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Muniz IDAF, Araujo M, Bouassaly J, Farshadi F, Atique M, Esfahani K, Bonan PRF, Hier M, Mascarella M, Mlynarek A, Alaoui-Jamali M, da Silva SD. Therapeutic Advances and Challenges for the Management of HPV-Associated Oropharyngeal Cancer. Int J Mol Sci 2024; 25:4009. [PMID: 38612819 PMCID: PMC11012756 DOI: 10.3390/ijms25074009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
The use of conventional chemotherapy in conjunction with targeted and immunotherapy drugs has emerged as an option to limit the severity of side effects in patients diagnosed with head and neck cancer (HNC), particularly oropharyngeal cancer (OPC). OPC prevalence has increased exponentially in the past 30 years due to the prevalence of human papillomavirus (HPV) infection. This study reports a comprehensive review of clinical trials registered in public databases and reported in the literature (PubMed/Medline, Scopus, and ISI web of science databases). Of the 55 clinical trials identified, the majority (83.3%) were conducted after 2015, of which 77.7% were performed in the United States alone. Eight drugs have been approved by the FDA for HNC, including both generic and commercial forms: bleomycin sulfate, cetuximab (Erbitux), docetaxel (Taxotere), hydroxyurea (Hydrea), pembrolizumab (Keytruda), loqtorzi (Toripalimab-tpzi), methotrexate sodium (Trexall), and nivolumab (Opdivo). The most common drugs to treat HPV-associated OPC under these clinical trials and implemented as well for HPV-negative HNC include cisplatin, nivolumab, cetuximab, paclitaxel, pembrolizumab, 5-fluorouracil, and docetaxel. Few studies have highlighted the necessity for new drugs specifically tailored to patients with HPV-associated OPC, where molecular mechanisms and clinical prognosis are distinct from HPV-negative tumors. In this context, we identified most mutated genes found in HPV-associated OPC that can represent potential targets for drug development. These include TP53, PIK3CA, PTEN, NOTCH1, RB1, FAT1, FBXW7, HRAS, KRAS, and CDKN2A.
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Affiliation(s)
- Isis de Araújo Ferreira Muniz
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
- Graduate Program in Dentistry, Federal University of Paraíba, João Pessoa 58051-900, PB, Brazil
| | - Megan Araujo
- Division of Experimental Medicine and Oncology, Department of Medicine and Health Sciences, McGill University, Montreal, QC HC3 1E2, Canada; (M.A.); (J.B.)
| | - Jenna Bouassaly
- Division of Experimental Medicine and Oncology, Department of Medicine and Health Sciences, McGill University, Montreal, QC HC3 1E2, Canada; (M.A.); (J.B.)
| | - Fatemeh Farshadi
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
- Division of Experimental Medicine and Oncology, Department of Medicine and Health Sciences, McGill University, Montreal, QC HC3 1E2, Canada; (M.A.); (J.B.)
| | - Mai Atique
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
| | - Khashayar Esfahani
- Department of Oncology, McGill University, Montreal, QC HC3 1E2, Canada;
| | - Paulo Rogerio Ferreti Bonan
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
- Graduate Program in Dentistry, Federal University of Paraíba, João Pessoa 58051-900, PB, Brazil
| | - Michael Hier
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
| | - Marco Mascarella
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
| | - Alex Mlynarek
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
| | - Moulay Alaoui-Jamali
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
| | - Sabrina Daniela da Silva
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
- Division of Experimental Medicine and Oncology, Department of Medicine and Health Sciences, McGill University, Montreal, QC HC3 1E2, Canada; (M.A.); (J.B.)
