Paclitaxel Plus Cetuximab as Induction Chemotherapy for Patients With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma Unfit for Cisplatin-Based Chemotherapy

Abstract

ObjectivesInduction chemotherapy (ICT) followed by definitive treatment is an accepted non-surgical approach for locoregionally advanced head and neck squamous cell carcinoma (LA-HNSCC). However, ICT remains a challenge for cisplatin-unfit patients. We evaluated paclitaxel and cetuximab (P-C) as ICT in a cohort of LA-HNSCC patients unfit for cisplatin.Materials and MethodsThis is a retrospective analysis of patients with newly diagnosed LA-HNSCC considered unfit for cisplatin-based chemotherapy (age >70 and/or ECOG≥2 and/or comorbidities) treated with weekly P-C followed by definitive radiotherapy and cetuximab (RT-C) between 2010 and 2017. Toxicity and objective response rate (ORR) to ICT and RT-C were collected. Median overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method. Cox regression analysis was performed to determine baseline predictors of OS and PFS.ResultsA total of 57 patients were included. Grade 3–4 toxicity rate to ICT was 54.4%, and there was a death deemed treatment-related (G5). P-C achieved an ORR of 66.7%, including 12.3% of complete responses (CR). After P-C, 45 patients (78.9%) continued with concomitant RT-C. Twenty-six patients (45.6%) achieved a CR after definitive treatment. With a median follow-up of 21.7 months (range 1.2–94.6), median OS and PFS were 22.9 months and 10.7 months, respectively. The estimated 2-year OS and PFS rates were 48.9% and 33.7%, respectively. Disease stage had a negative impact on OS (stage IVb vs. III–IVa: HR = 2.55 [1.08–6.04], p = 0.03), with a trend towards worse PFS (HR = 1.92 [0.91–4.05], p = 0.09). Primary tumor in the larynx was associated with improved PFS but not OS (HR = 0.45 [0.22–0.92], p = 0.03, and HR = 0.69 [0.32–1.54], p = 0.37, respectively).ConclusionP-C was a well-tolerated and active ICT regimen in this cohort of LA-HNSCC patients unfit for cisplatin-based chemotherapy. P-C might represent a valid ICT option for unfit patients and may aid patient selection for definitive treatment.

Head and neck carcinoma in patients not eligible for platinum

“…El uso de la QT de inducción no ha demostrado un aumento de la SG comparado con QTRT concurrente, pero puede ser una opción en pacientes con alta carga de enfermedad sintomática y para la preservación de la laringe (4). Los esquemas clásicos de QT de inducción están basados en una combinación con cisplatino (TPF) y no se dispone de estudios aleatorizados sobre el uso de QT de inducción meses; además, presentaba un perfil de tolerancia manejable (32).…”

A narrative review of the role of Eph receptors in head and neck squamous cell carcinoma

“…Chemotherapy is currently considered standard care in many malignancies, including HNSCC, and it has extensive applications either in induction, adjuvant, or neoadjuvant. The most common chemotherapeutic agents used in HNSCC are cisplatin, methotrexate, 5‐fluoruracil, and docetaxel (Sindhu & Bauman, 2019), and their combinations with cetuximab have demonstrated some benefits in some clinical settings (Marin‐Jimenez et al, 2022; Peron et al, 2014). However, induction toxicity and resistance to these agents are still the main obstacles in the treatment of advanced, recurrent, or metastasized HNSCC.…”