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Ferrari M, Mularoni F, Taboni S, Crosetti E, Pessina C, Carobbio ALC, Montalto N, Marchi F, Vural A, Paderno A, Caprioli S, Gaudioso P, Fermi M, Rigoni F, Saccardo T, Contro G, Ruaro A, Lo Manto A, Varago C, Baldovin M, Bandolin L, Filauro M, Sampieri C, Missale F, Ioppi A, Carta F, Ramanzin M, Ravanelli M, Maiolo V, Bertotto I, Del Bon F, Lancini D, Mariani C, Marrosu V, Tatti M, Cağlı S, Yüce I, Gündoğ M, Dogan S, Anile G, Gottardi C, Busato F, Vallin A, Gennarini F, Bossi P, Ghi MG, Lionello M, Zanoletti E, Marioni G, Maroldi R, Mattioli F, Puxeddu R, Bertolin A, Presutti L, Piazza C, Succo G, Peretti G, Nicolai P. How reliable is assessment of true vocal cord-arytenoid unit mobility in patients affected by laryngeal cancer? a multi-institutional study on 366 patients from the ARYFIX collaborative group. Oral Oncol 2024; 152:106744. [PMID: 38520756 DOI: 10.1016/j.oraloncology.2024.106744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE In clinical practice the assessment of the "vocal cord-arytenoid unit" (VCAU) mobility is crucial in the staging, prognosis, and choice of treatment of laryngeal squamous cell carcinoma (LSCC). The aim of the present study was to measure repeatability and reliability of clinical assessment of VCAU mobility and radiologic analysis of posterior laryngeal extension. METHODS In this multi-institutional retrospective study, patients with LSCC-induced impairment of VCAU mobility who received curative treatment were included; pre-treatment endoscopy and contrast-enhanced imaging were collected and evaluated by raters. According to their evaluations, concordance, number of assigned categories, and inter- and intra-rater agreement were calculated. RESULTS Twenty-two otorhinolaryngologists evaluated 366 videolaryngoscopies (total evaluations: 2170) and 6 radiologists evaluated 237 imaging studies (total evaluations: 477). The concordance of clinical rating was excellent in only 22.7% of cases. Overall, inter- and intra-rater agreement was weak. Supraglottic cancers and transoral endoscopy were associated with the lowest inter-observer reliability values. Radiologic inter-rater agreement was low and did not vary with imaging technique. Intra-rater reliability of radiologic evaluation was optimal. CONCLUSIONS The current methods to assess VCAU mobility and posterior extension of LSCC are flawed by weak inter-observer agreement and reliability. Radiologic evaluation was characterized by very high intra-rater agreement, but weak inter-observer reliability. The relevance of VCAU mobility assessment in laryngeal oncology should be re-weighted. Patients affected by LSCC requiring imaging should be referred to dedicated radiologists with experience in head and neck oncology.
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Affiliation(s)
- M Ferrari
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy.
| | - F Mularoni
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - S Taboni
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - E Crosetti
- Otorhinolaryngology Department - Head Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - C Pessina
- Radiology Unit, Sant'Antonio Hospital, University of Padova, Padova, Italy
| | - A L C Carobbio
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - N Montalto
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - F Marchi
- Unit of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - A Vural
- Otorhinolaryngology Unit, Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - A Paderno
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - S Caprioli
- Radiology Unit, San Martino Hospital, Genoa, Italy
| | - P Gaudioso
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - M Fermi
- Otorhinolaryngology Unit, Azienda Ospedaliera Universitaria di Bologna IRCCS, Bologna, Italy; Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - F Rigoni
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - T Saccardo
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - G Contro
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - A Ruaro
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - A Lo Manto
- Otorhinolaryngology Unit, Infermi Hospital, Rimini, Italy
| | - C Varago
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - M Baldovin
- Otorhinolaryngology Unit, San Martino di Belluno Hospital, Belluno, Italy
| | - L Bandolin
- Otorhinolaryngology Unit, Hospital of Santorso, Vicenza, Italy
| | - M Filauro
- Unit of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - C Sampieri
- Department of Experimental Medicine (DIMES), University of Genoa, Italy; Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
| | - F Missale
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, the Netherlands
| | - A Ioppi
- Department of Otorhinolaryngology-Head and Neck Surgery, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - F Carta
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - M Ramanzin
- Radiology Unit, Hospital of Vicenza, Vicenza, Italy
| | - M Ravanelli
- Radiology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - V Maiolo
- Pediatric and Adult Cardiothoracic and Vascular, Oncohematologic and Emergency Radiology Unit (IRCCS AOUBO), University of Bologna, Italy
| | - I Bertotto
- Radiology Unit, IRCCS Istituto di Candiolo, Turin, Italy
| | - F Del Bon
- Otorhinolaryngology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - D Lancini
- Otorhinolaryngology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - C Mariani
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - V Marrosu
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - M Tatti
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - S Cağlı
- Otorhinolaryngology Unit, Erciyes University, Kayseri, Turkey
| | - I Yüce
- Otorhinolaryngology Unit, Erciyes University, Kayseri, Turkey
| | - M Gündoğ
- Department of Radiation Oncology, Erciyes University, Kayseri, Turkey
| | - S Dogan
- Department of Radiology, Erciyes University, Kayseri, Turkey
| | - G Anile
- Unit of Medical Oncology 2, "Istituto Oncologico Veneto", Padova, Italy
| | - C Gottardi
- Unit of Medical Oncology 2, "Istituto Oncologico Veneto", Padova, Italy
| | - F Busato
- Unit of Radiation Oncology, Policlinico Abano, Padova, Italy
| | - A Vallin
- Unit of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - F Gennarini
- Otorhinolaryngology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - P Bossi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - M G Ghi
- Unit of Medical Oncology 2, "Istituto Oncologico Veneto", Padova, Italy
| | - M Lionello
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - E Zanoletti
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - G Marioni
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - R Maroldi
- Radiology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - F Mattioli
- Otorhinolaryngology Unit, University of Modena, Modena, Italy
| | - R Puxeddu
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy; King's College Hospital London, Dubai, United Arab Emirates
| | - A Bertolin
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - L Presutti
- Otorhinolaryngology Unit, Azienda Ospedaliera Universitaria di Bologna IRCCS, Bologna, Italy; Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - C Piazza
- Otorhinolaryngology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - G Succo
- Otorhinolaryngology Department - Head Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy; Oncology Department, University of Turin, Turin, Italy
| | - G Peretti
- Unit of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - P Nicolai
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
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Serafini MS, Cavalieri S, Licitra L, Pistore F, Lenoci D, Canevari S, Airoldi M, Cossu Rocca M, Strojan P, Kuhar CG, Merlano M, Perrone F, Vingiani A, Denaro N, Perri F, Argiris A, Gurizzan C, Ghi MG, Cassano A, Allegrini G, Bossi P, De Cecco L. Association of a gene-expression subtype to outcome and treatment response in patients with recurrent/metastatic head and neck squamous cell carcinoma treated with nivolumab. J Immunother Cancer 2024; 12:e007823. [PMID: 38290766 PMCID: PMC10828850 DOI: 10.1136/jitc-2023-007823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Immune checkpoint inhibitors have been approved and currently used in the clinical management of recurrent and metastatic head and neck squamous cell carcinoma (R/M HNSCC) patients. The reported benefit in clinical trials is variable and heterogeneous. Our study aims at exploring and comparing the predictive role of gene-expression signatures with classical biomarkers for immunotherapy-treated R/M HNSCC patients in a multicentric phase IIIb trial. METHODS Clinical data were prospectively collected in Nivactor tiral (single-arm, open-label, multicenter, phase IIIb clinical trial in platinum-refractory HNSCC treated with nivolumab). Findings were validated in an external independent cohort of immune-treated HNSCC patients, divided in long-term and short-term survivors (overall survival >18 and <6 months since the start of immunotherapy, respectively). Pretreatment tumor tissue specimen from immunotherapy-treated R/M HNSCC patients was used for PD-L1 (Tumor Proportion Score; Combined Positive Score (CPS)) and Tumor Mutational Burden (Oncopanel TSO500) evaluation and gene expression profiling; classical biomarkers and immune signatures (retrieved from literature) were challenged in the NIVACTOR dataset. RESULTS Cluster-6 (Cl6) stratification of NIVACTOR cases in high score (n=16, 20%) and low score (n=64, 80%) demonstrated a statistically significant and clinically meaningful improvement in overall survival in the high-score cases (p=0.00028; HR=4.34, 95% CI 1.84 to 10.22) and discriminative ability reached area under the curve (AUC)=0.785 (95% CI 0.603 to 0.967). The association of high-score Cl6 with better outcome was also confirmed in: (1) NIVACTOR progression-free survival (p=4.93E-05; HR=3.71, 95% CI 1.92 to 7.18) and objective-response-rate (AUC=0.785; 95% CI 0.603 to 0.967); (2) long survivors versus short survivors (p=0.00544). In multivariate Cox regression analysis, Cl6 was independent from Eastern Cooperative Oncology Group performance status, PDL1-CPS, and primary tumor site. CONCLUSIONS These data highlight the presence of underlying biological differences able to predict survival and response following treatment with immunotherapy in platinum-refractory R/M HNSCC that could have translational implications improving treatment selection. TRIAL REGISTRATION NUMBER EudraCT Number: 2017-000562-30.
