Alternating gemcitabine and cisplatin with gemcitabine and radiation in stage IV squamous cell carcinoma of the head and neck

Benasso, Marco; Corvò, Renzo; Ponzanelli, A.; Sanguineti, Giuseppe; Ricci, Isabella; Pallestrini, E; Santelli, Alida; Vitale, Vito; Rosso, Riccardo

doi:10.1093/annonc/mdh138

Cited by 27 publications

(12 citation statements)

References 19 publications

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“…Although this study and the 2004 trial from Benasso et al reported an important decrease in hematologic toxicity (grade 3-4 neutropenia) compared with the first Benasso et al study from 2001, there was no major change in nonhematologic (local) toxicity [49][50][51]. Moreover, in the 2004 and 2006 trials, 2 patients and 1 patient, respectively, died during the treatment as result of neutropenic fever, leading to toxic death rates of 2% and 7% [50,51].…”

Section: Studies Reporting On Chemoradiation With Gemcitabine As Partmentioning

confidence: 49%

“…Predominantly in terms of locoregional control, the inclusion of gemcitabine into the alternating regimen seemed to be better compared with the results from the authors' own database on previously used alternating cisplatin-fluorouracil regimens [50].…”

Section: Studies Reporting On Chemoradiation With Gemcitabine As Partmentioning

confidence: 86%

“…), whereas higher weekly dosages of gemcitabine ($50 mg/m 2 ) during chemoradiation in patients with SCCHN lead to unacceptable toxicity rates [31, [39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54].…”

Section: Discussionmentioning

confidence: 99%

“…From a general point of view, late radiation effects are defined as those occurring in a follow-up period longer than 90 days (Common Terminology Criteria for Adverse Events, version 4.0). However, the ratios between patients evaluable for late toxicity and those evaluable for response, which are usually assessed within 1-3 months after treatment discontinuation, were 22/35, 17/39, and 23/38 in trials published by Shaharyar et al in 2006, and Benasso et al in 2004. Other investigators do not describe the duration of tube feeding or objective evaluation of swallowing function [41,46,51].Taken together with data provided by Popovtzer et al [48] and the current lack of large randomized trials focusing on longterm survival in gemcitabine-based chemoradiation trials, it seems that the safe level may in fact lie below 50 mg/m 2 per week.…”

Section: Discussionmentioning

confidence: 99%

“…In terms of the CR rate, the difference between very low-dose and higher-dose gemcitabine did not reach statistical significance (p 5 .087). Correspondingly, based on survival data provided in 8 studies testing higher-dose gemcitabine, a 3-year overall survival ranged from 27% to 63% [41,43,[45][46][47][49][50][51].…”

Section: Studies Reporting On Chemoradiation With Gemcitabine As Partmentioning

confidence: 99%

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Gemcitabine-Based Chemoradiation in the Treatment of Locally Advanced Head and Neck Cancer: Systematic Review of Literature and Meta-Analysis

et al. 2015

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Background. Platinum-based concurrent chemoradiation (CCRT) improves locoregional control and overall survival of locoregionally advanced (LA) squamous cell carcinoma of the head and neck (SCCHN) when compared to radiotherapy alone, but this approach is hampered by significant toxicity. Therefore, alternative ways to enhance the radiation effects are worth investigating. Gemcitabine (29,29-difluorodeoxycytidine), in addition to its activity against a variety of solid tumors, including SCCHN, is one of the most potent radiosensitizers, and it has an overall favorable safety profile. In this paper, the clinical experience with gemcitabine-based chemoradiation in the treatment of patients with LA-SCCHN is reviewed. Methods. We conducted a review of the literature on the clinical experience with radiotherapy combined with either single-agent gemcitabine or gemcitabine/cisplatin-based polychemotherapy for the treatment of patients with LA-SCCHN. We also searched abstracts in databases of major international oncology meetings from the last 20 years. A meta-analysis was performed to calculate pooled proportions with 95% confidence intervals (CIs) for complete response rate and grade 3-4 acute mucositis rate.

