TP-F that.
Top Line: Is there an induction chemo regimen we haven’t tried yet for head and neck squamous cell carcinoma (HNSCC)?
The Study: GORTEC 2007-01 recently reported that adding chemo to cetuximab for low nodal volume HNSCC improves progression free survival. GORTEC 2007-02 is the sister trial that looks at induction chemo followed by cetuximab-radiation for high nodal volume disease. Patients in this trial had to be at least N2b per AJCC 7th ed. Over half had oropharyngeal cancer, but only about a third of those had p16(+) tumors. They were randomized to either 1) taxotere/ cisplatin/ 5FU (TPF) x 3 followed by cetuximab-radiation or 2) radiation concurrent with carbo/5FU. TPF had a tremendous increase in toxicity. We're talking a 6.6% rate of treatment-related death (versus 0.6% for carbo/5FU). Was it worth it? Sadly, induction chemo was not associated with any improvement in locoregional control, progression-free or overall survival. For what it’s worth (eh hm...a 7% death rate), it did reduce the rate of distant failure as a first event. Treatment effect was not influenced by p16 status, either. Ultimately, the potential benefits of induction chemo were negated by it’s toxicity and reduction in the number of patients who are able to receive the definitive portion of therapy. It's argued that induction chemo can spare the toxicity of chemoradiation for some patients by selecting out the worst actors, but it may be sparing cures instead.
Bottom Line: Induction TPF results in worse toxicity with no improvement in outcomes for HNSCC with bulky nodal disease. | Geoffrois, J Clin Oncol 2018
The Study: GORTEC 2007-01 recently reported that adding chemo to cetuximab for low nodal volume HNSCC improves progression free survival. GORTEC 2007-02 is the sister trial that looks at induction chemo followed by cetuximab-radiation for high nodal volume disease. Patients in this trial had to be at least N2b per AJCC 7th ed. Over half had oropharyngeal cancer, but only about a third of those had p16(+) tumors. They were randomized to either 1) taxotere/ cisplatin/ 5FU (TPF) x 3 followed by cetuximab-radiation or 2) radiation concurrent with carbo/5FU. TPF had a tremendous increase in toxicity. We're talking a 6.6% rate of treatment-related death (versus 0.6% for carbo/5FU). Was it worth it? Sadly, induction chemo was not associated with any improvement in locoregional control, progression-free or overall survival. For what it’s worth (eh hm...a 7% death rate), it did reduce the rate of distant failure as a first event. Treatment effect was not influenced by p16 status, either. Ultimately, the potential benefits of induction chemo were negated by it’s toxicity and reduction in the number of patients who are able to receive the definitive portion of therapy. It's argued that induction chemo can spare the toxicity of chemoradiation for some patients by selecting out the worst actors, but it may be sparing cures instead.
Bottom Line: Induction TPF results in worse toxicity with no improvement in outcomes for HNSCC with bulky nodal disease. | Geoffrois, J Clin Oncol 2018
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