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Weiss J, Gilbert J, Deal AM, Weissler M, Hilliard C, Chera B, Murphy B, Hackman T, Liao JJ, Grilley Olson J, Hayes DN. Induction chemotherapy with carboplatin, nab-paclitaxel and cetuximab for at least N2b nodal status or surgically unresectable squamous cell carcinoma of the head and neck. Oral Oncol 2018; 84:46-51. [DOI: 10.1016/j.oraloncology.2018.06.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/21/2018] [Accepted: 06/30/2018] [Indexed: 01/04/2023]
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Grover S, Mitra N, Wan F, Lukens JN, Sharma S, Bauman J, Masroor F, Cohen RB, Desai A, Algazy K, Alonso-Basanta M, Ahn P, Kevin Teo BK, Chalian AA, Weinstein GS, O'Malley BW, Lin A. A Single-institution Comparison of Cetuximab, Carboplatin, and Paclitaxel Induction Chemotherapy Followed by Chemoradiation (CRT) Versus CRT for Locally Advanced Squamous Cell Carcinoma of the Head and Neck (LA-SCCHN). Am J Clin Oncol 2017; 39:522-7. [PMID: 27441910 DOI: 10.1097/coc.0000000000000085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Comparisons of induction chemotherapy (IC) against upfront chemoradiation (CRT) for locally advanced head and neck cancer (LA-HNSCC) have demonstrated no differences except greater toxicity with IC. Effective induction regimens that are less toxic are therefore warranted. To inform future efforts with IC, we present our institutional experience comparing a less toxic IC regimen to CRT. METHODS We included patients with LA-HNSCC treated with organ-preservation CRT (+/-induction) between 2008 and 2011. Patients were of age above 18 years, ECOG performance status 0-1, and had minimum 6 months follow-up. IC consisted of 8 weekly cycles of cetuximab, carboplatin, and paclitaxel followed by CRT. The CRT regimen was platinum based, with cetuximab reserved for patients contraindicated to receive platinum. RESULTS Of 118 patients, 24 (20%) received IC and 94 (80%) received CRT. Median follow-up was 17 (IC) and 19 (CRT) months (P=0.05). There were no differences in toxicity between the groups. IC patients were more likely male, with more advanced tumor and nodal stage. Even when controlling for these factors, IC was still associated with worse locoregional control (HR=3.6, P=0.02), distant metastasis-free survival (HR=5.3, P=0.02), and overall survival (HR=5.1, P<0.01). CONCLUSIONS IC patients had greater disease burden than those receiving CRT. IC was well tolerated, but with significant rates of locoregional and systemic failures. Given the retrospective nature of the study, our findings are not meant to be definitive or conclusive, but rather suggestive in directing future efforts with IC. For now, we favor CRT as the standard option for treatment of inoperable LA-HNSCC.
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Affiliation(s)
- Surbhi Grover
- Departments of *Radiation Oncology †Biostatistics and Epidemiology ‡Internal Medicine §Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
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Fujii M. Recent multidisciplinary approach with molecular targeted drugs for advanced head and neck cancer. Int J Clin Oncol 2014; 19:220-9. [DOI: 10.1007/s10147-014-0671-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Indexed: 11/25/2022]
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Argiris A. Current status and future directions in induction chemotherapy for head and neck cancer. Crit Rev Oncol Hematol 2013; 88:57-74. [DOI: 10.1016/j.critrevonc.2013.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 01/22/2013] [Accepted: 03/05/2013] [Indexed: 02/06/2023] Open
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Posner MR. Integrating systemic agents into multimodality treatment of locally advanced head and neck cancer. Ann Oncol 2011; 21 Suppl 7:vii246-51. [PMID: 20943623 DOI: 10.1093/annonc/mdq291] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although highly debated in the 1980s, randomized clinical trials have provided undeniable evidence that systemic chemotherapy, as part of a multimodality treatment collaboration, is effective in improving survival, organ preservation and local-regional control in locally advanced head and neck cancer (HNC). We are entering an exciting period in which new chemotherapy agents, new paradigms of treatment, new surgical and radiation technology, and new prognostic factors are rapidly becoming available. Information on how to integrate these new tools and on how they affect long-term outcomes are lacking, making decision making and treatment planning more difficult. With unprecedented survival and the changing demographics of HNC we must now consider long-term consequences in addition to survival and local and regional control as important factors in therapeutic decision making. The availability of different treatment plans that incorporate systemic chemotherapy, radiotherapy and surgery give us many tools with which to craft a treatment for each individual patient. Today, in this exciting and chaotic period, a multidisciplinary and collaborative approach for each HNC patient at the start of decision making and planning is a necessity and the absolute standard of medical treatment for excellent patient care.