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Locke M, Kohn N, Seetharamu N. Efficacy and tolerability of a low dose weekly paclitaxel, carboplatin and cetuximab (PCC) regimen for metastatic or unresectable head and neck squamous cell carcinomas. Clin Otolaryngol 2023; 48:915-919. [PMID: 37517814 DOI: 10.1111/coa.14091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/13/2023] [Accepted: 07/15/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Margaret Locke
- Department of Internal Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Nina Kohn
- Office of Academic Affairs, Northwell Health, Manhasset, New York, USA
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Chauffert B, Zhou Y, Medjkoune L, Ouikene A, Galez A, Belkhir F, Saint-Germain P, Youssef A, Chehimi M. High Response Rate to Carboplatin-Paclitaxel-Cetuximab and Pembrolizumab in Patients with Recurrent and/or Metastatic Head and Neck Squamous Cell Carcinoma. Case Rep Oncol 2023; 16:13-20. [PMID: 36743882 PMCID: PMC9893993 DOI: 10.1159/000528326] [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: 05/31/2022] [Accepted: 11/16/2022] [Indexed: 01/18/2023] Open
Abstract
The management of R/M HNSCC is rapidly evolving with new available treatment molecules and combination modalities. Anti-EGFR cetuximab (CTX) and immune checkpoint inhibitors (ICI) can be used either alone or in combination with conventional platinum-based doublet chemotherapy (with taxanes or fluorouracil). No data have been reported to date on the association of doublet chemotherapy concomitantly with both CTX and ICI. We present a case series of patients treated with 4 cycles of quadritherapy, every 3 weeks, including paclitaxel 175 mg/m2, carboplatin AUC 5, pembrolizumab 200 mg, and weekly 250 mg/m2 CTX. All patients achieved an objective response (6 complete responses, 2 partial responses). Clinical response was fast, so 1 patient avoided an emergency tracheostomy for laryngeal dyspnea. Four patients furtherly benefited from cisplatin-based chemoradiotherapy on residual tumor sites after the response to quadritherapy. Adverse events were manageable, except for an ICI-related liver toxicity in a patient. Overall, this short series indicates that a quadruple therapy with carboplatin-paclitaxel-CTX and pembrolizumab seems to be safe and active in patients with R/M HNSCC. This observation could be confirmed through further clinical trials.
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Affiliation(s)
- Bruno Chauffert
- Department of Oncology-Hematology, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | - Yuedan Zhou
- Department of Oncology-Hematology, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | - Liza Medjkoune
- Department of Oncology-Hematology, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | - Abdenour Ouikene
- Department of Oncology-Hematology, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | - Agnes Galez
- Department of Head and Neck Surgery, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | - Farid Belkhir
- Department of Radiation Oncology, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | | | - Ali Youssef
- Department of Oncology-Hematology, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | - Mohamad Chehimi
- Department of Oncology-Hematology, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
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Doganlar O, Doganlar ZB, Erdogan S, Delen E. Antineoplastic multi-drug chemotherapy to sensitize tumors triggers multi-drug resistance and inhibits efficiency of maintenance treatment inglioblastoma cells. EXCLI JOURNAL 2023; 22:35-52. [PMID: 36660193 PMCID: PMC9837385 DOI: 10.17179/excli2022-5556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/08/2022] [Indexed: 01/21/2023]
Abstract
Combinations of the well-known antineoplastic agents 5-fluorouracil (5-Fu), cisplatin, and paclitaxel are employed to increase radiotherapy/immunotherapy efficacy against persistent and resistant tumors. However, data remains needed on the hormetic, chronic, and long-term side effects of these aggressive combination chemotherapies. Here we investigated cellular and molecular responses associated with these combined agents, and their potential to induce multi-drug resistance against the temozolomide (TMZ) and etoposide (EP) used in glioblastoma maintenance treatment. We analyzed resistance and survival signals in U87 MG cells using molecular probes, fluorescent staining, qRT-PCR, and immunoblot. Repeated treatment with combined 5-Fu, cisplatin, and paclitaxel induced cross-resistance against TMZ and EP. Resistant cells exhibited elevated gene/protein expression of MRP1/ABCC1, ABCC2, BRCP/ABCG2, and GST. Moreover, they managed oxidative stress, cell cycle, apoptosis, and autophagy signaling to ensure survival. In these groups TMZ and etoposide efficiency dramatically reduced. Our result suggests that combined high-dose treatments of classical antineoplastic agents to sensitize tumors may trigger multi-drug resistance and inhibit maintenance treatment. When deciding on antineoplastic combination therapy for persistent/resistant glioblastoma, we recommend analyzing the long-term hormetic and chronic effects on cross-resistance and multi-drug resistance in primary cell cultures from patients. See also the Graphical Abstract(Fig. 1).
