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

Abstract

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.

Efficacy and safety of a cisplatin and paclitaxel induction regimen followed by chemoradiotherapy for patients with locally advanced head and neck squamous cell carcinoma

“…As a safer and more tolerable induction regimen, some authors maintain that cisplatin and docetaxel, with a range of options for the third drug. The 5‐fluorouracil (5‐FU) has been replaced by capecitabine, ifosfamide, cetuximab, and gemcitabine . Other authors have replaced docetaxel with paclitaxel or split the docetaxel dose (biweekly docetaxel) to reduce hematological toxicity, whereas others omit the third agent …”

“…The 5-fluorouracil (5-FU) has been replaced by capecitabine, 29 ifosfamide, 24,26 cetuximab, 23 and gemcitabine. 34 Other authors have replaced docetaxel with paclitaxel 24,25,27,28 or split the docetaxel dose (biweekly docetaxel) 35 to reduce hematological toxicity, whereas others omit the third agent. 36 By contrast, the TPF regimen affects the administration of definitive locoregional treatment in the majority of patients with locally advanced HNSCC.…”

Phase 1 adaptive dose‐finding study of neoadjuvant gemcitabine combined with radiation therapy for patients with high‐risk extremity and trunk soft tissue sarcoma

“…Gemcitabine, both as a single agent and in combination with docetaxel, also appears to have activity against malignant fibrous histiocytoma, which is now known as undifferentiated pleomorphic sarcoma . In addition, gemcitabine has potent radiosensitizing properties; in fact, favorable clinical outcomes with gemcitabine plus radiation therapy have been reported for patients with advanced head and neck, pancreatic, and lung cancers . Preclinical data from cell lines and xenograft models also suggest that gemcitabine may have efficacy as a radiosensitizer, specifically for STS …”

“…5 In addition, gemcitabine has potent radiosensitizing properties 7 ; in fact, favorable clinical outcomes with gemcitabine plus radiation therapy have been reported for patients with advanced head and neck, pancreatic, and lung cancers. [7][8][9][10] Preclinical data from cell lines and xenograft models also suggest that gemcitabine may have efficacy as a radiosensitizer, specifically for STS. 11,12 For localized, high-risk solid tumors, our institution has had a longstanding interest in preoperative or neoadjuvant therapy, which offers several advantages, including the ability to monitor the primary tumor response in vivo and control potential sites of locoregional and distant microscopic disease upfront.…”

Chemotherapy with gemcitabine plus cisplatin in patients with advanced thymic squamous cell carcinoma: Evaluation of efficacy and toxicity

“…With this in mind, we selected the combination of gemcitabine and cisplatin (GP) because gemcitabine has a mechanism of action that differs from older agents and this combination has a relatively low toxic profile. In addition, GP has shown promising efficacy in the treatment of other squamous cell carcinomas . The objective of this study was to retrospectively evaluate the efficacy and toxicity of the GP combination as first‐line chemotherapy against advanced thymic squamous cell carcinoma.…”