Cetuximab, Paclitaxel and Carboplatin Promising for HNSCC

Cetuximab, paclitaxel and carboplatin induction and chemoradiation is worth further evaluating for advanced head and neck squamous cell carcinoma treatment

medwireNews: Induction therapy with cetuximab, paclitaxel and carboplatin followed by chemoradiation incorporating the same therapeutic agents has promise for the treatment of advanced head and neck squamous cell carcinoma (HNSCC), suggest phase II trial results.

Of the 63 patients with resectable stage III/IV disease treated with the regimen, 70% were alive and free from disease progression and did not require surgery at the primary site 1 year after treatment, report Harold Wanebo, from Landmark Medical Center in Woonsocket, Rhode Island, USA, and co-workers.

“This regimen merits further evaluation”, the researchers say in the Annals of Oncology.

At the last follow-up, after a median of 45 months, 86% of patients achieved an objective clinical response at the primary site, including 54 patients with a complete response, and the objective radiological response rate at the primary site was 70%, with 38 patients achieving a complete response and six a partial response.

Persistent tumour was detected in just one of the 60 patients who underwent restaging biopsy at week 8 after completion of induction treatment or at week 14 after receiving 50 Gy of chemoradiation. Thus, 95% of biopsied patients and 90% of all patients achieved a pathological complete response at the primary site.

The event-free survival rate at 16 months was estimated to be 73%, meeting the primary endpoint, and overall and progression-free survival were estimated to be 97% and 82%, respectively, the researchers add.

However, clinical response and post-induction biopsy results did not predict the likelihood of local failure or event-free survival. Eighteen of the 54 patients who achieved a clinical complete response experienced recurrence, including seven patients who had a pathological complete response after induction.

“Notably, one-third of patients believed on clinical grounds to harbor tumor had no cancer on biopsies performed after completion of induction chemotherapy; however, sampling error may account for some of these cases”, the researchers comment.

Maintenance cetuximab was given on the basis that residual microscopic disease may express Epidermal growth factor receptor (EGFR), the team explains. Also, cetuximab may reduce nuclear EGFR trafficking and prevent repair of radiation-induced DNA damage and improve locoregional control.

Although Harold Wanebo et al found no significant benefit in response or overall survival with maintenance cetuximab, they note only 48% of patients were treated, which might not be a large enough number to evaluate this strategy.

Reference

Wanebo H, Lee J, Burtness B, et al. Induction cetuximab, paclitaxel and carboplatin followed by chemoradiation with cetuximab, paclitaxel and carboplatin for stage III/IV head and neck squamous cancer: A phase II ECOG-ACRIN trial (E2303). Ann Oncol 2014; First published online 9 July. doi: 10.1093/annonc/mdu248

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