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Affiliation(s)
- M R Posner
- Mount Sinai School of Medicine, Mount Sinai Medical Center, Tisch Cancer Institute, New York, NY 10029-6574, USA.
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Argiris A, Heron DE, Smith RP, Kim S, Gibson MK, Lai SY, Branstetter BF, Posluszny DM, Wang L, Seethala RR, Dacic S, Gooding W, Grandis JR, Johnson JT, Ferris RL. Induction docetaxel, cisplatin, and cetuximab followed by concurrent radiotherapy, cisplatin, and cetuximab and maintenance cetuximab in patients with locally advanced head and neck cancer. J Clin Oncol 2010; 28:5294-300. [PMID: 21079141 DOI: 10.1200/jco.2010.30.6423] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE We incorporated cetuximab, a chimeric monoclonal antibody against the epidermal growth factor receptor (EGFR), into the induction therapy and subsequent chemoradiotherapy of head and neck cancer (HNC). PATIENTS AND METHODS Patients with locally advanced HNC, including squamous and undifferentiated histologies, were treated with docetaxel 75 mg/m2 day 1, cisplatin 75 mg/m2 day 1, and cetuximab 250 mg/m2 days 1, 8, and 15 (after an initial loading dose of 400 mg/m2), termed TPE, repeated every 21 days for three cycles, followed by radiotherapy with concurrent cisplatin 30 mg/m2 and cetuximab weekly (XPE), and maintenance cetuximab for 6 months. Quality of life (QOL) was assessed using Functional Assessment of Cancer Therapy-Head and Neck. In situ hybridization (ISH) for human papillomavirus (HPV), immunohistochemistry for p16, and fluorescence ISH for EGFR gene copy number were performed on tissue microarrays. RESULTS Of 39 enrolled patients, 36 had stage IV disease and 23 an oropharyngeal primary. Acute toxicities during TPE included neutropenic fever (10%) and during XPE, grade 3 or 4 oral mucositis (54%) and hypomagnesemia (39%). With a median follow-up of 36 months, 3-year progression-free survival and overall survival were 70% and 74%, respectively. Eight patients progressed in locoregional sites, three in distant, and one in both. HPV positivity was not associated with treatment efficacy. No progression-free patient remained G-tube dependent. The H&N subscale QOL scores showed a significant decrement at 3 months after XPE, which normalized at 1 year. CONCLUSION This cetuximab-containing regimen resulted in excellent long-term survival and safety, and warrants further evaluation in both HPV-positive and -negative HNC.
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Affiliation(s)
- Athanassios Argiris
- University of Pittsburgh Medical Center Cancer Pavilion, 5th Floor, Pittsburgh, PA 15232, USA.