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Affiliation(s)
- Mara Serena Serafini
- Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Stefano Cavalieri
- Head and Neck Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
| | - Lisa Licitra
- Head and Neck Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
| | - Federico Pistore
- Head and Neck Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Deborah Lenoci
- Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Mario Airoldi
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | | | | | - Cvetka Grasic Kuhar
- University of Ljubljana, Ljubljana, Slovenia
- Institute of Oncology, Ljubljana, Slovenia
| | | | - Federica Perrone
- Department of Diagnostic Pathology and Laboratory, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Vingiani
- Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
- Department of Diagnostic Pathology and Laboratory, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Francesco Perri
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Athanassios Argiris
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Cristina Gurizzan
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Maria Grazia Ghi
- Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Alessandra Cassano
- Policlinico Universitario Agostino Gemelli Dipartimento di scienze mediche e chirurgiche, Roma, Italy
| | | | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Loris De Cecco
- Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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3
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Busato F, Fiorentin D, Bettinelli A, Anile G, Ghi MG, Scaggion A, Dusi F, Paiusco M, Ferrari M, Nicolai P, Marturano F. Dosiomic-based prediction of dysgeusia in head & neck cancer patients treated with radiotherapy. Radiother Oncol 2023; 188:109896. [PMID: 37660751 DOI: 10.1016/j.radonc.2023.109896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/20/2023] [Accepted: 08/23/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE To investigate the potential of dosiomics in predicting radiotherapy-induced taste distortion (dysgeusia) in head & neck (H&N) cancer. METHODS A cohort of 80 H&N cancer patients treated with radical or adjuvant radiotherapy and with a follow-up of at least 24 months was enrolled. Treatment information, as well as tobacco and alcohol consumption were also collected. The whole tongue was manually delineated on the planning CT and mapped to the dose map retrieved from the treatment planning system. For every patient, 6 regions of the tongue were examined; for each of them, 145 dosiomic features were extracted from the dose map and fed to a logistic regression model to predict the grade of dysgeusia at follow-up, with and without including clinical features. A mean dose-based model was considered for reference. RESULTS Both dosiomics and mean dose models achieved good prediction performance for acute dysgeusia with AUC up to 0.88. For the dosiomic model, the central and anterior ⅔ regions of the tongue were the most predictive. For all models, a gradual reduction in the performance was observed at later times for chronic dysgeusia prediction, with higher values for dosiomics. The inclusion of smoke and alcohol habits did not improve model performances. CONCLUSION The dosiomic analysis of the dose to the tongue identified features able to predict acute dysgeusia. Dosiomics resulted superior to the conventional mean dose-based model for chronic dysgeusia prediction. Larger, prospective studies are needed to support these results before integrating dosiomics in radiotherapy planning.
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Affiliation(s)
- Fabio Busato
- Radiotherapy Unit, Veneto Institute of Oncology - IOV IRCCS, Padova, Italy; Department of Radiation Oncology, Abano Terme Hospital, Padova, Italy
| | - Davide Fiorentin
- Radiotherapy Unit, Veneto Institute of Oncology - IOV IRCCS, Padova, Italy; Department of Radiation Oncology, Abano Terme Hospital, Padova, Italy
| | - Andrea Bettinelli
- Medical Physics Department, Veneto Institute of Oncology - IOV IRCCS, Padova, Italy
| | - Giuseppe Anile
- Medical Oncology 2 Unit, Veneto Institute of Oncology - IOV IRCCS, Padova, Italy
| | - Maria Grazia Ghi
- Medical Oncology 2 Unit, Veneto Institute of Oncology - IOV IRCCS, Padova, Italy
| | - Alessandro Scaggion
- Medical Physics Department, Veneto Institute of Oncology - IOV IRCCS, Padova, Italy
| | - Francesca Dusi
- Medical Physics Department, Veneto Institute of Oncology - IOV IRCCS, Padova, Italy
| | - Marta Paiusco
- Medical Physics Department, Veneto Institute of Oncology - IOV IRCCS, Padova, Italy
| | - Marco Ferrari
- Section of Otorhinolaryngology-Head and Neck Surgery, Azienda Ospedaliera di Padova, University of Padova, Padova, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Azienda Ospedaliera di Padova, University of Padova, Padova, Italy
| | - Francesca Marturano
- Medical Physics Department, Veneto Institute of Oncology - IOV IRCCS, Padova, Italy; A. A. Martinos Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
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Le Tourneau C, Ghiani M, Cau MC, Depenni R, Ronzino G, Bonomo P, Montesarchio V, Leo L, Schulten J, Salmio S, Messinger D, Sbrana A, Borcoman E, Ghi MG. First-line cetuximab + platinum-based therapy for recurrent/metastatic head and neck squamous cell carcinoma: A real-world observational study-ENCORE. Cancer Rep (Hoboken) 2023; 6:e1804. [PMID: 37069784 PMCID: PMC10172179 DOI: 10.1002/cnr2.1804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/29/2023] [Accepted: 02/24/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND ENCORE, an observational, prospective, open-label study, investigated real-world treatment practices and outcomes with cetuximab plus platinum-based therapy (PBT) in first-line (1L) recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). AIMS This multinational study aimed to investigate the long-term use of cetuximab plus PBT for 1L R/M SCCHN in a clinical setting. In particular, this study aimed to explore clinical considerations such as the decision to prescribe cetuximab plus PBT in R/M SCCHN, the mode and duration of treatment, and patient outcomes. METHODS AND RESULTS Previously untreated patients with R/M SCCHN whose planned treatment was cetuximab plus PBT were enrolled from 6 countries. Among 221 evaluable patients, planned treatments included cetuximab plus carboplatin (31.2%), cisplatin plus 5-fluorouracil (31.7%), or carboplatin plus 5-fluorouracil (23.1%); 3.2% included a taxane, and 45.2% did not include 5-fluorouracil. Cetuximab treatment was planned for a fixed duration (≤24 weeks) in 15 patients (6.8%) and until disease progression in 206 (93.2%). Median progression-free survival and overall survival were 6.5 and 10.8 months, respectively. Grade ≥3 adverse events occurred in 39.8% of patients. Serious adverse events occurred in 25.8% of patients; 5.4% were cetuximab-related. CONCLUSION In patients with R/M SCCHN, first-line cetuximab plus PBT was feasible and modifiable in a real-world setting with similar toxicity and efficacy as in the pivotal phase III EXTREME trial. CLINICAL TRIAL REGISTRATION NUMBER EMR 062202-566.
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Affiliation(s)
- Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris, France
- INSERM U900 Research Unit, Saint-Cloud, France
- Faculty of Medicine, Paris-Saclay University, Paris, France
| | - Massimo Ghiani
- Department of Oncology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Maria Chiara Cau
- Department of Oncology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Roberta Depenni
- Department of Oncology and Hematology, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | | | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Luigi Leo
- AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Jeltje Schulten
- Global Medical Unit Oncology, Merck Healthcare KGaA, Darmstadt, Germany
| | - Satu Salmio
- Global Medical Unit Oncology, Merck Healthcare KGaA, Darmstadt, Germany
| | | | - Andrea Sbrana
- Service of Pneumo-Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Edith Borcoman
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris, France
| | - Maria Grazia Ghi
- Oncology Unit 2, Istituto Oncologico Veneto-IRCCS, Padova, Italy
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5
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Licitra LF, Serafini MS, Pistore F, Lenoci D, Airoldi M, Cossu Rocca M, Strojan P, Grasic Kuhar C, Merlano MC, Denaro N, Perri F, Argiris A, Gurizzan C, Perrone F, Ghi MG, Cassano A, Allegrini G, De Cecco L, Bossi P. Immune-related gene expression signature in patients with recurrent/metastatic head and neck cancer treated with immunotherapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6051 Background: In platinum-resistant recurrent-metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients (pts), survival improvements have been achieved with immune checkpoint inhibitors (ICI), however this benefit is limited to a relatively small subgroup of pts. Predictive biomarkers are still under investigation and their contribution to the clinic has been limited. An immune-related cluster (Cl6) has been defined by means of a metanalysis in locally advanced HNSCC. Methods: Gene expression profiling was performed on two cohorts of platinum resistant R/M HNSCC pts treated with ICI alone: i) 20 patients as training set, divided in long-term (OS >18 months; n=12) and short-term (OS < 6 months; n=8) survivors matched according to site of recurrence (distant metastases only, or locoregional recurrence with/out metastases); ii) 80 patients enrolled in a phase II trial (EudraCT number: 2017-000562-30; NIVACTOR study) as testing set. The molecular subtyping stratification (De Cecco, Oncotarget 2015) was applied. Subsequently, a score was determined between each sample and the centroids for the 6 clusters previously identified. The threshold point was imputed in the training set as the closest value to the observed prevalence. A Cox multivariable analysis including TMB, CPS and TPS PD-L1 status, age, tumoral subsite and performance status (PS) was performed. Results: Among all the clusters, Cl6 turned out to be significant and applied to training set it provided evidence to discriminate pts’ survivals (AUC=0.86, 95%CI=0.7-1.0; p=2E-05). The stratification based on Cl-6 along with the cut-off point defined in the training set were challenged in the testing set: samples were divided in 28 (35%) having high Cl-6 scores and 52 (65%) with low scores, reaching HR=0.46 (95% CI= 0.27-0.76; p=0.0024). Multivariate analysis showed that only Cl6 (high vs low, HR=0.44; p=0.00443) and PS (1,2 vs 0, HR 1.85; p=0.02686) resulted to be significant on pts’ OS. Conclusions: By analysing two series of pts receiving immunotherapy alone, we identified an immune-related gene expression signature, able to discriminate the prognosis of platinum-resistant R/M HNSCC pts. The multivariate analysis confirmed the immune-related Cl6 as factor linked to outcome in pts treated with immunotherapy, as well as it confirmed the importance of PS. An analysis of the signature on pts receiving first line treatment with immunotherapy is currently ongoing. [Table: see text]
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Affiliation(s)
- Lisa F. Licitra
- Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
| | | | - Federico Pistore
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Deborah Lenoci
- Integrated Biology Platform, Department of Applied Research and Technology Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Airoldi
- 2nd Medical Oncology Division, A. O. Città della Salute e della Scienza, Torino, Italy
| | - Maria Cossu Rocca
- Medical Oncology Division of Urogenital and Head and Neck Tumors. European Institute of Oncology, Milan, Italy
| | | | | | | | | | | | | | - Cristina Gurizzan
- Medical Oncology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Federica Perrone
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Alessandra Cassano
- Fondazione Policlinico Universitario A. Gemelli IRCCS-UOC Oncologia Medica, Rome, Italy
| | | | - Loris De Cecco
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Bossi
- Medical Oncology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
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Brunello A, Guarneri V, Coppola M, Bernardi M, Ottolitri K, Ghi MG, Mioranza E, Vianello F, Gottardi M, Lonardi S, Zagonel V. OUP accepted manuscript. Oncologist 2022; 27:e203-e205. [PMID: 35641217 PMCID: PMC8895736 DOI: 10.1093/oncolo/oyab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background Few data are available on the safety of COVID-19 vaccines in cancer patients undergoing active cancer-directed treatment. Patients and Methods This case series analyzes outcomes in terms of adverse events in 5297 patients undergoing anti-cancer treatment who were vaccinated with anti-SARS-CoV-2 Pfizer-BioNTech vaccine at a single cancer center from March 6, 2021 to May 9, 2021. Adverse events were retrieved from the national Italian pharmacovigilance platform (http://www.vigicovid.it). Results Of the 5297 patients treated for either solid tumors (87%) or onco-hematologic malignancies (13%) who were vaccinated, 8 adverse drug reactions (ADRs) were reported. One was a severe ADR and 7 were non-severe ADRs. Non-severe ADRs resolved within 48 hours. Conclusion BNT162b2 Pfizer-BioNTech vaccine was safely administered in the largest cohort of cancer patients reported to date.