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Affiliation(s)
- Oguzhan Doganlar
- Faculty of Medicine, Department of Medical Biology, Trakya University, Edirne, Turkiye,*To whom correspondence should be addressed: Oguzhan Doganlar, Faculty of Medicine, Department of Medical Biology, Trakya University, Edirne, Turkiye, E-mail:
| | - Zeynep Banu Doganlar
- Faculty of Medicine, Department of Medical Biology, Trakya University, Edirne, Turkiye
| | - Suat Erdogan
- Faculty of Medicine, Department of Medical Biology, Trakya University, Edirne, Turkiye
| | - Emre Delen
- Faculty of Medicine, Department of Neurosurgery, Trakya University, Edirne, Turkiye
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Tanaka N, Enokida T, Fujisawa T, Okano S, Wada A, Sato M, Tanaka H, Takeshita N, Tahara M. Biweekly administration of cetuximab in Japanese patients with recurrent or metastatic head and neck cancer. Int J Clin Oncol 2022; 27:1669-1674. [PMID: 35943644 DOI: 10.1007/s10147-022-02226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cetuximab (Cmab) plays an important role in the treatment for recurrent or metastatic head and neck cancer (R/M HNC). To date, however, no safety data on biweekly administration of cetuximab at a dose of 500 mg/m2 (biweekly Cmab) for Japanese HNC patients have been available. METHODS We retrospectively reviewed the clinical records of five R/M HNC patients who received biweekly Cmab in our institute between January 2016 and September 2021 and compared the safety profile between two phases of weekly 250 mg/m2 and biweekly 500 mg/m2 Cmab in the identical patients. RESULTS All patients initially received Cmab in combination with chemotherapy. Chemotherapy consisted of paclitaxel plus carboplatin in two patients, cisplatin + 5-FU in one patient, and paclitaxel in two patients. Three patients switched treatment schedule from weekly Cmab to biweekly Cmab, while two patients received biweekly Cmab after completion of chemotherapy. The main reason for switching to biweekly Cmab was an unacceptably long commuting time to the hospital. The median duration of Cmab was 217 days (49-321) during weekly Cmab with or without chemotherapy and 42 days (28-175) during biweekly Cmab. Median dose of biweekly Cmab was 4 (3-12). During biweekly Cmab, worsened (Grade ≥ 2) toxicities were observed in two patients: one with grade 2 dry skin and the second with grade 2 skin infection. None developed grade ≥ 3 adverse events or discontinued treatment due to Cmab-related adverse events. CONCLUSION Biweekly Cmab was well tolerated and did not demonstrate severe toxicities related to Cmab for R/M HNC.
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Affiliation(s)
- Nobukazu Tanaka
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Tomohiro Enokida
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Takao Fujisawa
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Susumu Okano
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Akihisa Wada
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Masanobu Sato
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Hideki Tanaka
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Naohiro Takeshita
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan.
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Paclitaxel and Cisplatin with or without Cetuximab in metastatic esophageal squamous cell carcinoma: A randomized, multicenter, open-label Phase II trial. Innovation (N Y) 2022; 3:100239. [PMID: 35509869 PMCID: PMC9059084 DOI: 10.1016/j.xinn.2022.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/04/2022] [Indexed: 12/24/2022] Open
Abstract
Lack of effective targeted therapy in metastatic esophageal squamous cell carcinoma (ESCC) underscores the urgent need for identifying new treatment approaches for this challenging disease. We sought to assess the addition of cetuximab to paclitaxel-cisplatin chemotherapy for first-line treatment in patients with metastatic ESCC. In this randomized, multicenter, open-label, phase II clinical trial, patients were randomized to receive paclitaxel-cisplatin (TP) (paclitaxel [175 mg/m2 intravenously (i.v.) on day 1 of every 3-week cycle] and cisplatin [75 mg/m2 i.v. on day 1 of every 3-week cycle]) and TP plus cetuximab (CTP) (cetuximab, 400 mg/m2 i.v. on day 1 of week 1, followed by 250 mg/m2 weekly), respectively. Targeted next-generation sequencing (NGS) was performed on 89 tumor samples for biomarker exploration. The primary