Induction chemotherapy prior to surgery with or without postoperative radiotherapy for oral cavity cancer patients: Systematic review and meta-analysis

Marta, Gustavo Nader; Riera, Rachel; Bossi, Paolo; Zhong, Lipeng; Licitra, Lisa; Macedo, Cristiane R; Castro, Gilberto de; Carvalho, André L.; William, William N.; Kowalski, Luiz Paulo

doi:10.1016/j.ejca.2015.08.007

Cited by 71 publications

(50 citation statements)

References 23 publications

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“…Patients who achieved a clinical response or favorable pathologic response (< 10% viable tumor cells) had improved OS and locoregional and distant control. A small meta-analysis did not show any improvement in clinical outcomes with neoadjuvant chemotherapy in patients with advanced OSCC [18]. Subgroup analysis of cN2 patients demonstrated a significant benefit in overall survival in favor of the neoadjuvant chemotherapy group, however this result must be interpreted with caution given the small number of patients (n = 52, 20.3%) with cN2 HNSCC in the study and the small number of events related to the assessed clinical outcomes.…”

Section: Neoadjuvant Chemotherapymentioning

confidence: 71%

The neoadjuvant paradigm reinvigorated: a review of pre-surgical immunotherapy in HNSCC

Stafford

Kaczmar

2020

Cancers Head Neck

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Background: There remains up to a 50% recurrence rate in advanced p16-head and neck squamous cell carcinoma with current standard of care treatment. In an attempt to improve survival, multiple trials administering induction or neoadjuvant chemotherapy have been conducted but none demonstrated improved overall survival. The established efficacy of immune checkpoint inhibitors in the recurrent and metastatic setting has produced widespread interest in their neoadjuvant use. Purpose: To survey the landscape of active neoadjuvant immunotherapy trials in head and neck squamous cell carcinoma and summarize and synthesize currently available outcomes from these trials. Conclusions: Neoadjuvant immunotherapy has proven safe and well tolerated in head and neck squamous cell carcinoma with encouraging efficacy results, including relatively high rates of pathologic response. Ongoing studies offer an opportunity to study immune responses in vivo. PD-L1 positivity, high tumor mutational burden and infiltration of NK cells, CD8, CD26 and Tim3 positive lymphocytes at time of surgery have been correlated with pathologic responses. We await updated reports of disease free survival and overall survival data and results of ongoing phase III studies utilizing neoadjuvant immunotherapy to determine if this treatment paradigm will have a place in the standard of care treatment in head and neck squamous cell carcinoma.

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Section: Neoadjuvant Chemotherapymentioning

confidence: 71%

The neoadjuvant paradigm reinvigorated: a review of pre-surgical immunotherapy in HNSCC

Stafford

Kaczmar

2020

Cancers Head Neck

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“…Th us, induction chemotherapy may help physicians screen for patients with hypopharyngeal cancer who are sensitive to chemotherapy and for whom radiotherapy could be used to preserve laryngeal function and help induce remission. Two-cycle induction chemotherapy has become a recommended therapy for progressive hypopharyngeal cancer as it could decrease tumor burden, improve tumor-associated symptoms, and ameliorate surgical outcomes [22]. Further, TPF has been demonstrated to improve outcomes, as compared with PF alone, but more recent phase III studies did not show a benefi t in survival when TPF induction was followed by chemotherapy and radiation, as compared with chemotherapy and radiation alone [6].…”

Section: Discussionmentioning

confidence: 99%

Value of two-cycle docetaxel, cisplatin, and 5-fluorouracil induction chemotherapy in hypopharyngeal carcinoma

Luo¹,

Zhang²,

Lian³

et al. 2018

neo

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Various studies have investigated laryngeal function and survival after induction chemotherapy in hypopharyngeal carcinoma, but potential factors to help predict response rates after induction chemotherapy remain unknown. This retro- spective study evaluated which factors are related to an ineffective response to two-cycle docetaxel, cisplatin, and 5-fluoro- uracil (TPF) induction chemotherapy in hypopharyngeal carcinoma to determine potential candidates for this treatment in clinical practice. From Jan 2005 to Dec 2015, 81 patients diagnosed with hypopharyngeal squamous cell carcinoma based on a pathological examination were analyzed. They were administered two-cycle TPF induction chemotherapy, and magnetic resonance imaging was performed before and after induction chemotherapy. The mean survival time was 5.7 years (95% confidence interval, 5.1-6.2 years). The 1, 3, 5 and 6-year survival rates were 98.8%, 80.1%, 64.5%, and 54.2%, respectively. TPF induction chemotherapy was well tolerated; the main adverse effects resolved with symptomatic treatment. A response to TPF induction chemotherapy was associated with lymph node size, tumor grade, invasion region, T stage, and primary tumor. The following issues were significantly associated with an increasing non-response rate to two-cycle induction chemotherapy: increasing lymph node size, moderately differentiated squamous cell carcinoma, invasion of the esophagus along with the thyroid cartilage, and primary tumor in the piriform sinus. Lymph nodes of ≥2.15 cm, moderately differenti- ated tumor grade, or thyroid cartilage invasion were the best cutoff values for patients who did not respond to induction chemotherapy. However, the initial cancer site, cancer stage, and degree of cancer differentiation were not closely related to the efficacy of induction chemotherapy.