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Affiliation(s)
- Antonella Brunello
- Medical Oncology 1, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
- Corresponding author: Antonella Brunello, MD PhD, UOC Oncologia 1, Dipartimento di Oncologia, Istituto Oncologico Veneto, IOV, IRCCS, via Gattamelata 64, 35128 Padova, Italy. Tel: +39 0498215953; Email
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Marina Coppola
- Pharmacy, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Matteo Bernardi
- Healthcare Professions, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Ketti Ottolitri
- Risk Management, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Maria Grazia Ghi
- Medical Oncology 2, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Eleonora Mioranza
- Medical Oncology 2, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Federica Vianello
- Radiotherapy, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Michele Gottardi
- Onco Hematology, Veneto Institute of Oncology IOV – IRCCS, Castelfranco Veneto, Italy
| | - Sara Lonardi
- Medical Oncology 3, Veneto Institute of Oncology IOV – IRCCS, Castelfranco Veneto, Italy
| | - Vittorina Zagonel
- Medical Oncology 1, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
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Caccialanza R, Cereda E, Klersy C, Nardi M, Masi S, Crotti S, Cappello S, Caissutti V, Brovia C, Lobascio F, Formisano E, Colombo S, Filippi AR, Bonzano E, Comoli P, Catenacci L, Alberti A, Musella V, Ferrari A, Imarisio I, Tancredi R, Monaco T, Ghi MG, Bossi P, Pedrazzoli P. The efficacy of immunonutrition in improving tolerance to chemoradiotherapy in patients with head and neck cancer, receiving nutritional counseling: study protocol of a randomized, open-label, parallel group, bicentric pilot study. Ther Adv Med Oncol 2021; 13:17588359211025872. [PMID: 34527079 PMCID: PMC8436314 DOI: 10.1177/17588359211025872] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/28/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Nutritional support, including nutritional counseling and oral nutritional supplements (ONSs), has been recommended at the earliest opportunity in head and neck (H&N) cancer patients. The limited available evidence on the efficacy of immunonutrition during chemoradiotherapy (CT-RT) in H&N cancer patients is positive with regard to some secondary endpoints, but is still scanty, particularly with regard to toxicity and treatment tolerance. We hypothesize that early systematic provision of ONSs with a high-protein–high-calorie mixture containing immunonutrients (Impact) compared to standard high-calorie–high-protein nutritional blends, in addition to nutritional counseling, may be beneficial to patients with H&N cancer during CT-RT. Hence, we designed the present study to evaluate the efficacy, in terms of treatment tolerance, toxicity and response, body weight, body composition, protein-calorie intake, quality of life (QoL), fatigue, muscle strength and immunological profile of the early systematic provision of ONSs enriched in immunonutrients compared to isonitrogenous standard blends, in H&N cancer patients undergoing CT-RT. Methods: This is a pragmatic, bicentric, randomized (1:1), parallel-group, open label, controlled, pilot clinical trial. Discussion: Many efforts are still to be taken to improve the efficacy of nutritional support in oncology. Immunonutrition represents a promising approach also in H&N cancer patients, but the evidence on its efficacy in improving clinical outcomes during CT-RT is still inconclusive. The present pilot study, which guarantees the early provision of nutritional assessment and support to all the enrolled patients in accordance with the recent guidelines and recommendations, could represent one of the first proofs of the clinical effectiveness of early oral immunonutrition in cancer patients undergoing CT-RT and could stimulate further large randomized trials, potentially resulting in the improvement of supportive care quality. Trial registration: This study is registered on ClinicalTrials.gov Identifier: NCT04611113.
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Affiliation(s)
- Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, Pavia, 27100, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mariateresa Nardi
- Clinical Nutrition Service, Veneto Institute of Oncology-IRCCS, Padua, Italy
| | - Sara Masi
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Crotti
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Cappello
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Caissutti
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlotta Brovia
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Lobascio
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elena Formisano
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Colombo
- Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Andrea Riccardo Filippi
- Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Elisabetta Bonzano
- Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Patrizia Comoli
- Cell Factory and Pediatric Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Catenacci
- Cell Factory and Pediatric Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Alberti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Valeria Musella
- Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Ferrari
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Imarisio
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Richard Tancredi
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Teresa Monaco
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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8
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Anile G, Bettinelli A, Paiusco M, De Conti G, Gottardi C, Conte P, Ghi MG. Radiomic features in recurrent/metastatic platinum refractory head and neck squamous cell carcinoma treated with immunotherapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18000 Background: Radiomics is the computerized extraction of quantitative features from medical images, beyond the level of detail accessible to an unaided human eye. Several studies on radiomic analysis have been carried out to identify predictive, prognostic and diagnostic biomarkers for diverse tumor types including HNSCC. Radiomic features proved to be effective in predicting outcomes in patients with locally advanced HNSCC. The aim of the present study was to dentify predictive and prognostic radiomic features in platinum-refractory HNSCC patients with recurrent and/or metastatic (R/M) disease treated with anti PD-1 monotherapy. Methods: We retrospectively reviewed the data of 38 patients treated with Nivolumab at our Institution between January 2018 and March 2020. Nasopharyngeal carcinomas were not eligible. CT radiomic textural features were extracted from regions of interests (ROIs) manually delineated around tumor volumes. Minimum Redundancy Maximum Relevance (mRMR) algorithm was the method of choice to rank radiomic features based on three outcomes: overall response rate (ORR); disease progression (PD) and overall survival (OS). Logistic regression was employed to build predictive/prognostic models. Area Under the Curve (AUC) of the Receiver Operating Characteristic (ROC) was chosen as the metric to assess model performances. Results: Data from 29 out of 38 patients were ultimately analyzed. Nine patients were excluded due to nasopharynx as primary tumor site and/or inadequate CT scan imaging. A total of 57 ROIs were extracted and analyzed. We obtained 9 models: 3 radiomic models, 3 clinical models and 3 combined models (radiomic plus clinical) for each outcome of interest (ORR, PD, OS). In the radiomic models 2 features were identified as predictor for ORR (AUC 0.69), 1 radiomic feature was predictive for PD (AUC 0.83) and 1 predictive for OS (AUC 0.72). In the clinical models, 3 clinical characteristics were identified for both ORR (AUC 0.91) and PD (AUC 0.73) and 2 clinical features were found to be predictive for OS (AUC 0.91). The combined model identified 3 features (2 radiomics and 1 clinical) predictive for ORR (AUC 0.76). No clinical characteristics were found in the combined model for PD. No radiomics features have been shown to be related to OS. Conclusions: This is an explorative study to test the power of radiomics and the potential value of combining radiomics and clinical data as a prognostic and predictive instrument. In this small sample size, the quantitative analysis of CT images seems to be an interesting tool which has to be further explored as predictor of outcome in a larger series of patients.[Table: see text]
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Affiliation(s)
- Giuseppe Anile
- Oncology Unit 2, Veneto Institute of Oncology IOV–IRCCS, Padua, Italy
| | - Andrea Bettinelli
- Department of Information Engineering - DEI, University of Padua and Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Marta Paiusco
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Chiara Gottardi
- Department of Surgery, Oncology and Gastroenterology, University of Padua and Oncology Unit 2, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padua and Oncology Unit 2, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Maria Grazia Ghi
- Oncology Unit 2, Veneto Institute of Oncology IOV–IRCCS, Padua, Italy
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9
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Petit C, Lacas B, Pignon JP, Le QT, Grégoire V, Grau C, Hackshaw A, Zackrisson B, Parmar MKB, Lee JW, Ghi MG, Sanguineti G, Temam S, Cheugoua-Zanetsie M, O'Sullivan B, Posner MR, Vokes EE, Cruz Hernandez JJ, Szutkowski Z, Lartigau E, Budach V, Suwiński R, Poulsen M, Kumar S, Ghosh Laskar S, Mazeron JJ, Jeremic B, Simes J, Zhong LP, Overgaard J, Fortpied C, Torres-Saavedra P, Bourhis J, Aupérin A, Blanchard P. Chemotherapy and radiotherapy in locally advanced head and neck cancer: an individual patient data network meta-analysis. Lancet Oncol 2021; 22:727-736. [PMID: 33862002 DOI: 10.1016/s1470-2045(21)00076-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Randomised, controlled trials and meta-analyses have shown the survival benefit of concomitant chemoradiotherapy or hyperfractionated radiotherapy in the treatment of locally advanced head and neck cancer. However, the relative efficacy of these treatments is unknown. We aimed to determine whether one treatment was superior to the other. METHODS We did a frequentist network meta-analysis based on individual patient data of meta-analyses evaluating the role of chemotherapy (Meta-Analysis of Chemotherapy in Head and Neck Cancer [MACH-NC]) and of altered fractionation radiotherapy (Meta-Analysis of Radiotherapy in Carcinomas of Head and Neck [MARCH]). Randomised, controlled trials that enrolled patients with non-metastatic head and neck squamous cell cancer between Jan 1, 1980, and Dec 31, 2016, were included. We used a two-step random-effects approach, and the log-rank test, stratified by trial to compare treatments, with locoregional therapy as the reference. Overall survival was the primary endpoint. The global Cochran Q statistic was used to assess homogeneity and consistency and P score to rank treatments (higher scores indicate more effective therapies). FINDINGS 115 randomised, controlled trials, which enrolled patients between Jan 1, 1980, and April 30, 2012, yielded 154 comparisons (28 978 patients with 19 253 deaths and 20 579 progression events). Treatments were grouped into 16 modalities, for which 35 types of direct comparisons were available. Median follow-up based on all trials was 6·6 years (IQR 5·0-9·4). Hyperfractionated radiotherapy with concomitant chemotherapy (HFCRT) was ranked as the best treatment for overall survival (P score 97%; hazard ratio 0·63 [95% CI 0·51-0·77] compared with locoregional therapy). The hazard ratio of HFCRT compared with locoregional therapy with concomitant chemoradiotherapy with platinum-based chemotherapy (CLRTP) was 0·82 (95% CI 0·66-1·01) for overall survival. The superiority of HFCRT was robust to sensitivity analyses. Three other modalities of treatment had a better P score, but not a significantly better HR, for overall survival than CLRTP (P score 78%): induction chemotherapy with taxane, cisplatin, and fluorouracil followed by locoregional therapy (ICTaxPF-LRT; 89%), accelerated radiotherapy with concomitant chemotherapy (82%), and ICTaxPF followed by CLRT (80%). INTERPRETATION The results of this network meta-analysis suggest that further intensifying chemoradiotherapy, using HFCRT or ICTaxPF-CLRT, could improve outcomes over chemoradiotherapy for the treatment of locally advanced head and neck cancer. FUNDINGS French Institut National du Cancer, French Ligue Nationale Contre le Cancer, and Fondation ARC.
