoto
- Department of Otolaryngology – Head Neck SurgeryTokai UniversityKanagawaJapan
| | - Shogo Nomura
- Biostatistics DivisionCenter for Research Administration and SupportNational Cancer CenterChibaJapan
| | - Susumu Okano
- Department of Head and Neck Medical OncologyNational Cancer Center Hospital EastChibaJapan
| | - Makoto Tahara
- Department of Head and Neck Medical OncologyNational Cancer Center Hospital EastChibaJapan
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Towards risk-stratified induction regimens. Nat Rev Clin Oncol 2019; 16:209. [PMID: 30647429 DOI: 10.1038/s41571-019-0168-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Cui J, Zheng X, Yang D, Hu Y, An C, Bo Y, Li H, Zhang Y, Niu M, Xue X, Lu Y, Tang Y, Yin H, Li Z, Gao W, Wu Y. Astragali radix total flavonoid synergizes cisplatin to inhibit proliferation and enhances the chemosensitivity of laryngeal squamous cell carcinoma. RSC Adv 2019; 9:24471-24482. [PMID: 35527911 PMCID: PMC9069756 DOI: 10.1039/c9ra04701h] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 07/19/2019] [Indexed: 01/26/2023] Open
Abstract
Laryngeal squamous cell carcinoma (LSCC) is the most common head and neck cancer. Astragali radix extracts play crucial roles in the regulation of cancer progression. However, the role of Astragali radix extracts in LSCC and the related mechanisms remains unclear. Here, we evaluated the inhibitory effects of the combined use of Astragali radix total flavonoid (TFA) and cisplatin (CDDP) on an LSCC mouse model by pharmacodynamics. Ultra-high-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) was employed to define the prototype of TFA in vivo. The potential drug targets were identified through the integrative analysis of LSCC microarrays, RNA sequencing data and the main bioactive component of TFA. Furthermore, a protein–protein interaction network, compound–target network and target–pathway network were constructed based on the prototype and potential drug targets to identify the main targets and pathways. Animal experiments showed that TFA has significant synergistic antitumor activity with cisplatin and attenuates the nephrotoxicity caused by CDDP chemotherapy, improving the survival of LSCC-bearing mice. Using UPLC-MS/MS, we identified 8 constituents of TFA in experimental mice serum: formononetin, ononin, calycosin, calycosin-7-O-β-D-glucoside, 7,2′-dihydroxy-3′,4′-dimethoxyisoflavan, 7,2′-dihydroxy-3′,4′-dimethoxyisoflavaneglucoside, 3-hydroxy-9,10-dimethoxypterocarpan and 9,10-dimethoxyptercarpan-3-O-β-d-glucoside. Integrative analysis predicted 19 target genes for TFA constituents, and the target genes were mainly involved in the EGFR-related cancer signaling, metabolism and oxidative stress. Collectively, these findings highlight the role of TFA in the regulation of LSCC and provide potential targets for a high-efficiency and low-toxicity therapeutic strategy of LSCC. Astragali radix total flavonoid synergizes with cisplatin to inhibit tumorigenesis of laryngeal squamous cell carcinoma.![]()
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16
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Goepfert RP, Lewin JS, Barrow MP, Gunn GB, Fuller CD, Beadle BM, Garden AS, Rosenthal DI, Kies MS, Papadimitrakopoulou V, Lai SY, Gross ND, Schwartz DL, Hutcheson KA. Long-Term, Prospective Performance of the MD Anderson Dysphagia Inventory in "Low-Intermediate Risk" Oropharyngeal Carcinoma After Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 97:700-708. [PMID: 27485284 DOI: 10.1016/j.ijrobp.2016.06.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 05/24/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To characterize long-term MD Anderson Dysphagia Inventory (MDADI) results after primary intensity modulated radiation therapy (IMRT) for oropharyngeal carcinoma (OPC) among patients with "low-intermediate risk" OPC who would be eligible for current trials (eg, ECOG 3311, NRG HN002, CRUK PATHOS). METHODS AND MATERIALS A retrospective pooled analysis combined data from 3 single-institution clinical trials for advanced-stage head and neck carcinoma. Inclusion criteria were clinical stage III/IV OPC (T1-2/N1-2b, T3/N0-2b) treated with definitive split-field IMRT and prospectively collected MDADI at baseline and at least 1 posttreatment interval available in trial