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Efficacy and feasibility of induction chemotherapy with paclitaxel, carboplatin and cetuximab for locally advanced unresectable head and neck cancer patients ineligible for combination treatment with docetaxel, cisplatin, and 5-fluorouracil

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Abstract

Background

Docetaxel, cisplatin, and 5-fluorouracil (TPF) induction chemotherapy (ICT) is a treatment option for locally advanced unresectable head and neck squamous cell carcinoma (LA-HNSCC). However, patients with advanced age, or renal, cardiac or neurogenic dysfunction are ineligible for ICT-TPF.

Methods

We retrospectively assessed 24 unresectable LA-HNSCC patients who received paclitaxel, carboplatin and cetuximab (PCE) as ICT at the Shizuoka Cancer Center between April 2013 and October 2018.

Results

Patient characteristics were as follows: median age, 72 years (range 60–81); 0, 1, and 2 performance status (PS), 1, 15, and 8 patients, respectively, and creatinine clearance ≥ 60 mL/min or < 60 mL/min, 8 and 16 patients, respectively. The main reasons for PCE selection were renal impairment, older age, cardiac dysfunction, poor PS, and cerebral infarction. Twenty-two patients (92%) completed two or three cycles of ICT-PCE. After ICT-PCE, one patient (4%) and 20 patients (83%) achieved a complete response and partial response, respectively. Twenty-one patients (87%) advanced to definitive locoregional treatment. Median observation period was 25.2 months. The 12-month progression-free and overall survival rates were 75 and 92%, respectively. Median progression-free survival and overall survival were 29.4 and 34.8 months, respectively. Grade 3 or 4 toxicities included neutropenia (58%), oral mucositis (8%), and febrile neutropenia (4%).

Conclusions

ICT-PCE may be a tolerable and potential option for unresectable LA-HNSCC patients ineligible for TPF.

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Abbreviations

ICT:

Induction chemotherapy

LA-HNSCC:

Locally advanced head and neck squamous cell carcinoma

CDDP:

Cisplatin

CBDCA:

Carboplatin

5-FU:

5-Fluorouracil

CRT:

Chemoradiotherapy

OS:

Overall survival

TPF:

Docetaxel, cisplatin, and 5-fluorouracil

PCE:

Paclitaxel, carboplatin and cetuximab

AUC:

Area under the blood concentration–time curve

PET:

Positron-emission tomography

CCI:

Charlson comorbidity index

PFS:

Progression-free survival

CR:

Complete response

PR:

Partial response

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Funding

No specific funding was received in support of this study.

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Authors and Affiliations

  1. Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho Sunto-gun, Shizuoka, 411-8777, Japan

    Hiromichi Shirasu, Tomoya Yokota, Takeshi Kawakami & Satoshi Hamauchi

  2. Division of Medical Oncology, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan

    Yusuke Onozawa

  3. Division of Radiation Oncology and Proton Therapy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan

    Hirofumi Ogawa & Tsuyoshi Onoe

  4. Clinical Research Center, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan

    Keita Mori

  5. Division of Head and Neck Surgery, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan

    Tetsuro Onitsuka

Authors
  1. Hiromichi Shirasu
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  2. Tomoya Yokota
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  3. Takeshi Kawakami
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  4. Satoshi Hamauchi
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  5. Yusuke Onozawa
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  6. Hirofumi Ogawa
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  7. Tsuyoshi Onoe
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  8. Keita Mori
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  9. Tetsuro Onitsuka
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Corresponding author

Correspondence to Tomoya Yokota.

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Shirasu, H., Yokota, T., Kawakami, T. et al. Efficacy and feasibility of induction chemotherapy with paclitaxel, carboplatin and cetuximab for locally advanced unresectable head and neck cancer patients ineligible for combination treatment with docetaxel, cisplatin, and 5-fluorouracil. Int J Clin Oncol 25, 1914–1920 (2020). https://doi.org/10.1007/s10147-020-01742-6

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  • DOI: https://doi.org/10.1007/s10147-020-01742-6

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