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Affiliation(s)
- Claire Petit
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Ligue Contre le Cancer, INSERM, Université Paris-Saclay, Villejuif, France; Department of Radiation Oncology, Gustave Roussy Cancer Campus, Université Paris-Sud, Université Paris-Saclay, F-94805 Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Benjamin Lacas
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Ligue Contre le Cancer, INSERM, Université Paris-Saclay, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Jean-Pierre Pignon
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Ligue Contre le Cancer, INSERM, Université Paris-Saclay, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Quynh Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Cai Grau
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Allan Hackshaw
- Cancer Research UK and University College London Cancer Trials Centre, Cancer Institute, University College London Hospital, London, UK
| | - Björn Zackrisson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Mahesh K B Parmar
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Ju-Whei Lee
- ECOG-ACRIN Biostatistics Center, Dana Farber Cancer Institute, Boston, MA, USA
| | - Maria Grazia Ghi
- Oncology Unit 2, Veneto Institute of Oncology-IRCCS, Padua, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Stéphane Temam
- Service de Cancérologie Cervico-faciale, Gustave Roussy, Université Paris-Saclay, F-94805 Villejuif, France
| | - Maurice Cheugoua-Zanetsie
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Ligue Contre le Cancer, INSERM, Université Paris-Saclay, Villejuif, France
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Marshall R Posner
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Everett E Vokes
- Section of Hematology-Oncology, The University of Chicago Medical Center, Chicago, IL, USA
| | | | - Zbigniew Szutkowski
- Department of Radiotherapy, Cancer Center, Marie Curie-Sklodowska Memorial Institute, Warsaw, Poland
| | - Eric Lartigau
- Department of Radiotherapy, Centre Oscar Lambret, Lille, France
| | - Volker Budach
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Rafal Suwiński
- Radiotherapy and Chemotherapy Clinic and Teaching Hospital, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Michael Poulsen
- Radiation Oncology Services, Mater Centre, Brisbane, QLD, Australia
| | - Shaleen Kumar
- Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | | | | | - John Simes
- NHMRC Clinical Trials Center, Camperdown, NSW, Australia
| | - Lai-Ping Zhong
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jens Overgaard
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Pedro Torres-Saavedra
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Jean Bourhis
- Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France; Department of Radiotherapy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Anne Aupérin
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Ligue Contre le Cancer, INSERM, Université Paris-Saclay, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Pierre Blanchard
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Ligue Contre le Cancer, INSERM, Université Paris-Saclay, Villejuif, France; Department of Radiation Oncology, Gustave Roussy Cancer Campus, Université Paris-Sud, Université Paris-Saclay, F-94805 Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France.
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Lacas B, Carmel A, Landais C, Wong SJ, Licitra L, Tobias JS, Burtness B, Ghi MG, Cohen EEW, Grau C, Wolf G, Hitt R, Corvò R, Budach V, Kumar S, Laskar SG, Mazeron JJ, Zhong LP, Dobrowsky W, Ghadjar P, Fallai C, Zakotnik B, Sharma A, Bensadoun RJ, Ruo Redda MG, Racadot S, Fountzilas G, Brizel D, Rovea P, Argiris A, Nagy ZT, Lee JW, Fortpied C, Harris J, Bourhis J, Aupérin A, Blanchard P, Pignon JP. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group. Radiother Oncol 2021; 156:281-293. [PMID: 33515668 DOI: 10.1016/j.radonc.2021.01.013] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE The Meta-Analysis of Chemotherapy in squamous cell Head and Neck Cancer (MACH-NC) demonstrated that concomitant chemotherapy (CT) improved overall survival (OS) in patients without distant metastasis. We report the updated results. MATERIALS AND METHODS Published or unpublished randomized trials including patients with non-metastatic carcinoma randomized between 1965 and 2016 and comparing curative loco-regional treatment (LRT) to LRT + CT or adding another timing of CT to LRT + CT (main question), or comparing induction CT + radiotherapy to radiotherapy + concomitant (or alternating) CT (secondary question) were eligible. Individual patient data were collected and combined using a fixed-effect model. OS was the main endpoint. RESULTS For the main question, 101 trials (18951 patients, median follow-up of 6.5 years) were analyzed. For both questions, there were 16 new (2767 patients) and 11 updated trials. Around 90% of the patients had stage III or IV disease. Interaction between treatment effect on OS and the timing of CT was significant (p < 0.0001), the benefit being limited to concomitant CT (HR: 0.83, 95%CI [0.79; 0.86]; 5(10)-year absolute benefit of 6.5% (3.6%)). Efficacy decreased as patients age increased (p_trend = 0.03). OS was not increased by the addition of induction (HR = 0.96 [0.90; 1.01]) or adjuvant CT (1.02 [0.92; 1.13]). Efficacy of induction CT decreased with poorer performance status (p_trend = 0.03). For the secondary question, eight trials (1214 patients) confirmed the superiority of concomitant CT on OS (HR = 0.84 [0.74; 0.95], p = 0.005). CONCLUSION The update of MACH-NC confirms the benefit and superiority of the addition of concomitant CT for non-metastatic head and neck cancer.
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Affiliation(s)
- Benjamin Lacas
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France
| | | | | | | | | | | | | | | | | | - Cai Grau
- H. Lee Moffitt Cancer Center & Research Institute, USA
| | | | | | - Renzo Corvò
- Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer, India
| | - Volker Budach
- State University of New York Downstate Medical Center, USA
| | | | | | | | | | | | - Pirus Ghadjar
- Johns Hopkins Univ/Sidney Kimmel Cancer Center, MD, USA
| | - Carlo Fallai
- Centre Hospitalier Universitaire de Tours, France
| | | | - Atul Sharma
- Cancer Research UK & UCL Cancer Trials Centre, UK
| | | | | | - Séverine Racadot
- Princess Margaret Cancer Centre/University of Toronto, Ontario, Canada
| | | | | | - Paolo Rovea
- Kragulevac University Hospital, Yugoslavia, Serbia
| | | | | | | | | | | | - Jean Bourhis
- Institut Saint Catherine, France; Stanford University School of Medicine, CA, USA
| | - Anne Aupérin
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France
| | - Pierre Blanchard
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France; University of Texas-MD Anderson Cancer Center, USA.
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11
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Zakeri K, Rotolo F, Lacas B, Vitzthum LK, Le QT, Gregoire V, Overgaard J, Hackshaw A, Zackrisson B, Parmar MKB, Burtness BA, Ghi MG, Sanguineti G, O'Sullivan B, Fortpied C, Bourhis J, Shen H, Harris J, Michiels S, Pignon JP, Mell LK. Predictive classifier for intensive treatment of head and neck cancer. Cancer 2020; 126:5263-5273. [PMID: 33017867 DOI: 10.1002/cncr.33212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/24/2020] [Accepted: 06/10/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study was designed to test the hypothesis that the effectiveness of intensive treatment for locoregionally advanced head and neck cancer (LAHNC) depends on the proportion of patients' overall event risk attributable to cancer. METHODS This study analyzed 22,339 patients with LAHNC treated in 81 randomized trials testing altered fractionation (AFX; Meta-Analysis of Radiotherapy in Squamous Cell Carcinomas of Head and Neck [MARCH] data set) or chemotherapy (Meta-Analysis of Chemotherapy in Head and Neck Cancer [MACH-NC] data set). Generalized competing event regression was applied to the control arms in MARCH, and patients were stratified by tertile according to the ω score, which quantified the relative hazard for cancer versus competing events. The classifier was externally validated on the MACH-NC data set. The study tested for interactions between the ω score and treatment effects on overall survival (OS). RESULTS Factors associated with a higher ω score were a younger age, a better performance status, an oral cavity site, higher T and N categories, and a p16-negative/unknown status. The effect of AFX on OS was greater in patients with high ω scores (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.85-0.99) and medium ω scores (HR, 0.91; 95% CI, 0.84-0.98) versus low ω scores (HR, 0.97; 95% CI, 0.90-1.05; P for interaction = .086). The effect of chemotherapy on OS was significantly greater in patients with high ω scores (HR, 0.81; 95% CI, 0.75-0.88) and medium ω scores (HR, 0.86; 95% CI, 0.78-0.93) versus low ω scores (HR, 0.96; 95% CI, 0.86-1.08; P for interaction = .011). CONCLUSIONS LAHNC patients with a higher risk of cancer progression relative to competing mortality, as reflected by a higher ω score, selectively benefit from more intensive treatment.