databases. Patients were sampled to represent likely human papillomavirus (HPV)-associated disease (HPV+/p16+ or <10 pack-years if HPV/p16 unknown). The MDADI composite scores were collected at baseline and 6, 12, and 24 months after treatment. Pairwise tests were Bonferroni corrected for multiple comparisons. RESULTS Forty-six patients were included. All received bilateral neck irradiation with a median dose of 70 Gy and systemic therapy (57% concurrent, 43% induction only). Overall the mean baseline MDADI composite score was 90.1, dropping to 74.6 at 6 months (P<.0001) and rising to 78.5 (P<.0001) and 83.1 (P=.002) by 12 and 24 months relative to baseline, respectively, representing a clinically meaningful drop in MDADI scores at 6 months that partially recovers by 24 months (6 vs 24 months, P=.05). Poor MDADI scores (composite <60) were reported in 4%, 11%, 15%, and 9% of patients at baseline and 6, 12, and 24 months, respectively. Fifteen percent of patients had a persistently depressed composite score by at least 20 points at the 24-month interval. CONCLUSION "Low-intermediate risk" patients with OPC treated with laryngeal/esophageal inlet dose-optimized split-field IMRT are highly likely to report recovery of acceptable swallowing function in long-term follow-up. Only 15% report poor swallowing function and/or persistently depressed MDADI at 12 months or more after IMRT. These data serve as a benchmark future trial design and endpoint interpretation.
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Affiliation(s)
- Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Martha P Barrow
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - C David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beth M Beadle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Merrill S Kies
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neil D Gross
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David L Schwartz
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Sacco AG, Worden FP. Molecularly targeted therapy for the treatment of head and neck cancer: a review of the ErbB family inhibitors. Onco Targets Ther 2016; 9:1927-43. [PMID: 27110122 PMCID: PMC4831599 DOI: 10.2147/ott.s93720] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The majority of patients with head and neck squamous cell carcinoma (HNSCC) present with locally advanced disease, which requires site-specific combinations of surgery, radiation, and chemotherapy. Despite aggressive therapy, survival outcomes remain poor, and treatment-related morbidity is not negligible. For patients with recurrent or metastatic disease, therapeutic options are further limited and prognosis is dismal. With this in mind, molecularly targeted therapy provides a promising approach to optimizing treatment efficacy while minimizing associated toxicity. The ErbB family of receptors (ie, epidermal growth factor receptor [EGFR], ErbB2/human epidermal growth factor receptor [HER]-2, ErbB3/HER3, and ErbB4/HER4) is known to contribute to oncogenic processes, such as cellular proliferation and survival. EGFR, specifically, is upregulated in more than 90% of HNSCC, has been implicated in radiation resistance, and correlates with poorer clinical outcomes. The central role of EGFR in the pathogenesis of HNSCC suggests that inhibition of this pathway represents an attractive treatment strategy. As a result, EGFR inhibition has been extensively studied, with the emergence of two classes of drug therapy: monoclonal antibodies and tyrosine kinase inhibitors. While the monoclonal antibody cetuximab is currently the only US Food and Drug Administration-approved EGFR inhibitor for the treatment of HNSCC, numerous investigational drugs are being evaluated in clinical trials. This paper will review the role of the ErbB family in the pathogenesis of HNSCC, as well as the evidence-based data for the use of ErbB family inhibition in clinical practice.
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Affiliation(s)
- Assuntina G Sacco
- Department of Internal Medicine, Division of Hematology/Oncology, University of California at San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Francis P Worden
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Health System, Ann Arbor, MI, USA
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