Weekly paclitaxel, carboplatin, cetuximab, and cetuximab, docetaxel, cisplatin, and fluorouracil, followed by local therapy in previously untreated, locally advanced head and neck squamous cell carcinoma

BACKGROUND

The survival advantage of induction chemotherapy (IC) followed by locoregional treatment is controversial in locally advanced head and neck squamous cell carcinoma (LAHNSCC). We previously showed feasibility and safety of cetuximab-based IC (paclitaxel/carboplatin/cetuximab-PCC, and docetaxel/cisplatin/5-fluorouracil/cetuximab-C-TPF) followed by local therapy in LAHNSCC. The primary end point of this phase II clinical trial with randomization to PCC and C-TPF followed by combined local therapy in patients with LAHNSCC stratified by human papillomavirus (HPV) status and T-stage was 2-year progression-free survival (PFS) compared with historical control.

PATIENTS AND METHODS

Eligible patients were ≥18 years with squamous cell carcinoma of the oropharynx, oral cavity, nasopharynx, hypopharynx, or larynx with measurable stage IV (T0-4N2b-2c/3M0) and known HPV by p16 status. Stratification was by HPV and T-stage into one of the two risk groups: (i) low-risk: HPV-positive and T0-3 or HPV-negative and T0-2; (ii) intermediate/high-risk: HPV-positive and T4 or HPV-negative and T3-4. Patient reported outcomes were carried out.

RESULTS

A total of 136 patients were randomized in the study, 68 to each arm. With a median follow up of 3.2 years, the 2-year PFS in the PCC arm was 89% in the overall, 96% in the low-risk and 67% in the intermediate/high-risk groups; in the C-TPF arm 2-year PFS was 88% in the overall, 88% in the low-risk and 89% in the intermediate/high-risk groups.

CONCLUSION

The observed 2-year PFS of PCC in the low-risk group and of C-TPF in the intermediate/high-risk group showed a 20% improvement compared with the historical control derived from RTOG-0129, therefore reaching the primary end point of the trial.

Merkel cell carcinoma in a patient with GATA2 deficiency: a novel association with primary immunodeficiency

A 55-year-old woman with GATA2 deficiency and neurofibromatosis 1 was diagnosed with Merkel cell carcinoma (MCC). This polyomavirus-associated cutaneous malignancy has previously been associated with immunosuppression and acquired immunodeficiencies such as HIV/AIDS. However, MCC has not been previously reported in the setting of underlying primary or inherited immunodeficiency.

Variables in the correct subclassification of non-small cell lung cancer (NSCLC)

e17561

Background: Targeting specific cancer growth pathways has become standard in treating NSCLC. Distinguishing subclasses of NSCLC is therefore increasingly important. However, 20–30% of cases in major clinical trials are categorized as “not otherwise specified” (NOS), similar to our cancer registry at the University of Louisville hospital. This study examines clinical and pathological variables that may affect the probability to accurately specify NSCLC histology. Methods: 147 cases of NSCLC after 2004 were randomly selected and reviewed. The variables examined included time of diagnosis, amount of tissue at diagnosis, use of immuno-histochemistry (IHC), and eligibility for systemic therapy. NOS was defined as unclassified histology, including poorly differentiated carcinoma. Results: NSCLC was confirmed by cytomorphology in all but one case. 69 cases were adeno ca (47%), 45 squamous (31%), 2 large cell (1%), 31 NOS (21%), with the percentage of NOS being constant over the years. The patient's eligibility for systemic therapy was not associated with any particular histology. Only 3/31 (10%) cases of NOS had surgical specimens, whereas 36/116 (31%) with specified histology had surgical specimens (p<0.05). 47 % of adeno ca, 24% of squamous ca, and 41% of NOS cases had IHC. Of all specimens only 39% had IHC performed. Conclusions: Cytomorphology alone is not able to subclassify all cases of NSCLC in FNA specimens. Our study found a significant association between adequate tissue quantity and correct subclassification of NSCLC. IHC helps to subclassify NSCLC, but was not done in most cases. Lack of sufficient tissue is a major reason for absent IHC's and failure to subclassify NSCLC. To retrieve genomic and proteomic information from tissue and target therapy correctly, it becomes important to do core needle biopsies whenever possible. Pathology assistance at time of biopsy to assure adequacy of the sample is another practical measure to decrease the proportion of cases with NOS.

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No significant financial relationships to disclose.