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Affiliation(s)
- Kaveh Zakeri
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Federico Rotolo
- Ligue Nationale Contre le Cancer Meta-Analysis Plateform, Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Centre d'Etude des Supports de Publicite, Institut National de la Santé et de la Recherche Médicale U1018, Université Paris Sud, Université Paris-Saclay, Villejuif, France
| | - Benjamin Lacas
- Ligue Nationale Contre le Cancer Meta-Analysis Plateform, Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Centre d'Etude des Supports de Publicite, Institut National de la Santé et de la Recherche Médicale U1018, Université Paris Sud, Université Paris-Saclay, Villejuif, France
| | - Lucas K Vitzthum
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | | | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Allan Hackshaw
- Cancer Research United Kingdom and University College London Cancer Trials Centre, Cancer Institute, University College London Hospital, London, United Kingdom
| | - Björn Zackrisson
- Department of Radiation Sciences-Oncology, Umeå University, Umeå, Sweden
| | - Mahesh K B Parmar
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
| | | | | | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Fortpied
- Headquarters, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Jean Bourhis
- Department of Radiotherapy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Hanjie Shen
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, Pennsylvania
| | - Stefan Michiels
- Ligue Nationale Contre le Cancer Meta-Analysis Plateform, Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Centre d'Etude des Supports de Publicite, Institut National de la Santé et de la Recherche Médicale U1018, Université Paris Sud, Université Paris-Saclay, Villejuif, France
| | - Jean-Pierre Pignon
- Ligue Nationale Contre le Cancer Meta-Analysis Plateform, Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Centre d'Etude des Supports de Publicite, Institut National de la Santé et de la Recherche Médicale U1018, Université Paris Sud, Université Paris-Saclay, Villejuif, France
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
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12
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Alessandrini L, Franz L, Ottaviano G, Ghi MG, Lanza C, Blandamura S, Marioni G. Prognostic role of programmed death ligand 1 (PD-L1) and the immune microenvironment in laryngeal carcinoma. Oral Oncol 2020; 108:104836. [PMID: 32512470 DOI: 10.1016/j.oraloncology.2020.104836] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The immune system is crucial in the evolution of head and neck cancer. Programmed cell death ligand 1 (PD-L1) seems to rely on close relations between neoplastic cells and immune cells in the tumor microenvironment. The main aim of this study was to apply univariate/multivariate analysis to investigate the prognostic significance of PD-L1, tumor-infiltrating lymphocytes (TILs), and tertiary lymphoid structures (TLS) in laryngeal carcinoma (LSCC). MATERIALS AND METHODS PD-L1 (in terms of combined positive score [CPS]), TILs and TLS were assessed at pathology on 70 consecutive samples of LSCC. RESULTS A CPS ≥ 1 coincided with a lower recurrence rate (RR) (p = 0.007) and longer disease-free survival (DFS) than a CPS < 1 (p = 0.0027). Cases with higher TIL counts showed a lower RR (p = 0.036) and longer DFS than those with lower TIL counts (p = 0.0062). Cases revealing TLS had a lower RR (p = 0.004) and longer DFS (p = 0.0034) than those with no TLS. On multivariate analysis, the presence of TLS retained its positive prognostic value (p = 0.024), while CPS remained significant as regards disease recurrence (p = 0.050). CONCLUSIONS PD-L1 seems to be an indirect marker of effective anti-tumor response in LSCC, possibly being expressed as a result of a greater immune pressure on cancer cells. The presence of TLS emerged as a positive prognostic factor. Further prospective studies are needed to characterize the role of PD-L1 as a marker of anti-tumor immune response and prognostic factor in LSCC, also with regard to the effectiveness of immunotherapeutic protocols.
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Affiliation(s)
| | - Leonardo Franz
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Giancarlo Ottaviano
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Maria Grazia Ghi
- Oncology Unit 2, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Cristiano Lanza
- Department of Medicine DIMED, Padova University, Padova, Italy
| | | | - Gino Marioni
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy.
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13
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Ferrari D, Ghi MG, Franzese C, Codecà C, Gau M, Fayette J. The Slippery Role of Induction Chemotherapy in Head and Neck Cancer: Myth and Reality. Front Oncol 2020; 10:7. [PMID: 32038985 PMCID: PMC6989487 DOI: 10.3389/fonc.2020.00007] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/06/2020] [Indexed: 12/17/2022] Open
Abstract
Chemoradiotherapy as an alternative to surgery can be offered to patients affected by loco-regionally advanced head and neck cancer (HNC). Induction chemotherapy is a valid option, supported by few positive trials, but its real efficacy is still a matter of debate. The standard regimen for induction chemotherapy in Europe is a combination of docetaxel (75 mg/m2) and reduced dose doses of cisplatin (75 mg/m2) and 5-fluorouracil (750 mg/m2 day, for five consecutive days) (TPF). It is less toxic and more effective than the historical therapy PF (cisplatin 100 mg/m2 and fluorouracil 1,000 mg/m2/day for five consecutive days). However, in some studies treatment-related mortality has been reported to be as high as 6%. Therefore, some less toxic combinations, such as a modified TPF regimen and the combination of carboplatin plus paclitaxel have been studied. These regimens are showing promising results but deserve further validation in comparative trials. Furthermore, several trials are underway in order to enhance TPF with immune checkpoints inhibitors. Compared to chemoradiotherapy, induction chemotherapy followed by chemoradiation was shown to be non-inferior, and it could decrease the distant metastatic progression, especially in high-risk populations. For selected patients, induction chemotherapy could be a strong option. The chemoselective process that leads to immediate surgery for non-responders, the high response rate (complete responses are sometimes observed), and the survival data, are all arguments in favor of induction chemotherapy, if performed in experienced centers involving health professionals in the context of a skilled multidisciplinary team.
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Affiliation(s)
- Daris Ferrari
- Department of Oncology, San Paolo Hospital, Milan, Italy
| | | | - Ciro Franzese
- Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center, Rozzano, Italy
| | - Carla Codecà
- Department of Oncology, San Paolo Hospital, Milan, Italy
| | - Max Gau
- Rhône-Alpes, Centre de Lutte Contre le Cancer Léon Bérard, Lyon, France
| | - Jerome Fayette
- Rhône-Alpes, Centre de Lutte Contre le Cancer Léon Bérard, Lyon, France
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14
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Benasso M, Bonomo P, Buglione M, Ghi MG, Licitra L, Magrini SM, Merlano MC, Presutti L, Ronzino G, Ferrari D. Selection of systemic therapy in patients with locally advanced and recurrent/metastatic head and neck cancer: RAND-based expert opinion by an Italian multidisciplinary panel. Tumori 2019; 106:300891619868289. [PMID: 31462160 DOI: 10.1177/0300891619868289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSCC) is a heterogeneous disease often presenting at an already advanced stage. Cisplatin chemoradiotherapy is the standard treatment for locally advanced disease, although its efficacy varies according to different studies. Thus, treatment selection is a challenge, especially in older patients, who frequently have several comorbidities. Moreover, the majority of patients with recurrent and/or metastatic disease are unsuitable for local treatment, either surgery or radiation therapy. The only treatment option for them is systemic therapy, but prognosis remains poor, with a median overall survival of less than 12 months. METHODS A group of Italian key opinion leaders in the field of HNSCC gathered several times in 2018 in order to retrieve a set of statements to help clinicians in their daily decision-making process for the treatment of patients with different scenarios of HNSCC. RESULTS AND CONCLUSION The panel agreed on 22 statements that were identified as "good clinical points" based on the available literature or after discussion of the most relevant aspect of the underlying diseases when no international consensus was available. The panel identified a number of possible scenarios (namely 71) in which these statements may be helpful to guide decision-making for the best treatment selection.
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Affiliation(s)
- Marco Benasso
- 1 Medical Oncology Units, Ospedale San Paolo Savona, Ospedale Santa Corona Pietra Ligure, Pietra Ligure, Italy
| | - Pierluigi Bonomo
- 2 Department of Radiation Oncology, AOU Careggi, Università di Firenze, Firenze, Italy
| | - Michela Buglione
- 3 Department of Radiation Oncology, Istituto del Radio "Olindo Alberti," University of Brescia, Brescia, Italy
| | | | - Lisa Licitra
- 5 Department of Head and Neck Cancer, IRCCS Istituto Nazionale dei Tumori e Università di Milano, Milan, Italy
| | - Stefano Maria Magrini
- 3 Department of Radiation Oncology, Istituto del Radio "Olindo Alberti," University of Brescia, Brescia, Italy
| | | | - Livio Presutti
- 7 Otolaryngology Department, Ospedale Università di Modena, Modena, Italy
| | | | - Daris Ferrari
- 9 Department of Medical Oncology, Ospedale San Paolo, Milan, Italy
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15
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Dauzier E, Lacas B, Blanchard P, Le QT, Simon C, Wolf G, Janot F, Horiuchi M, Tobias JS, Moon J, Simes J, Deshmane V, Mazeron JJ, Mehta S, Zaktonik B, Tamura M, Moyal E, Licitra L, Fortpied C, Haffty BG, Ghi MG, Gregoire V, Harris J, Bourhis J, Aupérin A, Pignon JP. Role of chemotherapy in 5000 patients with head and neck cancer treated by curative surgery: A subgroup analysis of the meta-analysis of chemotherapy in head and neck cancer. Oral Oncol 2019; 95:106-114. [PMID: 31345376 DOI: 10.1016/j.oraloncology.2019.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/29/2019] [Accepted: 06/02/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the effect of chemotherapy added to a surgical locoregional treatment (LRT) for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS We studied the sub-group of trials with surgical LRT included in the meta-analysis on chemotherapy in head and neck cancer (MACH-NC). Data from published and unpublished randomized trials comparing the addition of chemotherapy to LRT in HNSCC patients were sought using electronic database searching for the period 1965-2000, hand searching and by contacting experts in the field. Trials with less than 60 patients, or preoperative radiotherapy or where the type of LRT could not be individually determined were excluded. All individual patient data were checked for internal consistency, compared with published reports, and validated with trialists. Data were pooled using a fixed-effect model. Heterogeneity was assessed using Cochrane test and I2 statistic. RESULTS Twenty-four trials were eligible (5000 patients). Chemotherapy improved overall survival (HR = 0.92 [95%CI: 0.85-0.99] p = 0.02). There was a significant interaction between treatment effect and timing of chemotherapy (p = 0.08 at pre-specified threshold of 0.10) with a greater effect for concomitant chemotherapy (HR = 0.79, 95%CI: 0.69-0.92). The benefit of chemotherapy was greater in women (HRwomen = 0.63, 95%CI: 0.50-0.80) compared to men (HRmen = 0.96, 95%CI: 0.89-1.04; p for interaction = 0.001). CONCLUSIONS This analysis confirmed the benefit of concomitant chemotherapy added to surgical LRT. The role of induction therapy as yet to be determined as it did not improve OS. Women may benefit more than men from chemotherapy.