endpoint was progression-free survival (PFS) in the intention-to-treat population. With a median follow-up of 22.6 months, median PFS was 5.7 months (95% confidence interval [CI]: 4.8–7.0) in patients administered CTP versus 4.2 months (95% CI: 3.0–5.3) in the TP group (hazard ratio [HR] = 0.61; 95% CI: 0.40–0.93; p = 0.02). Median overall survival was 11.5 months (95% CI: 7.9–13.1) in the CTP group and 10.5 months (95% CI: 9.0–13.2) in the TP arm (HR = 0.98; 95% CI: 0.67–1.44; p = 0.91). The most common reported greater than or equal to grade 3 adverse events were neutropenia (35.2% versus 22.4%) and leukopenia (25.4% versus 13.2%). In patients with epidermal growth factor receptor (EGFR) amplification tumors (15.7%), PFS was improved with CTP compared with TP treatment (HR = 0.11; 95% CI: 0.01–0.98; p = 0.018). First-line CTP significantly improves PFS, with a manageable safety profile in patients with metastatic ESCC. Compare the effect of Cetuximab + chemotherapy with chemotherapy alone in ESCC CTP regimen improves progression-free survival with a manageable safety profile ESCC patients with EGFR amplification obtain greater therapeutic benefit from CTP CTP regimen represents a new treatment option for ESCC
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Falco A, Leiva M, Blanco A, Cefarelli G, Rodriguez A, Melo J, Cayol F, Rizzo MM, Sola A, Rodríguez Montani H, Chacon M, Enrico D, Waisberg F. First-line cisplatin, docetaxel, and cetuximab for patients with recurrent or metastatic head and neck cancer: A multicenter cohort study. World J Clin Oncol 2022; 13:147-158. [PMID: 35316930 PMCID: PMC8894270 DOI: 10.5306/wjco.v13.i2.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/04/2021] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The targeted therapy cetuximab [directed at the epidermal growth factor receptor (EGFR)] in combination with 5-fluorouracil and platinum-based chemotherapy (the EXTREME regimen) has shown substantial efficacy for patients with recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). Thus, this scheme has been established as the preferred first-line option for these patients. However, more recently, a new strategy combining platinum, taxanes, and cetuximab (the TPEx regimen) has demonstrated similar efficacy with a more favorable toxicity profile in clinical trials.
AIM To evaluate the safety and efficacy of the TPEx scheme as first-line therapy in advanced SCCHN in a multicenter cohort study.
METHODS This retrospective multicenter cohort study included patients with histologically confirmed recurrent or metastatic SCCHN treated with first-line TPEx at five medical centers in Argentina between January 1, 2017 and April 31, 2020. Chemotherapy consisted of four cycles of docetaxel, cisplatin, and cetuximab followed by cetuximab maintenance therapy. Clinical outcomes and toxicity profiles were collected from medical charts. Treatment response was assessed by the investigator in accordance with Response Evaluation Criteria in Solid Tumors (version 1.1). Adverse events were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.0).
RESULTS Twenty-four patients were included. The median age at diagnosis was 58 years (range: 36-77 years). The majority of patients (83.3%) received at least four chemotherapy cycles in the initial phase. In the included group, the overall response rate was 62.5%, and 3 patients achieved a complete response (12.5%). The median time to response was 2.4 mo [95% confidence interval (CI): 1.3-3.5]. With a median follow-up of 12.7 mo (95%CI: 8.8-16.6), the median progression-free survival (PFS) was 6.9 mo (95%CI: 6.5-7.3), and the overall survival rate at 12 mo was 82.4%. Patients with documented tumor response showed a better PFS than those with disease stabilization or progression [8.5 mo (95%CI: 5.5-11.5) and 4.5 mo (95%CI: 2.5-6.6), respectively; P = 0.042]. Regarding the safety analysis, two-thirds of patients reported at least one treatment-related adverse event, and 25% presented grade 3 toxicities. Of note, no patient experienced grade 4 adverse events.
CONCLUSION TPEx was an adequately tolerated regimen in our population, with low incidence of grade 3-4 adverse events. The median PFS were consistent with those in recent reports of clinical trials evaluating this treatment combination. This regimen may be considered an attractive therapeutic strategy due to its simplified administration, decreased total number of chemotherapy cycles, and treatment tolerability.