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Cassell A, Grandis JR. Investigational EGFR-targeted therapy in head and neck squamous cell carcinoma. Expert Opin Investig Drugs 2010; 19:709-22. [PMID: 20415598 DOI: 10.1517/13543781003769844] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
IMPORTANCE OF THE FIELD EGFR is an established therapeutic target in head and neck squamous cell carcinoma (HNSCC). The EGFR-targeting monoclonal antibody cetuximab (Erbitux, Imclone Systems, Inc., Branchburg, USA) was FDA-approved for use in HNSCC in 2006. The molecular basis for the efficacy of an antibody approach compared with inhibition of EGFR tyrosine kinase function using small-molecule inhibitors, or downregulation of protein expression via antisense strategies, remains incompletely understood. AREAS COVERED IN THIS REVIEW A literature search was performed to identify studies elucidating mechanisms of action of several approaches to targeting EGFR in HNSCC (monoclonal antibodies, tyrosine kinase inhibitors, antisense approaches, and ligand-toxin conjugates). WHAT THE READER WILL GAIN Monoclonal antibodies decrease tumor growth via receptor endocytosis and recruitment of host immune defenses. Tyrosine kinase inhibitors bind to the ATP binding pocket of the tyrosine kinase domain, inhibiting signaling. Antisense approaches decrease EGFR expression with high specificity, though drug delivery remains problematic. Ligand-toxin conjugates facilitate the entry of toxin and the ADP-ribosylation of the ribosome, thereby inhibiting translation. TAKE HOME MESSAGE Elucidation mechanisms by which these different strategies inhibit EGFR function may enhance the development of more effective treatments for HNSCC and enable prospective identification of individuals who will benefit from EGFR inhibition.
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Affiliation(s)
- Andre Cassell
- University of Pittsburgh School of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213, USA.
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Moon C, Chae YK, Lee J. Targeting epidermal growth factor receptor in head and neck cancer: lessons learned from cetuximab. Exp Biol Med (Maywood) 2010; 235:907-20. [DOI: 10.1258/ebm.2009.009181] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
As early detection strategies have not been successful, most patients with head and neck cancer (HNC) present with advanced (stages III and IV) disease. Oral cavity tumors are treated primarily with surgical resection and advanced tumors of the pharynx and larynx are generally treated with combined modality therapy (chemoradiation). The major advances in the management of HNC have evolved from the integration of targeted therapeutics into treatment regimens. Presently, the most important target for new therapeutic strategies in HNC is the epidermal growth factor receptor (EGFR) and so far only cetuximab, a monoclonal antibody targeting EGFR, has been approved by the United States Food and Drug Administration in the HNC population as a radiation-sensitizing agent for patients undergoing primary radiation-based treatment and for patients with recurrent or metastatic disease. Other receptor and non-receptor kinase targeting strategies are under active clinical investigation as well. The increasing number of molecular targeting strategies in clinical development underscores the need to identify which HNC patients will respond to specific therapies. This article focuses on the current preclinical and clinical evidence of monoclonal antibodies targeting EGFR in HNC. We will first review the mechanisms of action of cetuximab, its clinical trials and side-effect profiles, and its present clinical application. Then, the current development status of other molecular antibodies and two molecular inhibitors, gefitinib and erlotinib, will be examined. Finally, by focusing on cetuximab, the current issues in EGFR targeting will be reviewed and we propose future directions of EGFR targeting. We hope that this review will provide further insight into the future directions of targeted therapy in the management of advanced HNC.
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Affiliation(s)
- Chulso Moon
- Graduate Program in Human Genetics
- Department of Otolaryngology – Head and Neck Surgery, The Johns Hopkins University School of Medicine
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, 1550 Orleans Street, Baltimore, MD 21231, USA
- Current address: Cleo Craig Cancer Research Program, 5002 Lee Boulevard, Lawton, OK 73505
| | - Young Kwang Chae
- Housestaff Training Program, Department of Internal Medicine, Albert Einstein Medical School, Philadelphia, PA 10461, USA
| | - Juna Lee
- Graduate Program in Human Genetics