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Affiliation(s)
- Etienne Dauzier
- Meta-Analysis Unit, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Benjamin Lacas
- Meta-Analysis Unit, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Pierre Blanchard
- Meta-Analysis Unit, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France; Department of Radiation Therapy, Gustave Roussy Cancer Campus, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Christian Simon
- Department of Otolaryngology and Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Gregory Wolf
- Department of Otolaryngology, University of Michigan, Ann Arbor, USA
| | - François Janot
- Département de Cancérologie Cervico-faciale, Gustave Roussy Cancer Campus, Université Paris Sud, Villejuif, France
| | - Masatoshi Horiuchi
- Department of Otolaryngology, Tokai University School of Medicine, Kanagawa, Japan
| | - Jeffrey S Tobias
- Department of Radiotherapy, University College London Hospital, London, UK
| | - James Moon
- SWOG Statistical Center, Seattle, WA, USA
| | - John Simes
- NHMRC Clinical Trials Center, Camperdown, Australia
| | - Vinay Deshmane
- Surgical Oncology & Breast Diseases, P.D. Hinduja National Hospital & Medical Research Centre, Mumbai, India
| | | | - Samir Mehta
- Department of Surgery, Sarla Hospital, Mumbai, India
| | - Branko Zaktonik
- Department of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Minoru Tamura
- Dept. of Dentistry and Oral Surgery, Shinshu University School of Medicine, Japan
| | - Elizabeth Moyal
- Département de radiothérapie, IUCT Oncopole - CLCC Institut Claudius Regaud, Toulouse, France
| | - Lisa Licitra
- Department of Medical Oncology 3, Fondazione IRCCS-Istituto Nazionale dei Tumori, Milano and University of Milan, Italy
| | | | - Bruce G Haffty
- Dept. of Therapeutic Radiology, Rutgers Robert Wood Johnson and NJ Medical School, NJ, USA
| | | | | | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, USA
| | - Jean Bourhis
- Department of Radiotherapy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Anne Aupérin
- Meta-Analysis Unit, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.
| | - Jean-Pierre Pignon
- Meta-Analysis Unit, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
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16
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Alterio D, Codecà C, Nolè F, Verri E, Orecchia R, Morelli F, Parisi S, Mastromauro C, Mione CA, Rossetto C, Polsinelli M, Koussis H, Loreggian L, Bonetti A, Campostrini F, Azzarello G, D'Ambrosio C, Bertoni F, Casanova C, Emiliani E, Guaraldi M, Bunkheila F, Bidoli P, Niespolo RM, Gava A, Massa E, Frattegiani A, Valduga F, Pieri G, Cipani T, Da Corte D, Chiappa F, Rulli E. Induction TPF followed by concomitant treatment versus concomitant treatment alone in locally advanced head and neck cancer. A phase II-III trial. Ann Oncol 2018; 28:2206-2212. [PMID: 28911070 DOI: 10.1093/annonc/mdx299] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Platinum-based chemoradiation (CCRT) is the standard treatment for Locally Advanced Head and Neck Squamous-Cell Carcinoma (LAHNSCC). Cetuximab/RT (CET/RT) is an alternative treatment option to CCRT. The efficacy of induction chemotherapy (IC) followed by chemoradiation compared to chemoradiation alone has not been demonstrated in randomized clinical trials. The goals of this phase II-III trial were to assess: (i) the overall survival (OS) of IC versus no-induction (no-IC) and (ii) the Grade 3-4 in-field mucosal toxicity of CCRT versus CET/RT. The present paper focuses on the analysis of efficacy. Materials and methods Patients with LAHNSCC were randomized to receive concomitant treatment alone [CCRT (Arm A1) or CET/RT (Arm A2)], or three cycles of induction docetaxel/cisplatin/5 fluorouracil (TPF) followed by CCRT (Arm B1) or followed by CET/RT (Arm B2). The superiority hypothesis of OS comparison of IC versus no-IC (Arms B1 + B2 versus A1 + A2) required 204 deaths to detect an absolute 3-year OS difference of 12% (HR 0.675, with 80% power at two-sided 5% significance level). Results 414 out of 421 patients were finally analyzed: 206 in the IC and 208 in the no-IC arm. Six patients were excluded because of major violation and one because of metastatic disease at diagnosis. With a median follow-up of 44.8 months, OS was significantly higher in the IC arm (HR 0.74; 95% CI 0.56-0.97; P = 0.031). Complete Responses (P = 0.0028), Progression Free Survival (P = 0.013) and the Loco-regional Control (P = 0.036) were also significantly higher in the IC arm. Compliance to concomitant treatments was not affected by induction TPF. Conclusions IC followed by concomitant treatment improved the outcome of patients with LAHNSCC without compromising compliance to the concomitant treatments. The degree of the benefit of IC could be different according to the type of the subsequent concomitant strategy. Clinical Trial Number NCT01086826, www.clinicaltrials.gov.
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Affiliation(s)
- M G Ghi
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - A Paccagnella
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - D Ferrari
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | - P Foa
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | | | - C Codecà
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | - F Nolè
- Unit of Urogenital and Head and Neck Oncology, Istituto Europeo di Oncologia, Milano
| | - E Verri
- Unit of Urogenital and Head and Neck Oncology, Istituto Europeo di Oncologia, Milano
| | | | | | - S Parisi
- U.O.C. Radiation Oncology, IRCCS Casa Sollievo della Sofferenza, San Giovanni, Rotondo
| | - C Mastromauro
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - C A Mione
- Radiotherapy Department, Ospedale SS Giovanni e Paolo, Venezia
| | | | - M Polsinelli
- S.O.C. Radiation Oncology, Azienda Ospedaliero-Universitaria S.Maria della Misericordia, Udine
| | - H Koussis
- Medical Oncology Department 2, Istituto Oncologico Veneto- IRCCS, Padova
| | - L Loreggian
- Radiotherapy Department, Istituto Oncologico Veneto - IRCCS, Padova
| | - A Bonetti
- Medical Oncology Department, Ospedale Mater Salutis, Legnago
| | - F Campostrini
- Radiotherapy Department, Ospedale Mater Salutis, Legnago
| | - G Azzarello
- Oncology Unit, Department of Internal Medical Sciences, Mirano
| | | | - F Bertoni
- Radiotherapy Department, Azienda Ospedaliero Universitaria, Modena
| | | | - E Emiliani
- Radiotherapy Department, Azienda USL, Ravenna
| | - M Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna
| | - F Bunkheila
- Radiotherapy Department, Policlinico Sant'Orsola-Malpighi, Bologna
| | - P Bidoli
- Medical Oncology Department, Ospedale San Gerardo, Monza
| | - R M Niespolo
- Radiotherapy Department, Ospedale San Gerardo, Monza, Ospedale San Gerardo, Monza
| | - A Gava
- Radiotherapy Department, Ospedale Ca' Foncello, Treviso
| | - E Massa
- Department of Medical Science, Università degli Studi di Cagliari, Cagliari
| | - A Frattegiani
- Radiation Oncology Department, Ospedale S. Maria della Misericordia, Perugia
| | - F Valduga
- Medical Oncology Department, Ospedale S. Chiara, Trento
| | - G Pieri
- Medical Oncology Department, AO Triestina, Trieste
| | - T Cipani
- Niguarda Cancer Center, Ospedale Niguarda Cà Granda, Milano
| | - D Da Corte
- Oncology Department, Ospedale S. Martino, Belluno
| | - F Chiappa
- Laboratory of Clinical Research, Istituto di Ricerche Farmacologiche "Mario Negri," Milano, Italy
| | - E Rulli
- Laboratory of Clinical Research, Istituto di Ricerche Farmacologiche "Mario Negri," Milano, Italy
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Cossu Rocca M, Verri E, Morelli F, Azzarello G, D'Ambrosio C, Cruciani G, Guaraldi M, Massa E, Rossetto C, Bonetti A, Siena S, Minotti V, Koussis H, Pieri G, Baggio V, Floriani I. Concomitant chemoradiation (CRT) or cetuximab/RT (CET/RT) versus induction Docetaxel/ Cisplatin/5-Fluorouracil (TPF) followed by CRT or CET/RT in patients with Locally Advanced Squamous Cell Carcinoma of Head and Neck (LASCCHN). A randomized phase III factorial study (NCT01086826). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.6004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Daris Ferrari
- Medical Oncology Unit, San Paolo Hospital, Milan, Italy
| | - Paolo Foa
- Medical Oncology, San Paolo Hospital, Milano, Italy
| | - Maria Cossu Rocca
- Medical Oncology Unit of Urogenital and Head and Neck Tumors- European Institute of Oncology, Milano, Italy
| | - Elena Verri
- Medical Oncology Unit of Urogenital and Head and Neck Tumors- European Institute of Oncology, Milano, Italy
| | - Franco Morelli
- U.O.C. Oncologia, IRCCS Caa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Azzarello
- Department of Internal Medical Sciences,Oncology Unit ASL 13, Mirano, Italy
| | | | | | - Monica Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Elena Massa
- Dipartimento di Scienze Mediche Internistiche, Cagliari, Italy
| | - Ciro Rossetto
- Department of Oncology University Hospital - Udine, Udine, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital-AULSS 21 della Regione Veneto, Legnago, Italy
| | | | - Vincenzo Minotti
- Division of Medical Oncology, Azienda Ospedaliera, Perugia, Italy
| | | | - Gabriella Pieri
- Oncology Department, Oncology Unit, Ospedali Riuniti di Trieste, Trieste, Italy
| | - Vittorio Baggio
- Division of Medical Oncology, Ospedale Cà Foncello, Treviso, Italy
| | - Irene Floriani
- Laboratory of Clinical Trials, Oncology Department, Istituto di Ricerche Farmacologiche, Milano, Italy
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Cossu Rocca M, Verri E, Maiello E, Azzarello G, D'Ambrosio C, Casanova C, Guaraldi M, Mantovani G, Rossetto C, Bonetti A, Cipani T, Crino L, Koussis H, Pieri G, Gava A, Floriani I. A phase II-III study comparing concomitant chemoradiotherapy (CRT) versus cetuximab/RT (CET/RT) with or without induction docetaxel/cisplatin/5-fluorouracil (TPF) in locally advanced head and neck squamous cell carcinoma (LASCCHN): Efficacy results (NCT01086826). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6003 Background: This is the first phase III study directly comparing CRT vs CET/RT in LASCCHN. Primary endpoints of this study were to compare: 1) overall survival (OS) of induction vs. no induction arms; 2) Grade 3-4 in-field toxicity of CRT vs. CET/RT. Preliminary toxicity results of concomitant treatments (primary endpoint for this comparison) were reported at the 2012 ASCO meeting. Here we present response rate and survival data for the two concomitant treatments (CRT vs. CET/RT), irrespective of induction chemotherapy. Methods: Untreated patients with unresectable LASCCHN, stage III-IV, ECOG PS 0–1 were randomized to a 2x2 factorial design: Arm A1: CRT (2 cycles of cisplatin/5fluorouracil concomitant to RT); Arm A2: CET/RT; Arm B1: 3 cycles of TPF followed by the same CRT; Arm B2:3 cycles of TPF followed by CET/RT. Results: A total of421 patients were randomized: 261 received CRT (131 Arm A1+ 130 Arm B1) and 160 received CET/RT (80 Arm A2+ 80 Arm B2). 82% were male; median age was 60y; PS of 0 (79%) or 1 (21%). Stage was III (32%) or IV (68%). Sites of disease were: oral cavity 20%, oropharynx 57%, hypopharynx: 23%. No significant differences were observed in patients’ characteristics distribution. At a median follow-up of 32.9 months, a total of 174 deaths occurred (204 required for final OS analysis). Data on activity and efficacy of CRT and CET/RT are shown in the Table. Conclusions: No significant differences were observed in response rate, progression free survival and OS between CRT and CET/RT. Pts are still being followed-up to assess OS of induction vs. no induction arms. Clinical trial information: NCT01086826. [Table: see text]