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Section: Studies Reporting On Chemoradiation With Gemcitabine As Partmentioning

confidence: 49%

Section: Studies Reporting On Chemoradiation With Gemcitabine As Partmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Studies Reporting On Chemoradiation With Gemcitabine As Partmentioning

confidence: 99%

See 3 more Smart Citations

Gemcitabine-Based Chemoradiation in the Treatment of Locally Advanced Head and Neck Cancer: Systematic Review of Literature and Meta-Analysis

et al. 2015

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Strategies for Non-Resectable Head and Neck Cancer

Denaro¹,

Russi²,

Merlano³

2013

Curr. Treat. Options in Oncol.

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Treatment of unresectable, locally advanced head and neck cancer consists of many different options, all of them based on radiotherapy. The main variable is represented by chemotherapy, i.e., the way in which chemotherapy is combined with radiation. More recently, the combination of cetuximab and radiotherapy emerged as a new treatment opportunity and induction chemotherapy, with the combination of docetaxel, cisplatin, and 5-fluoruracil, gained a renewed interest. Concurrent chemoradiation is based on the most robust evidence and is regarded as the leading standard of care for unresectable locally advanced head and neck cancer. Unfortunately, chemoradiation is hampered by severe toxicity and patients must be selected carefully before treatment. The experience of the staff (medical oncologists, radiation oncologists, and nurses), and in particular its familiarity with toxicity management, as well the structural facilities, play an important role in the final outcome. When the patient is unfit for chemoradiation, or when experienced staff or adequate structures are unavailable, induction chemotherapy, cetuximab and radiotherapy, or radiotherapy alone are all evidence-based alternative options. The choice among them will be based on the clinical condition of the patient, the physician's experience, and the patient's preference. Whatever is the treatment of choice, it is important to involve a multidisciplinary staff in the management of these patients. Indeed, also unresectable patients may require supportive surgical interventions before or during treatment, or removal of residual disease after treatment.

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Gemcitabine-based induction chemotherapy and concurrent with radiation in advanced head and neck cancer

2012

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To evaluate the efficacy and toxicity of gemcitabine-based induction chemotherapy followed by concurrent gemcitabine and radiotherapy in advanced squamous cell carcinoma of head and neck. A total of 28 patients with locally advanced squamous cell carcinoma of the head and neck were enrolled. All patients were treated with 2 cycles of induction gemcitabine 1 gm/m(2) on days 1 and 8 plus cisplatin 75 mg/m(2)no day 1 of a 3-week cycles followed by conventionally fractionated radiotherapy to 70 Gy in 35 fractions concurrent with weekly gemcitabine 100 mg/m(2) within 2 h before radiotherapy. Median age was 56.5 years (range, 30-68). Four patients (14.3 %) achieved complete response (CR) and 19 patients (67.9 %) had partial response (PR) after induction chemotherapy. After concurrent chemo-radiotherapy, we reported 17 (60.7 %) CR and 8 (28.6 %) PR. Median loco-regional recurrence-free survival, progression-free survival, and overall survival were 17, 12.5, and 21 months, respectively. Performance status, T stage, AJCC stage, and response to chemo-radiation were found to have significant impact on survival. Acute grade 3 toxicity of concurrent chemo-radiation included 35.7 % dysphagia, 25 % stomatitis, and 10.7 % neutropenia, whereas late grade 3 toxicity included xerostomia in 7.1 % and stomatitis in 3.6 % of patients. Gemcitabine-based induction and concurrent chemo-radiotherapy is effective treatment for locally advanced squamous cell carcinoma of head and neck with acceptable and manageable toxicity. Optimizing dose and schedule of gemcitabine-based chemo-radiation is still needed.

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Alternating gemcitabine and cisplatin with gemcitabine and radiation in stage IV squamous cell carcinoma of the head and neck

Cited by 27 publications

References 19 publications

Gemcitabine-Based Chemoradiation in the Treatment of Locally Advanced Head and Neck Cancer: Systematic Review of Literature and Meta-Analysis

Gemcitabine-Based Chemoradiation in the Treatment of Locally Advanced Head and Neck Cancer: Systematic Review of Literature and Meta-Analysis

Strategies for Non-Resectable Head and Neck Cancer

Gemcitabine-based induction chemotherapy and concurrent with radiation in advanced head and neck cancer

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