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Affiliation(s)
- Agustín Falco
- Department of Medical Oncology, Head and Neck Unit, Alexander Fleming Cancer Institute, Buenos Aires 1428, Argentina
| | - Mariano Leiva
- Department of Medical Oncology, Head and Neck Unit, Alexander Fleming Cancer Institute, Buenos Aires 1428, Argentina
| | - Albano Blanco
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires 1426, Argentina
| | - Guido Cefarelli
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires 1426, Argentina
| | - Andrés Rodriguez
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires 1426, Argentina
| | - Juan Melo
- Department of Medical Oncology, Hospital Italiano de Buenos Aires, Buenos Aires 1199, Argentina
| | - Federico Cayol
- Department of Medical Oncology, Hospital Italiano de Buenos Aires, Buenos Aires 1199, Argentina
| | - Manglio Miguel Rizzo
- Department of Medical Oncology, Hospital Universitario Austral, Pilar 1629, Argentina
| | - Alejandro Sola
- Department of Medical Oncology, Fundación Centro Oncológico de Integración Regional, Mendoza 5500, Argentina
| | - Hernán Rodríguez Montani
- Department of Medical Oncology, Hospital Italiano Rosario; Sanatorio de la Mujer, Rosario 2001, Argentina
| | - Matías Chacon
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires 1426, Argentina
| | - Diego Enrico
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires 1426, Argentina
| | - Federico Waisberg
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires 1426, Argentina
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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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Hsieh MC, Wang CC, Yang CC, Lien CF, Wang CC, Shih YC, Yeh SA, Hwang TZ. Tegafur-Uracil versus 5-Fluorouracil in Combination with Cisplatin and Cetuximab in Elderly Patients with Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: A Propensity Score Matching Analysis. BIOLOGY 2021; 10:biology10101011. [PMID: 34681110 PMCID: PMC8533478 DOI: 10.3390/biology10101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
Abstract
Simple Summary Elderly patients with recurrent or metastatic head and neck squamous cell carcinoma are a unique subset because they are at increased risks of miserable prognosis. Although cisplatin, 5-fluorouracil plus cetuximab (EXTREME) is the most commonly used regimen, chemotherapy de-escalation strategy was suggested in elderly patients due to toxicity. Herein, an oral tegafur–uracil is usually substituted for 5-fluorouracil and combined with cisplatin plus cetuximab (UPEx) as a novel agent for elderly patients with recurrent or metastatic head and neck squamous cell carcinoma. The median progression-free survival was 5.4 months in UPEx and 5.8 months in EXTREME (p = 0.451). The median overall survival was 10.8 months in UPEx and 10.2 months in EXTREME (p = 0.807). Grade 3/4 adverse events were much fewer in UPEx than in EXTREME (p < 0.001). Our study demonstrated that UPEx is effective with improving safety profiles. We suggested UPEx might be a better treatment option for elderly patients with recurrent or metastatic head and neck squamous cell carcinoma. Abstract There are increasing incidences of elderly patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC). However, the treatment is not yet established. We conducted a propensity score matching analysis to evaluate the efficacy and safety of tegafur–uracil versus 5-fluorouracil in combination with cisplatin plus cetuximab in elderly patients with R/M HNSCC. Elderly patients with R/M HNSCC treated with cetuximab-containing chemotherapy were recruited into this study. In order to reduce the selection bias, propensity score matching was performed. Kaplan–Meier curves were plotted for progression-free survival (PFS) and overall survival (OS). Toxicities were graded according to the National Cancer Institute’s Common Terminology Criteria V3.0. After propensity sore matching, 54 patients with tegafur–uracil, cisplatin plus cetuximab (UPEx), and 54 patients with 5-fluorouracil, cisplatin plus cetuximab (EXTREME) were identified. The median PFS was 5.4 months in UPEx and 5.8 months in EXTREME (p = 0.451). The median OS was 10.8 months in UPEx and 10.2 months in EXTREME (p = 0.807). The overall response rate (ORR) and disease control rate (DCR) were insignificant in both arms, accounting for 61% versus 59% (p = 0.680) and 72% versus 70% (p = 0.732) in the UPEx arm and the EXTREME arm, respectively. A multivariate analysis showed that age and ECOG PS were, independently, predictors. Grade 3/4 adverse events were much fewer in UPEx than in EXTREME (p < 0.001). Both cetuximab-containing chemotherapies are effective in elderly patients with R/M HNSCC. Safety profiles are improved when tegafur–uracil is substituted for 5-fluorouracil. Further prospective studies are warranted to validate our conclusions.
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Affiliation(s)
- Meng-Che Hsieh
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung City 82445, Taiwan;
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-C.W.); (C.-C.Y.); (C.-F.L.); (C.-C.W.); (Y.-C.S.); (S.-A.Y.)
| | - Chih-Chun Wang
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-C.W.); (C.-C.Y.); (C.-F.L.); (C.-C.W.); (Y.-C.S.); (S.-A.Y.)
- Department of Otolaryngology, E-Da Hospital, Kaohsiung City 82445, Taiwan
| | - Chuan-Chien Yang
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-C.W.); (C.-C.Y.); (C.-F.L.); (C.-C.W.); (Y.-C.S.); (S.-A.Y.)