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Affiliation(s)
| | | | | | - Paolo Foa
- Medical Oncology, San Paolo Hospital, Milano, Italy
| | | | - Elena Verri
- European Institute of Oncology, Milano, Italy
| | - Evaristo Maiello
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Azzarello
- Department of Internal Medical Sciences,Oncology Unit ASL 13, Mirano, Italy
| | | | | | - Monica Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | - Ciro Rossetto
- Department of Oncology University Hospital, Udine, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital-AULSS 21 della Regione Veneto, Legnago, Italy
| | - Tiziana Cipani
- Department of Oncology, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Lucio Crino
- Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Gabriella Pieri
- Oncology Department, Oncology Unit, Ospedali Riuniti di Trieste, Trieste, Italy
| | - Alessandro Gava
- Radiotherapy Department, Ospedale Ca' Foncello, Treviso, Italy
| | - Irene Floriani
- Laboratory of Clinical Trials, Oncology Department, Istituto di Ricerche Farmacologiche, Milano, Italy
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Nole F, Morelli F, Azzarello G, D'Ambrosio C, Casanova C, Guaraldi M, Mantovani G, Rossetto C, Bonetti A, Siena S, Crino L, Buffoli A, Koussis H, Pieri G, Gava A, Floriani I. Cetuximab/radiotherapy (CET+RT) versus concomitant chemoradiotherapy (cCHT+RT) with or without induction docetaxel/cisplatin/5-fluorouracil (TPF) in locally advanced head and neck squamous cell carcinoma (LASCCHN): Preliminary results on toxicity of a randomized, 2x2 factorial, phase II-III study (NCT01086826). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.5513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5513 Background: The standard treatment options for LASCCHN are cCHT+RT or CET+RT. Strategies to improve the efficacy with the integration of induction chemotherapy are being investigated. Primary endpoints of this study were to compare: 1) the overall survival (OS) of induction vs. no induction arms; 2) the Grade(G)3-4 in-field toxicity of cCHT+RT vs. CET+RT. Methods: Patients (pts) with unresectable LASCCHN, stage III-IV, ECOG PS 0–1 were randomized to a 2x2 factorial design: Arm A1: cCHT+RT (2 cycles of ciplatin/5fluorouracil); Arm A2: CET+RTX; Arm B1: 3 cycles of TPF followed by the same cCHT+RT; Arm B2: 3 cycles of TPF followed by CET+RT. A total of 204 deaths over 420 pts ( including the 101 randomized in the phase II part of the study comparing cCHT+RT with or w/o induction TPF) were required to detect a HR of death of 0.675 (A1+A2 vs. B1+B2; 2-sided a=0.05; b=0.20) and a 10% difference in G3-4 in-field mucosal toxicity (A1+B1 vs. A2+B2). Results: By February 2012, 387 pts over 413 pts were evaluable for toxicity. 82% of pts were male; median age was 60y; PS: 0=77.8% and 1=22.2%. Disease stage was III (31%) or IV (69%). Sites of disease were oral cavity (21.7%), oropharynx (54.8%), hypopharynx (23.5%). At a median follow-up of 21 months, 126 deaths occurred. Data on G3-4 in-field toxicity (primary endpoint) and compliance to cCHT+RT vs CET+RT are shown in the table. Conclusions: No advantage for CET+RT over cCHT+RT was observed regarding G3-4 in-field toxicities and feasibility. Pts are still being followed-up to assess OS. [Table: see text]
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Affiliation(s)
| | | | | | | | - Franco Nole
- Unit for Medical Care, European Institute of Oncology, Milan, Italy
| | - Franco Morelli
- Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Azzarello
- Department of Internal Medical Sciences,Oncology Unit ASL 13, Mirano, Italy
| | | | | | - Monica Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | - Ciro Rossetto
- Department of Oncology University Hospital, Udine, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital, Legnago, Italy
| | - Salvatore Siena
- Department of Oncology, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Lucio Crino
- Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | | | - Gabriella Pieri
- Oncology Department, Oncology Unit, Ospedali Riuniti di Trieste, Trieste, Italy
| | | | - Irene Floriani
- Laboratory of Clinical Trials, Oncology Department, Istituto di Ricerche Farmacologiche, Milan, Italy
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Paccagnella A, Ghi MG, Loreggian L, Buffoli A, Koussis H, Mione CA, Bonetti A, Campostrini F, Gardani G, Ardizzoia A, Dondi D, Guaraldi M, Cavallo R, Tomio L, Gava A. Concomitant chemoradiotherapy versus induction docetaxel, cisplatin and 5 fluorouracil (TPF) followed by concomitant chemoradiotherapy in locally advanced head and neck cancer: a phase II randomized study. Ann Oncol 2009; 21:1515-1522. [PMID: 20032123 DOI: 10.1093/annonc/mdp573] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Concomitant chemoradiotherapy (CT/RT) is the standard treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN). We evaluated the efficacy of induction docetaxel (Taxotere), cisplatin, and 5-fluorouracil (TPF) before CT/RT versus CT/RT alone. PATIENTS AND METHODS Patients with stage III-IVM0 SCCHN, Eastern Cooperative Oncology Group performance status of zero to one, were randomly assigned to receive CT/RT alone (arm A: two cycles of cisplatin 20 mg/m(2), days1-4, plus 5-fluorouracil 800 mg/m(2)/day 96 h continuous infusion, during weeks 1 and 6 of radiotherapy) or three cycles of TPF (arm B: docetaxel 75 mg/m(2) and cisplatin 80 mg/m(2), day 1, and 5-fluorouracil 800 mg/m(2)/day 96 h continuous infusion, every 3 weeks) followed by the same CT/RT. The primary end point was the rate of radiologic complete response (CR) at 6-8 weeks after the end of CT/RT. RESULTS A total of 101 patients were randomly allocated to the study (51 arm A; 50 arm B). CR rates were 21.2% (arm A) versus 50% (arm B). Median progression-free survival and overall survival were, respectively, 19.7 and 33.3 months (arm A) and 30.4 and 39.6 months (arm B). Hematologic and non-hematologic toxic effects during CT/RT were similar in the two arms. CONCLUSION Induction TPF followed by CT/RT was associated with higher radiologic CR in patients with locally advanced SCCHN with no negative impact on CT/RT feasibility.
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Affiliation(s)
| | - M G Ghi
- Department of Medical Oncology, Venezia
| | - L Loreggian
- Department of Radiotherapy, Istituto Oncologico Veneto, Istituto di Ricerca e Cura a Carattere Scientifico, Padova
| | - A Buffoli
- Department of Radiotherapy, Azienda Ospedaliera Universitaria, Udine
| | - H Koussis
- Department of Medical Oncology, Istituto Oncologico Veneto, IRCCS, Padova
| | - C A Mione
- Department of Radiotherapy, Ospedale SS. Giovanni e Paolo, Venezia
| | - A Bonetti
- Department of Medical Oncology, Ospedale Mater Salutis, Legnago
| | - F Campostrini
- Department of Radiotherapy, Ospedale Mater Salutis, Legnago
| | - G Gardani
- Department of Radiotherapy, S. Gerardo Hospital, Monza
| | - A Ardizzoia
- Department of Medical Oncology, S. Gerardo Hospital, Monza
| | | | - M Guaraldi
- Department of Medical Oncology, S. Orsola-Malpighi Hospital, Bologna
| | - R Cavallo
- Department of Medical Oncology, P. Cosma Hospital, Camposampiero, Padova
| | - L Tomio
- Department of Radiotherapy, S. Chiara Hospital, Trento
| | - A Gava
- Department of Radiotherapy, Ospedale Ca' Foncello, Treviso, Italy
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Paccagnella A, Oniga F, Bearz A, Favaretto A, Clerici M, Barbieri F, Riccardi A, Chella A, Tirelli U, Ceresoli G, Tumolo S, Ridolfi R, Biason R, Nicoletto MO, Belloni P, Veglia F, Ghi MG. Adding Gemcitabine to Paclitaxel/Carboplatin Combination Increases Survival in Advanced Non–Small-Cell Lung Cancer: Results of a Phase II-III Study. J Clin Oncol 2006; 24:681-7. [PMID: 16446341 DOI: 10.1200/jco.2005.03.2722] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Paclitaxel/carboplatin (PC) is one of the reference combinations in the treatment of non–small-cell lung cancer (NSCLC). No triplet novel agent combination has until now shown superiority over a two-drug combination for advanced NSCLC. We therefore conducted a clinical trial to test if paclitaxel/carboplatin/gemcitabine (PCG) increases overall survival (OS) and response rate (RR) over PC. Methods Stage IIIB patients not suitable for radical radiation treatment and stage IV chemotherapy-naive patients with measurable disease and performance status of 0 to 2 were randomly assigned to PC arm (paclitaxel 200 mg/m2 and carboplatin area under the concentration-time curve 6 day 1/q21 days) or the PCG arm (paclitaxel 200 mg/m2 and carboplatin area under the concentration-time curve 6 day 1, and gemcitabine 1,000 mg/m2 days 1 and 8 every 21 days). Results A total of 324 patients were randomly assigned to the two arms. The RR for PC arm and PCG arm were 20.2% and 46% (P < .0001). The median time to the progression was 5.1 months in the PC group and 7.6 months in the PCG group (P = .012; hazard ratio [HR] 1.34; 95% CI: 1.06 to 1.72). Median OS was 8.3 months and 10.8 months (P = .032; HR 1.309; 95% CI: 1.03 to 1.67) in favor of the PCG arm. One-year survival was 34% (PC arm) and 45% (PCG arm; P = .032). Only hematologic toxicity (neutropenia, thrombocytopenia, and anemia) was significantly increased in the PCG arm and the experimental arm required more platelet and red blood cell transfusions, and more granulocyte colony-stimulating factor usage. No toxic/early deaths were observed. Conclusion The PCG regimen offers a significant survival advantage over PC in advanced NSCLC, making PCG a treatment option for advanced NSCLC patients.
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Affiliation(s)
- Adriano Paccagnella
- Medical Oncology Department, SS Giovanni and Paolo Hospital, Venezia, Italy.
