Prospective Phase II Trial of PFL-Induction Chemotherapy Followed by Definitive Local Treatment for Advanced Squamous Cell Carcinoma of the Head and Neck

Abstract

Reported is an analysis of overall survival at 10 years of 102 patients with advanced squamous cell carcinoma of the head and neck (SCCHN) who were enrolled in a prospective phase II trial of high-dose cisplatin, 5-fluorouracil (5-FU), and high-dose leucovorin (PFL) induction chemotherapy followed by surgery and/or definitive radiation therapy (RT) between 1987 and 1991. Initially, 14 patients underwent primary site (PS) and neck surgery irrespective of the clinical response to PFL. The high rate of clinical and pathologic complete response (CR) to PFL prompted a switch from PS surgery to definitive RT. Of 102 patients, 18 (17.6%) who completed PFL and local-regional treatment for SCCHN between 1988 to 1991 were alive in December 2000. Among these, 1 of 14 patients (7%) who had undergone PS resection and 17 of 85 (20%) who were treated after PFL with definitive RT but without PS surgery were alive at 10 years. Median survival time was higher in the nonsurgical group (98.9 vs. 51.9 months). Subset analysis suggested that patients with oropharyngeal PS had the longest median survival (108.6 months). The oropharyngeal patients represented the 61% (11/18) of the long-term survivors with organ preservation. An organ preservation approach for patients with advanced SCCHN who demonstrated PS CR to chemotherapy demonstrated a trend to improved overall survival.

Paradigm Shift in the Treatment of Head and Neck Cancer: The Role of Neoadjuvant Chemotherapy

“…Investigators at the Dana Farber Cancer Institute have conducted a series of four phase II studies evaluating the addition of docetaxel to PF-based chemotherapy [22][23][24][25][26]. Those trials were built, in part, on their institutional experience using the combination of cisplatin, 5-fluorouracil, and leucovorin as induction therapy for head and neck cancer [31][32][33]. Consistently high complete (42%-61%) and overall (93%-100%) response rates were reported in this series of studies, with 3-year overall survival rates of 62%-78% [22][23][24][25][26].…”