- Department of Otolaryngology – Head and Neck Surgery, The Johns Hopkins University School of Medicine
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Bourhis J, Lefebvre JL, Vermorken JB. Cetuximab in the management of locoregionally advanced head and neck cancer: expanding the treatment options? Eur J Cancer 2010; 46:1979-89. [PMID: 20561781 DOI: 10.1016/j.ejca.2010.05.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 05/06/2010] [Accepted: 05/10/2010] [Indexed: 11/30/2022]
Abstract
The treatment of locoregionally advanced squamous cell carcinoma of the head and neck (SCCHN) has evolved in recent years as a consequence of a better understanding of the potential benefits associated with altered radiation fractionation regimens, concurrently administered chemotherapy and radiotherapy (chemoradiotherapy) and induction chemotherapy. Concurrent chemoradiotherapy is a treatment option for technically resectable disease, where functional morbidity precludes the use of surgery. Induction chemotherapy followed by radiotherapy may also be used in this setting, and has been validated for larynx preservation. Concurrent chemoradiotherapy is a standard treatment approach for medically fit patients with locoregionally advanced unresectable disease. However, the toxicity burden of additional chemotherapy in both the concurrent chemoradiotherapy and induction chemotherapy settings can have implications for treatment compliance and may impede the administration of chemotherapy and/or radiotherapy to schedule. The epidermal growth factor receptor (EGFR)-targeted IgG1 monoclonal antibody, cetuximab (Erbitux), has shown significant clinical benefits in the treatment of both locoregionally advanced and recurrent and/or metastatic SCCHN. A phase III study in locoregionally advanced disease demonstrated significant improvements in locoregional control and progression-free and overall survival with cetuximab plus radiotherapy compared with radiotherapy alone, and overall survival benefits were maintained at 5 years. The addition of cetuximab to concurrent chemoradiotherapy has been shown to be feasible in phase II trials and is being investigated in phase III trials. Preliminary evidence suggests that cetuximab could be incorporated into induction management strategies. Taken together, these data support an important role for cetuximab in the treatment paradigm for locoregionally advanced SCCHN.
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Affiliation(s)
- Jean Bourhis
- Institut Gustave Roussy, 39 rue Camille Desmoulins, Villejuif 94805, France
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Herchenhorn D, Dias FL, Viegas CMP, Federico MH, Araújo CMM, Small I, Bezerra M, Fontão K, Knust RE, Ferreira CG, Martins RG. Phase I/II study of erlotinib combined with cisplatin and radiotherapy in patients with locally advanced squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2010; 78:696-702. [PMID: 20421154 DOI: 10.1016/j.ijrobp.2009.08.079] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 08/20/2009] [Accepted: 08/20/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE Erlotinib, an oral tyrosine kinase inhibitor, is active against head-and-neck squamous cell carcinoma (HNSCC) and possibly has a synergistic interaction with chemotherapy and radiotherapy. We investigated the safety and efficacy of erlotinib added to cisplatin and radiotherapy in locally advanced HNSCC. METHODS AND MATERIALS In this Phase I/II trial 100 mg/m(2) of cisplatin was administered on Days 8, 29, and 50, and radiotherapy at 70 Gy was started on Day 8. During Phase I, the erlotinib dose was escalated (50 mg, 100 mg, and 150 mg) in consecutive cohorts of 3 patients, starting on Day 1 and continuing during radiotherapy. Dose-limiting toxicity was defined as any Grade 4 event requiring radiotherapy interruptions. Phase II was initiated 8 weeks after the last Phase I enrollment. RESULTS The study accrued 9 patients in Phase I and 28 in Phase II; all were evaluable for efficacy and safety. No dose-limiting toxicity occurred in Phase I, and the recommended Phase II dose was 150 mg. The most frequent nonhematologic toxicities were nausea/vomiting, dysphagia, stomatitis, xerostomia and in-field dermatitis, acneiform rash, and diarrhea. Of the 31 patients receiving a 150-mg daily dose of erlotinib, 23 (74%; 95% confidence interval, 56.8%-86.3%) had a complete response, 3 were disease free after salvage surgery, 4 had inoperable residual disease, and 1 died of sepsis during treatment. With a median 37 months' follow-up, the 3-year progression-free and overall survival rates were 61% and 72%, respectively. CONCLUSIONS This combination appears safe, has encouraging activity, and deserves further studies in locally advanced HNSCC.