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Zorat PL, Paccagnella A, Cavaniglia G, Loreggian L, Gava A, Mione CA, Boldrin F, Marchiori C, Lunghi F, Fede A, Bordin A, Da Mosto MC, Sileni VC, Orlando A, Jirillo A, Tomio L, Pappagallo GL, Ghi MG. Randomized phase III trial of neoadjuvant chemotherapy in head and neck cancer: 10-year follow-up. J Natl Cancer Inst 2004; 96:1714-7. [PMID: 15547184 DOI: 10.1093/jnci/djh306] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In 1986, we initiated a multicenter, randomized trial to compare induction chemotherapy with cisplatin and 5-fluorouracil followed by locoregional treatment (surgery and radiotherapy or radiotherapy alone) with locoregional treatment alone in patients with head and neck squamous cell carcinoma. Here we report the long-term results of the trial. A total of 237 patients with nonmetastatic stage III or IV head and neck carcinoma were randomly assigned to receive four cycles of neoadjuvant chemotherapy followed by locoregional treatment (group A) or locoregional treatment alone (group B). Among all patients, overall survival at 5 and 10 years was 23% (95% confidence interval [CI] = 15.3% to 30.9%) and 19% (95% CI = 11.6% to 26.4%), respectively, for those in group A and 16% (95% CI = 9.6% to 23.4%) and 9% (95% CI = 3.5% to 14.7%), respectively, for those in group B (P = .13). Among operable patients, we observed no difference between group A and group B in overall survival at 5 and 10 years (group A, 31% [95% CI = 14.9% to 47.3%] and 22.7% [95% CI = 7.1% to 38.3%], respectively; group B, 43.3% [95% CI = 25.6% to 61.0%] and 14.2% [95% CI = 0.1% to 28.3%], respectively; P = .73). Among inoperable patients, overall survival at 5 and 10 years was 21% (95% CI = 12.3% to 30.1%) and 16% (95% CI = 7.7% to 23.9%), respectively, for group A and 8% (95% CI = 1.5% to 12.3%) and 6% (95% CI = 0.1% to 9.1%), respectively, for group B (log-rank P = .04). Four cycles of neoadjuvant chemotherapy is a promising approach for treating patients with inoperable advanced head and neck cancer but not for treating patients with operable disease.
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23
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Ghi MG, Paccagnella A, D'Amanzo P, Mione CA, Fasan S, Paro S, Mastromauro C, Carnuccio R, Turcato G, Gatti C, Pallini A, Nascimben O, Biason R, Oniga F, Medici M, Rossi F, Fila G. Neoadjuvant docetaxel, cisplatin, 5-fluorouracil before concurrent chemoradiotherapy in locally advanced squamous cell carcinoma of the head and neck versus concomitant chemoradiotherapy: a phase II feasibility study. Int J Radiat Oncol Biol Phys 2004; 59:481-7. [PMID: 15145166 DOI: 10.1016/j.ijrobp.2003.10.055] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2003] [Revised: 10/22/2003] [Accepted: 10/23/2003] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the feasibility of neoadjuvant docetaxel, cisplatin, and 5-fluorouracil (TPF) followed by concurrent chemoradiotherapy (CHT-RT) compared with the same CHT-RT regimen alone in locally advanced head-and-neck squamous cell carcinoma. METHODS AND MATERIALS We treated 24 patients (20 men and 4 women) who had Stage III-IVM0 squamous cell carcinoma of the oral cavity, oropharynx, nasopharynx, or hypopharynx. The median patient age was 59 years (range, 41-73 years). The stage distribution was as follows: Stage II, 1 patient; Stage III, 6 patients; and Stage IV, 17; 18 patients had a performance status of 0 and 6 had a performance status of 1. None had undergone previous CHT or RT. Group 1 underwent three cycles of CHT (carboplatin area under the curve 1.5 on Days 1-4 and 5-fluorouracil 600 mg/m(2)/d continuous infusion for 96 h) starting on Days 1, 22, and 43 during RT (one daily fraction, 66-70 Gy within 33-35 fractions). Group 2 underwent three cycles of neoadjuvant TPF (docetaxel 75 mg/m(2), cisplatin 80 mg/m(2), 5-fluorouracil 800 mg/m(2)/d continuous infusion for 96 h) followed by the same CHT-RT regimen. RESULTS After the first 16 patients, 8 in Group 1 and 8 in Group 2, the concomitant CHT-RT schedule was modified. The limiting toxicity observed during concomitant CHT-RT was similar in Groups 1 and 2, independent of neoadjuvant TPF administration. An excess of G3-G4 mucositis and other relevant toxicity that did not allowing completion of CHT-RT without interruption occurred in 44% of the patients. A reduction of at least one cycle of concurrent CHT was required in 31% of patients. On the basis of these data, the next 8 patients (Group 3) received three cycles of neoadjuvant TPF followed by two cycles only of CHT (cisplatin 20 mg/m(2) on Days 1-4 and 5-fluorouracil 800 mg/m(2)/d continuous infusion for 96 h) (PF) during Weeks 1 and 6 of the planned 7 weeks of RT. In Group 3, 25% of the patients developed World Health Organization G3-G4 mucositis. No World Health Organization hematologic G3-G4 toxicity was seen. RT interruption was required for 2 patients (25%). In 1 patient (12%), one cycle of CHT was omitted. During neoadjuvant TPF (Groups 2 and 3), the principal toxicities were G3-G4 neutropenia (37.5%) and G2 mucositis (44%). At the end of therapy, the CR rate was 62.5% for CHT-RT alone (Group 1) and 80% for neoadjuvant TPF followed by CHT-RT (Groups 2 and 3). CONCLUSION Three cycles of neoadjuvant TPF followed by two cycles of PF during RT are feasible without limiting toxicity. Three cycles of TPF were well tolerated and did not compromise subsequent concomitant CHT-RT. A randomized multicenter Phase III study has been started with the aim of comparing two cycles of PF during RT as standard treatment vs. the experimental arm with three cycles of neoadjuvant TPF followed by two cycles of PF during RT.
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Affiliation(s)
- Maria Grazia Ghi
- Department of Medical Oncology, Ospedale Civile Venezia, Venice, Italy
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Paccagnella A, Favaretto A, Oniga F, Barbieri F, Ceresoli G, Torri W, Villa E, Verusio C, Cetto GL, Santo A, De Pangher V, Artioli F, Cacciani GC, Parodi G, Soresi F, Ghi MG, Morabito A, Biason R, Giusto M, Mosconi P, Chiarion Sileni V. Cisplatin versus carboplatin in combination with mitomycin and vinblastine in advanced non small cell lung cancer. A multicenter, randomized phase III trial. Lung Cancer 2004; 43:83-91. [PMID: 14698542 DOI: 10.1016/s0169-5002(03)00280-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In advanced not selected NSCLC chemotherapy achieved an advantage of approximately 1-2 months on median survival versus best supportive care. Chemotherapy seems to improve symptoms control, even if randomised studies with quality of life as first endpoint are lacking and often chemotherapy toxicity compromises the frail cost/benefit ratio. The aim of the present study is to evaluate the impact on QoL, substituting cisplatin, a pivot drug in NSCLC therapy, with carboplatin, an analogue with an improved toxicity profile. The combination of cisplatin with Mitomycin and Vinblastine was one of the most frequently used in the palliative setting at the time of design of our study. METHODS Patients were randomized to receive MVP regimen (Mitomycin-C 8 mg/m2 d1, Vinblastine 4 mg/m2 d 1-8, Cisplatin 100 mg/m2 d1) or MVC regimen (Mitomycin-C 8 mg/m2 d1, Vinblastine 4 mg/m2 d 1-8, Carboplatin 300 mg/m2 d1) every 3 weeks. The QoL was evaluated by the Spitzer QL-Index and by the EORTC QLQ-C30+LC 13 questionnaires before chemotherapy, after one cycle, after three cycles, and then every 6 weeks in the first 6 months and every 3 months thenafter. RESULTS From September 1994 to July 1997, 153 consecutive patients were randomized to MVP (75 patients) or MVC arm (78 patients). Despite difficulties in carrying out and analysing QoL items in such patients, the global QoL evaluated by the Spitzer's questionnaire suggested an advantage for MVC regimen (P=0.05) and a significant difference was observed in global health subdomain (P=0.04). The disease-related symptoms improved with time, and the benefits lasted for the entire treatment period. When evaluated with the EORTC questionnaire there was significantly less nausea and vomiting (P=0.0001), appetite loss (P=0.01), insomnia (P=0.03), constipation (P=0.01) and peripheral neuropathy (P=0.01) in favour of MVC, and a trend for less hair loss (P=0.05). The advantage lasted for all the duration of chemotherapy. No differences were observed in global quality of life subdomain (P=0.40) between the two regimen. QoL was the first endpoint and the statistical power was inadequate to assess other parameters. However, we reported a response rate of 43.1 and 38.6%, respectively, in MVP and MVC arm (P=0.59) and a median survival of 10.2 and 7.2 months, respectively, for cisplatin and carboplatin arm (P=0.39). CONCLUSIONS The carboplatin containing regimen (MVC) has a significant better toxicity profile than the cisplatin containing (MVP) regimen as proven both by the EORTC questionnaires and by the WHO toxicity data reported by physicians. No significant differences in terms of response rate, time to progression and overall survival were observed between the two regimen. The two chemotherapy regimen showed a similar effectiveness in symptom palliation when evaluated with C30 addendum of EORTC QOL questionnaire. With the Spitzer's questionnaires a trend towards an improved quality of life index was observed during treatment with the carboplatin combination in comparison to the cisplatin combination. This difference, however, was not observed when the global quality of life was evaluated with the EORTC patients compiled questionnaires. A carboplatin containing regimen with better toxicity profile and a similar potentiality for symptoms control offers an option in comparison to similar cisplatin containing combinations in the palliative treatment of advanced NSCLC.
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Affiliation(s)
- Adriano Paccagnella
- Department of Medical Oncology, SS Giovanni and Paolo Hospital, Campo S Giovanni e Paolo, 30100 Venice, Italy.
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Paccagnella A, Favaretto A, Oniga F, Bearz A, Clerici M, Barbieri F, Riccardi A, Ghi MG, Biason R, Tumolo S. O-92 Paclitaxel/carboplatin (PC) vs paclitaxel/carboplatin/gemcitabine (PCG) in advanced NSCLC: Preliminary results of an ongoing phase II–III multicentric study. Lung Cancer 2003. [DOI: 10.1016/s0169-5002(03)91750-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Paccagnella A, Oniga F, Favaretto A, Biason R, Ghi MG. Elderly Patients with Small Cell Lung Cancer. Tumori 2002; 88:S145-7. [PMID: 11989911 DOI: 10.1177/030089160208800143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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