High rate of clinical complete response to weekly outpatient neoadjuvant chemotherapy in oral carcinoma patients using a new regimen of cisplatin, 5-fluorouracil, and bleomycin alternating with methotrexate and epirubicin

Abstract

BACKGROUND A Phase II trial was initiated to evaluate the response to and toxicity of a new regimen of weekly outpatient neoadjuvant chemotherapy in patients with oral carcinoma. METHODS Patients with previously untreated squamous cell carcinoma of the oral cavity were eligible for this trial. The neoadjuvant chemotherapy was comprised of cisplatin, 25 mg/m2, 5‐fluorouracil, 1000 mg/m2, and bleomycin, 10 mg/m2, mixed in normal saline as a 24‐hour intravenous (i.v.) infusion, alternating with methotrexate, 30 mg/m2, and epirubicin, 30 mg/m2, as an i.v. bolus (PFB/ME) on a weekly schedule for 8–12 weeks. In patients with American Joint Committee on Cancer Stage IV disease who completed neoadjuvant chemotherapy, surgery was preferred to radiotherapy, unless patients refused surgery. RESULTS A total of 40 patients (82.5% with Stage IV disease) with previously untreated oral carcinoma were enrolled. The median size of the primary tumor was 7 cm (range, 3–13 cm). Fifty percent of patients had tumor penetrating through the oral mucosa to the cheek skin and 62.5% had bony destruction. Detectable cervical lymph nodes were noted in 77.5% of patients. After neoadjuvant weekly chemotherapy, 22 patients (55%) showed complete response (CR) and 15 patients (37.5%) showed partial response, for an overall response rate of 92.5%. World Health Organization Grade 3/4 toxicity included mucositis (7.5%), leukopenia (25%), anemia (10%), and thrombocytopenia (2.5%). Eleven of 33 patients with Stage IV disease underwent surgery, and pathologic CR (2 patients) or microscopic residual tumor (4 patients) was noted (54.5%). CONCLUSIONS The results of the current study indicate that a weekly PFB/ME neoadjuvant chemotherapy regimen is highly effective for the treatment of patients with oral carcinoma. In addition, this regimen has low toxicity. The authors believe that implementation of this regimen into a multimodality therapy protocol deserves further study. Cancer 1999;85:1430–8. © 1999 American Cancer Society.

Histological study on pN upgrading of oral cancer

“…Micrometastases were rarely detected in the lymph nodes with sinus histiocytosis and/or follicular hyperplasia. postoperative adjuvant chemotherapy [9,16]. The detection rate was comparable to or lower than those found in similar studies on regional lymph nodes of breast cancer or colorectal cancer.…”

Silencing of the p53R2 gene by RNA interference inhibits growth and enhances 5-fluorouracil sensitivity of oral cancer cells

“…The fluoropyrimidine drug 5-fluorouracil (5-FU) is widely used in the treatment of gastrointestinal, breast, head and neck cancers [1]. In fact, the combination of 5-FU with other anticancer agents such as cisplatin and methotrexate as a neoadjuvant chemotherapy has improved the response rate for advanced oral cancer [2]. However, some patients have a poor response to 5-FU-based chemotherapy.…”

Surgical site infection after preoperative neoadjuvant chemotherapy in patients with locally advanced oral squamous cell carcinoma

“…In addition, the coagulation function can also be influenced by thrombocytopenia, and this eventually leads to more perioperative blood loss in patients who receive neoadjuvant chemotherapy. Other side effects caused by chemotherapy include nausea, emesis, mucositis, and diarrhea 12. It was anticipated that all of these side effects could lead to anorexia and poor nutritional status in patients after neoadjuvant chemotherapy.…”

“…All patients who received neoadjuvant chemotherapy as a result of locally advanced oral squamous cell carcinoma (OSCC) were identified. The regimen of neoadjuvant chemotherapy consisted of a combination of cisplatin‐based multidrugs 12, 13. Those who had no pathologic report, had been treated at other institutes, or had inadequate chart records were excluded.…”