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Affiliation(s)
- Daniel Herchenhorn
- Department of Medical Oncology, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
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Marur S, Forastiere AA. Update on role of chemotherapy in head and neck squamous cell cancer. Indian J Surg Oncol 2010; 1:85-95. [PMID: 22930623 PMCID: PMC3421005 DOI: 10.1007/s13193-010-0021-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 06/07/2010] [Indexed: 12/31/2022] Open
Abstract
Head and neck squamous cell cancer (HNSCC) is most commonly a tobacco-related disease, affecting nearly 600,000 people worldwide each year. For decades, HNSCC has been treated successfully with multimodality treatments including, surgery, radiation, and chemotherapy, though the 'perfect' treatment paradigm remains elusive. This review will discuss a number of clinical trials, comparing various combinations of chemotherapy and the settings in which they are most successful. Promising research and recent data on the combination of cytotoxic chemotherapy with new biological agents indicate chemotherapy plays a critical role in treatment of HNSCC and will only continue to improve.
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Affiliation(s)
- S. Marur
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Bunting-Blaustein CRB1 G92 1650 Orleans Street, Baltimore, MD 21231-1000 USA
| | - A. A. Forastiere
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Bunting-Blaustein CRB1 G92 1650 Orleans Street, Baltimore, MD 21231-1000 USA
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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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Haddad RI, Tishler RB, Norris C, Goguen L, Balboni TA, Costello R, Wirth L, Lorch J, Andreozzi B, Annino D, Posner MR. Phase I Study of C-TPF in Patients With Locally Advanced Squamous Cell Carcinoma of the Head and Neck. J Clin Oncol 2009; 27:4448-53. [PMID: 19704061 DOI: 10.1200/jco.2009.22.1333] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposePhase I study to determine the maximum tolerated dose (MTD) of fluorouracil (FU) in the docetaxel/cisplatin/FU (TPF) regimen when combined with cetuximab (C) for induction treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN).Patients and MethodsPatients with previously untreated SCCHN were enrolled. FU cohorts were 700, 850, and 1,000 mg/m2/d for 4 days via continuous infusion. TPF given every 3 weeks for three cycles and C was given weekly for a total of 9 weeks, starting on day 1 of TPF. All patients received chemoradiotherapy after C-TPF.ResultsA total of 30 patients were enrolled and 28 were assessable. The median age was 57 years, 92% had stage 4 disease, 71% were oropharynx, and 100% had a performance status of 0. No dose-limiting toxicity (DLT) was encountered on dose levels 1 and 2. At dose level 3 of 1000 mg/m2, one DLT was encountered and three more patients were enrolled with no DLTs. In the expansion cohort at the MTD, three DLT's were encountered. The decision was made to decrease the FU from 1,000 mg/m2to dose level 2 of 850 mg/m2. A total of 13 patients were enrolled at the MTD of 850 mg/m2. The number of average weeks that C was delivered was seven of nine planned.ConclusionC-TPF appears to be safe and feasible as given in this study. GI toxicity (mucositis, enteritis, and diarrhea) appears to be the major combined DLT. Reducing the FU in TPF to 850 mg/m2reduces GI toxicity and is the recommended phase II dose.
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Affiliation(s)
- Robert I. Haddad
- From the Department of Medical and Radiation Oncology, Dana-Farber Cancer Institute and Harvard Medical School; and the Departments of Medicine, Radiation Oncology, and Head and Neck Surgery, Brigham and Women's Hospital, Boston, MA
| | - Roy B. Tishler
- From the Department of Medical and Radiation Oncology, Dana-Farber Cancer Institute and Harvard Medical School; and the Departments of Medicine, Radiation Oncology, and Head and Neck Surgery, Brigham and Women's Hospital, Boston, MA
| | - Charles Norris
- From the Department of Medical and Radiation Oncology, Dana-Farber Cancer Institute and Harvard Medical School; and the Departments of Medicine, Radiation Oncology, and Head and Neck Surgery, Brigham and Women's Hospital, Boston, MA
| | - Laura Goguen
- From the Department of Medical and Radiation Oncology, Dana-Farber Cancer Institute and Harvard Medical School; and the Departments of Medicine, Radiation Oncology, and Head and Neck Surgery, Brigham and Women's Hospital, Boston, MA
| | - Tracy A. Balboni
- From the Department of Medical and Radiation Oncology, Dana-Farber Cancer Institute and Harvard Medical School; and the Departments of Medicine, Radiation Oncology, and Head and Neck Surgery, Brigham and Women's Hospital, Boston, MA
| | - Rosemary Costello
- From the Department of Medical and Radiation Oncology, Dana-Farber Cancer Institute and Harvard Medical School; and the Departments of Medicine, Radiation Oncology, and Head and Neck Surgery, Brigham and Women's Hospital, Boston, MA