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“…Conflicting results have been reported by various randomised controlled clinical trials designed with different inclusion criteria to test different chemotherapeutic regimens; results from meta-analyses were also inconsistent ( Table 2). [3][4][5]9,10 The definitions of locally advanced cancer and therefore the population of patients included in these studies were heterogeneous, ranging from cT2N0 (>3 cm) to cT4N3. 3,4 TPF has been shown to be superior to PF in multiple clinical trials and this was also confirmed in a meta-analysis using individual patient data.…”

Section: Discussionmentioning

confidence: 99%

“…As well as the study reported by Zhong et al 4 that suggested improved distant metastasis-free survival and OS in a cN2 subgroup, an updated meta-analysis performed on individual patient data obtained from two large studies (one using PF and another using TPF) has also confirmed such findings. 5 more regionally advanced cN2 tumours could benefit, reiterating the importance of patient selection for NC.…”

Section: Discussionmentioning

confidence: 99%

“…4 Although the results from another study that included patients with earlierstage disease and the use of neoadjuvant cisplatin-5fluorouracil (PF) chemotherapy were negative, 3 a pooled analysis of individual patient data derived from these two large trials yielded favourable results in the subset of cN2 patients, consolidating the role of NC in this patient subgroup, especially when TPF was used. 5 As the waiting time for definitive surgery can vary in busy local public hospitals in Hong Kong, upfront NC has the additional advantage of arresting tumour growth while awaiting surgery, particularly in those with marginal resectability. We report our single-institution experience of TPF NC given prior to definitive surgery and other adjuvant locoregional treatment in a cohort of patients with resectable stage IVA SCC of the OC.…”

Section: Introductionmentioning

confidence: 99%

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Can Neoadjuvant Chemotherapy before Definitive Surgery Improve Outcome in Operable Stage IVA Oral Cavity Cancers?

Cheung¹,

Ngan²,

Chow³

et al. 2018

Hong Kong J Radiol

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Introduction: To report the outcome for patients with stage IVA oral cavity (OC) cancer treated by docetaxelcisplatin-5-fluorouracil (TPF) neoadjuvant chemotherapy (NC) and surgery. Methods: This retrospective cohort study involved 69 consecutive patients with squamous cell carcinoma (SCC) of the OC managed from April 2012 to April 2015. Eleven stage IVA patients were treated by TPF NC before surgery following tumour board assessment. Another 11 stage IVA patients from the same cohort who received upfront surgery and adjuvant treatment were identified as controls. Results: TPF NC was given to four (36.4%) patients with a marginally resectable tumour and seven (63.6%) to prevent rapid clinical progression while awaiting definitive surgery. The median age at treatment was 55 (range, 32-65) years. A median of three (range, 3-4) cycles of NC were given. NC was well tolerated; grade 3 or 4 neutropenia or anaemia were observed in one (9.1%) patient each. Clinical complete response (CR), partial response, stable disease and progressive disease were observed in one (9.1%), five (45.4%), three (27.3%) and two (18.2%) patients, respectively. Complete (R0) resection was achieved in 10 (90.9%) patients. One (9.1%) patient had pathological CR. Median follow-up period was 49.5 months. Overall survival was significantly improved with NC (hazard ratio 0.24, median survival not reached [NR] vs. 12 months, p = 0.022). Distant relapse-free survival was also significantly improved with NC (hazard ratio 0.24, NR vs. 9.5 months, p = 0.024). Locoregional control rates were not significantly different (66% with NC vs. 53% without NC, p = 0.191). Conclusion: The outcomes of our small cohort suggested that TPF NC given before surgery could improve overall and distant relapse-free survival in patients with stage IVA OC SCC.

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Induction chemotherapy prior to surgery with or without postoperative radiotherapy for oral cavity cancer patients: Systematic review and meta-analysis

Cited by 71 publications

References 23 publications

The neoadjuvant paradigm reinvigorated: a review of pre-surgical immunotherapy in HNSCC

The neoadjuvant paradigm reinvigorated: a review of pre-surgical immunotherapy in HNSCC

Value of two-cycle docetaxel, cisplatin, and 5-fluorouracil induction chemotherapy in hypopharyngeal carcinoma

Can Neoadjuvant Chemotherapy before Definitive Surgery Improve Outcome in Operable Stage IVA Oral Cavity Cancers?

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