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Noronha V, Patil V, Chaturvedi P, Mathrudev V, Menon N, Bhattacharjee A, Singh A, Peelay Z, Chakraborty S, Jadhav M, Alone M, Bhagyavant P, Kolkur M, Srinivas S, Das S, Roy S, Mandal T, Dsouza H, Saha S, Rai R, Srikanth A, Shah D, Khan A, Muthuluri H, Kumar A, Agarwal A, Rajpurohit A, Goli VB, Sekar A, Mantri A, Kanteti APK, Majumdar S, Khaddar S, Shenoy R, Elamarthi P, Rathnasamy N, Kashyap L, Abraham G, Booma N, Simha V, Chaukar D, Pai P, Nair S, Laskar S, Nawale K, Naidu P, Salian S, Shelar P, Raulo R, Dhumal SB, Prabhash K. Phase 3 RCT comparing docetaxel-platinum with docetaxel-platinum-5FU as neoadjuvant chemotherapy in borderline resectable oral cancer. Eur J Cancer 2024; 200:113560. [PMID: 38306841 DOI: 10.1016/j.ejca.2024.113560] [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: 10/09/2023] [Revised: 12/27/2023] [Accepted: 01/13/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NACT) with TPF (docetaxel, cisplatin, and 5FU) is one of the treatment options in very locally advanced oral cancer with a survival advantage over PF (cisplatin and 5FU). TP (docetaxel and cisplatin) has shown promising results with a lower rate of adverse events but has never been compared to TPF. METHODS In this phase 3 randomized superiority study, adult patients with borderline resectable locally advanced oral cancers were randomized in a 1:1 fashion to either TP or TPF. After the administration of 2 cycles, patients were evaluated in a multidisciplinary clinic and further treatment was planned. The primary endpoint was overall survival (OS) and secondary endpoints were progression-free survival (PFS) and adverse events. RESULTS 495 patients were randomized in this study, 248 patients in TP arm and 247 in TPF arm. The 5-year OS was 18.5% (95% CI 13.8-23.7) and 23.9% (95% CI 18.1-30.1) in TP and TPF arms, respectively (Hazard ratio 0.778; 95% CI 0.637-0.952; P = 0.015). Following NACT, 43.8% were deemed resectable, but 34.5% underwent surgery. The 5-year OS was 50.7% (95% CI 41.5-59.1) and 5% (95%CI 2.9-8.1), respectively, in the surgically resected versus unresected cohort post NACT (P < 0.0001). Grade 3 or above adverse events were seen in 97 (39.1%) and 179 (72.5%) patients in the TP and TPF arms, respectively (P < 0.0001). CONCLUSION NACT with TPF has a survival benefit over TP in borderline resectable oral cancers, with an increase in toxicity which is manageable. Patients who undergo surgery achieve a relatively good, sustained survival.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Atanu Bhattacharjee
- Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Ajay Singh
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Zoya Peelay
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Monica Jadhav
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Mitali Alone
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Manali Kolkur
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Sujay Srinivas
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Sudeep Das
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Somnath Roy
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Tanmoy Mandal
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Hollis Dsouza
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Saswata Saha
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Rahul Rai
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Anne Srikanth
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Darshit Shah
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Arif Khan
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Hemanth Muthuluri
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Amit Kumar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Amit Agarwal
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Anu Rajpurohit
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Vasu Babu Goli
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Anbarasan Sekar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Anoop Mantri
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Swaratika Majumdar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Satvik Khaddar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Ramnath Shenoy
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Prahlad Elamarthi
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Lakhan Kashyap
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - George Abraham
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Naveen Booma
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Vijay Simha
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Devendra Chaukar
- Department of Head and Neck Surgery, Tata Memorial Centre, HBNI, Mumbai, India
| | - Prathamesh Pai
- Department of Head and Neck Surgery, Tata Memorial Centre, HBNI, Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Centre, HBNI, Mumbai, India
| | - Sarbani Laskar
- Department of Radiation Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Kavita Nawale
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Priyanka Naidu
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Sushmita Salian
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Priyanka Shelar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Ravinarayan Raulo
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India.
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Ramaswamy A, Bhargava P, Srinivas S, Kannan S, Bhandare M, Chaudhari V, Mantri A, Kapoor A, Das S, Booma N, Chaugule D, Shrikhande SV, Ostwal V. Perioperative Modified FLOT Versus EOX in Locally Advanced Resectable Gastric and Gastro-Oesophageal Junction Adenocarcinoma: Results of a Matched-Pair Analysis. J Gastrointest Cancer 2023; 54:820-828. [PMID: 36242748 DOI: 10.1007/s12029-022-00867-3] [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] [Accepted: 09/25/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND OBJECTIVES There is limited real-world data on the efficacy of 2-weekly cycles of docetaxel, oxaliplatin, leucovorin, and fluorouracil (FLOT) compared to epirubicin, oxaliplatin, and capecitabine (EOX) as perioperative therapy in esophagogastric adenocarcinomas (EGAC). METHODS The data of 611 patients with EGAC treated with perioperative chemotherapy and planned for curative resection between January 2013 and December 2019 were retrieved. Patients receiving EOX and a dose-modified version of FLOT (mFLOT) were evaluated. A 1:1 matching, using age, tumour location, signet ring histology, and Eastern Cooperative Oncology Group performance status, without replacement was performed by using nearest neighbour matching method. The primary endpoint of the study was 3-year event-free survival (EFS). RESULTS A total of 593 patients (261 with EOX and 332 with mFLOT) were matched. One hundred and nighty-eight patients (76%) and 285 patients (86%) in the EOX and mFLOT cohorts underwent curative resection, respectively (p = 0.002). With a median follow-up of 35 and 53 months, respectively, the primary outcome of 3-year EFS was statistically superior in patients receiving mFLOT as compared to the EOX regimen (60% vs. 39%; p < 0.001). There was a greater incidence of grade 3 and grade 4 neutropenia (neoadjuvant: 18% vs. 2%; p < 0.001, adjuvant: 18% vs. 1%; p = 0.001) and febrile neutropenia (neoadjuvant: 8% vs. 1.1%; p < 0.001, adjuvant: 6% vs. 0; p = 0.001) with mFLOT. INTERPRETATION AND CONCLUSION mFLOT is associated with improved resection rates and survival in comparison to EOX as perioperative therapy in gastric adenocarcinomas in this large real-world cohort, with manageable increase in clinically relevant toxicities such as grade 3 and grade 4 febrile neutropenia and neutropenia.
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Affiliation(s)
- Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai, 400 012, India
| | - Prabhat Bhargava
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai, 400 012, India
| | - Sujay Srinivas
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai, 400 012, India
| | - Sadhana Kannan
- Department of Statistics, Advanced Centre for Treatment, Research and Education in Cancer Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Manish Bhandare
- Department of GI & HPB Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai, 400 012, India
| | - Vikram Chaudhari
- Department of GI & HPB Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai, 400 012, India
| | - Anoop Mantri
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai, 400 012, India
| | - Akhil Kapoor
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai, 400 012, India
| | - Sudeep Das
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai, 400 012, India
| | - Naveen Booma
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai, 400 012, India
| | - Deepali Chaugule
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai, 400 012, India
| | - Shailesh V Shrikhande
- Department of GI & HPB Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai, 400 012, India
| | - Vikas Ostwal
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai, 400 012, India.
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