- Department of Otolaryngology, E-Da Hospital, Kaohsiung City 82445, Taiwan
| | - Ching-Feng Lien
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-C.W.); (C.-C.Y.); (C.-F.L.); (C.-C.W.); (Y.-C.S.); (S.-A.Y.)
- Department of Otolaryngology, E-Da Hospital, Kaohsiung City 82445, Taiwan
| | - Chien-Chung Wang
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-C.W.); (C.-C.Y.); (C.-F.L.); (C.-C.W.); (Y.-C.S.); (S.-A.Y.)
- Department of Otolaryngology, E-Da Hospital, Kaohsiung City 82445, Taiwan
| | - Yu-Chen Shih
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-C.W.); (C.-C.Y.); (C.-F.L.); (C.-C.W.); (Y.-C.S.); (S.-A.Y.)
- Department of Otolaryngology, E-Da Cancer Hospital, Kaohsiung City 82445, Taiwan
| | - Shyh-An Yeh
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-C.W.); (C.-C.Y.); (C.-F.L.); (C.-C.W.); (Y.-C.S.); (S.-A.Y.)
- Department of Radiation Oncology, E-Da Hospital, Kaohsiung City 82445, Taiwan
| | - Tzer-Zen Hwang
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-C.W.); (C.-C.Y.); (C.-F.L.); (C.-C.W.); (Y.-C.S.); (S.-A.Y.)
- Department of Otolaryngology, E-Da Hospital, Kaohsiung City 82445, Taiwan
- Correspondence:
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Jin Z, Zhang B, Zhang L, Huang W, Mo X, Chen Q, Wang F, Chen Z, Li M, Zhang S. Immune-checkpoint inhibitor plus chemotherapy versus conventional chemotherapy for treatment of recurrent or metastatic head and neck squamous cell carcinoma: a systematic review and network meta-analysis. Ther Adv Med Oncol 2020; 12:1758835920983717. [PMID: 33488783 PMCID: PMC7768319 DOI: 10.1177/1758835920983717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/01/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Multiple therapies including immune-checkpoint inhibitors are emerging as effective treatment for patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSSC). However, the optimal first-line and second-line treatments remains controversial. Methods: We systematically searched databases and conducted a systematic review of phase II/III randomized controlled trials (RCTs) that compared two or more treatments for R/M HNSSC. Progression-free survival (PFS), overall survival (OS) and adverse events (AEs) ⩾3 with hazard ratios (HRs) were extracted and synthesized based on a frequentist network meta-analysis. Results: Twenty-six trials involving 8908 patients were included. Of first-line treatments, pembrolizumab plus cisplatin plus 5-fluorouracil is associated with significantly improved OS (P-score = 0.91) and TPEx ranked first for prolonging PFS (0.91). EXTREME plus docetaxel (0.18) ranked lowest for AEs ⩾3. Of second-line treatments, nivolumab was the highest-ranked treatment for prolonging OS (0.95), while buparlisib plus paclitaxel was the highest-ranked treatment for PFS (0.94). Subgroup analyses suggested that nivolumab was significantly associated with improvement of OS in patients with high PD-L1 expression (HR 0.55, 0.43–0.70), whereas its OS benefit is similar with conventional chemotherapy for those with low PD-L1 expression. Buparlisib plus paclitaxel showed the best OS benefit in subgroups of patients with HPV-negative status, and with oral cavity or larynx as primary tumor sites. Conclusions: Pembrolizumab plus cisplatin plus 5-fluorouracil is likely to be the best first-line treatment when OS is a priority. Otherwise, TPEx should be the optimal first-line option due to its superior PFS prolongation efficacy, best safety profile, and similar OS benefit with pembrolizumab plus cisplatin plus 5-fluorouracil. Nivolumab appears to be the best second-line option with best OS prolongation efficacy and outstanding safety profile in the overall population. Future RCTs with meticulous grouping of patients and detailed reporting are urgently needed for individualized treatment.
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Affiliation(s)
- Zhe Jin
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Bin Zhang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lu Zhang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wenhui Huang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaokai Mo
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qiuyin Chen
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Fei Wang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhuozhi Chen
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Minmin Li
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shuixing Zhang
- The First Affiliated Hospital of Jinan University, No. 613, West Huangpu Avenue, Guangzhou, Guangdong Province 510630, PR China
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