| | - Lori Wirth
- From the Department of Medical and Radiation Oncology, Dana-Farber Cancer Institute and Harvard Medical School; and the Departments of Medicine, Radiation Oncology, and Head and Neck Surgery, Brigham and Women's Hospital, Boston, MA
| | - Jochen Lorch
- From the Department of Medical and Radiation Oncology, Dana-Farber Cancer Institute and Harvard Medical School; and the Departments of Medicine, Radiation Oncology, and Head and Neck Surgery, Brigham and Women's Hospital, Boston, MA
| | - Britta Andreozzi
- From the Department of Medical and Radiation Oncology, Dana-Farber Cancer Institute and Harvard Medical School; and the Departments of Medicine, Radiation Oncology, and Head and Neck Surgery, Brigham and Women's Hospital, Boston, MA
| | - Donald Annino
- From the Department of Medical and Radiation Oncology, Dana-Farber Cancer Institute and Harvard Medical School; and the Departments of Medicine, Radiation Oncology, and Head and Neck Surgery, Brigham and Women's Hospital, Boston, MA
| | - Marshall R. Posner
- From the Department of Medical and Radiation Oncology, Dana-Farber Cancer Institute and Harvard Medical School; and the Departments of Medicine, Radiation Oncology, and Head and Neck Surgery, Brigham and Women's Hospital, Boston, MA
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Burri RJ, Lee NY. Concurrent chemotherapy and radiotherapy for head and neck cancer. Expert Rev Anticancer Ther 2009; 9:293-302. [PMID: 19275508 DOI: 10.1586/14737140.9.3.293] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Head and neck cancer is best managed in a multidisciplinary setting. Surgery, radiation therapy, chemotherapy and, more recently, biologic therapy are often employed in various combinations in an attempt to eradicate both clinically apparent and occult disease. The goals of treatment include maximizing tumor control while maintaining function and quality of life. Most patients present with locally advanced disease, and multimodality organ-conserving therapy is often employed for these patients based on the results of multiple Phase III clinical trials. This article focuses on the rationale and evidence supporting the use of concurrent chemotherapy and radiation therapy in the management of locally advanced head and neck cancers.
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Affiliation(s)
- Ryan J Burri
- Mount Sinai School of Medicine, Department of Radiation Oncology, One Gustave L. Levy Place, Box 1236, New York, NY 10029, USA.
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Tejwani A, Wu S, Jia Y, Agulnik M, Millender L, Lacouture ME. Increased risk of high-grade dermatologic toxicities with radiation plus epidermal growth factor receptor inhibitor therapy. Cancer 2009; 115:1286-99. [PMID: 19170238 DOI: 10.1002/cncr.24120] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The addition of epidermal growth factor receptor (EGFR) inhibitors to radiotherapy has produced increased locoregional control and has reduced mortality from various solid tumors with few additional toxicities. Although anecdotal reports have suggested increased radiation dermatitis, the overall effect of these regimens on dermatologic toxicities has not been ascertained. METHODS Dermatologic toxicity data were analyzed from abstracts presented at the annual meetings of the American Society of Clinical Oncology, the American Society of Therapeutic Radiology and Oncology, Cochrane Collaboration, MEDLINE, and EMBASE databases. Phase 1, 2, and 3 trials that reported on radiation dermatitis, rash, and mucositis were included. Collaborative group, phase 3, randomized radiotherapy and chemoradiation trials served as controls. The summary incidence rate and relative risk were calculated using a random-effects or fixed-effects model, depending on the heterogeneity of included studies. RESULTS The summary incidence of high-grade radiation dermatitis in patients who received radiation plus EGFR inhibitors was 31.3% (95% confidence interval [95% CI], 17.7%-49.1%), rash in 16.1% (95% CI, 12.8%-20.1%), and mucositis occurred in 52.7% (95% CI, 38.1%-66.9%). When the combination of radiotherapy plus EGFR inhibitors was compared with radiation alone, the risk ratio for radiation dermatitis was 2.38 (95% CI, 1.8-3.2; P<.001), rash was 3.01 (95% CI, 2.0-4.6; P<.001), for mucositis it was 1.76 (95% CI, 1.5-2.0; P<.001), suggesting that there was an increased risk of dermatologic toxicities with the combined regimen. CONCLUSIONS EGFR inhibitors combined with radiation were associated with a significant increase in the risk for high-grade radiation dermatitis, rash, and mucositis. Although increased rash is expected with EGFR inhibitors, in-field dermatitis and mucositis represent new safety concerns. Improved reporting and management strategies are critical for quality of life and the optimization of radiation plus EGFR inhibitor protocols.
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Affiliation(s)
- Ajay Tejwani
- Tulane University School of Medicine, New Orleans, Louisiana, USA
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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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Brown AP, Wendler DS, Camphausen KA, Miller FG, Citrin D. Performing nondiagnostic research biopsies in irradiated tissue: a review of scientific, clinical, and ethical considerations. J Clin Oncol 2008; 26:3987-94. [PMID: 18711189 PMCID: PMC2587354 DOI: 10.1200/jco.2008.16.9896] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 04/24/2008] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Recent development of drugs that target specific pathways in tumors has increased scientific interest in studying drug effects on tumor tissue. As a result, biopsies have become an important part of many early-phase clinical trials. Performing nondiagnostic tumor biopsies raises technical and ethical concerns mostly related to the use of a potentially harmful procedure with no potential benefit to the patient. This issue is complicated by uncertainty about whether performing biopsies in irradiated fields adds significant risk. This article reviews the clinical, scientific, and ethical considerations involved in performing nondiagnostic tumor biopsies in competent adults for research purposes, with a focus on biopsies performed in the setting of therapeutic irradiation. METHODS Clinical trials that performed biopsies during or within 4 months of the completion of radiotherapy were identified with a literature review. RESULTS Twenty-nine studies with 2,160 patients were identified. Sixteen of 29 studies reported adverse events (AEs) but did not report active evaluation for biopsy complications. Ten studies did not mention AEs within the study report. At least three studies actively evaluated patients for biopsy complications. Taking this into consideration, 17 (>1%) of 2,160 patients were reported to have biopsy complications, although reporting of AEs was suboptimal in most studies. CONCLUSION Limited data suggest that biopsies can be performed in irradiated tissues without clinically significant excess risk. Ongoing and future trials including nondiagnostic research biopsies should record and report AEs related to this procedure to provide additional data on safety and toxicity.
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Affiliation(s)
- Aaron P Brown
- Radiation Oncology Branch, National Cancer Institute, 10 CRC, B2-3500, Bethesda, MD 20892, USA
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Multidisciplinary Management of Locally Advanced SCCHN: Optimizing Treatment Outcomes. Oncologist 2008; 13:899-910. [DOI: 10.1634/theoncologist.2007-0157] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Mehra R, Cohen RB, Harari PM. EGFR inhibitors for the treatment of squamous cell carcinoma of the head and neck. Curr Oncol Rep 2008; 10:176-84. [DOI: 10.1007/s11912-008-0027-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Panikkar RP, Astsaturov I, Langer CJ. The emerging role of cetuximab in head and neck cancer: a 2007 perspective. Cancer Invest 2008; 26:96-103. [PMID: 18181051 DOI: 10.1080/07357900701601002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The integration of targeted therapies into clinical practice constitutes the paradigm of oncology treatment in the current era. Cetuximab, a recombinant human/mouse chimeric epidermal growth factor (EGFR) monoclonal antibody is a targeted agent that has seen expanding indication in recent years. Originally approved for colorectal cancer, its role in the treatment of squamous cell carcinoma of the head and neck has augmented treatment options for patients who are refractory to or cannot tolerate platinum. This article will review the science underlying cetuximab, data supporting its use in patients with locally advanced and recurrent/metastatic disease, common toxicities of therapy, and the integration of this treatment with radiation therapy.
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