Induction chemotherapy (ICT) followed by bioradiotherapy (BRT) is a validated conservative approach for fit LA-HNSCC patients (pts). However, in pts unfit for cisplatin-based chemotherapy, this treatment strategy remains a challenge. Paclitaxel in combination with anti-EGFR therapy is active and well-tolerated in the recurrent/metastatic setting. This study aims to evaluate this regimen as ICT followed by BRT.
A retrospective single institution analysis (2010-2016) of LA-HNSCC pts unfit for cisplatin-based chemotherapy (≥70 years-old and/or significant comorbidity) was performed. Pts were treated with paclitaxel plus anti-EGFR monoclonal antibody up to 9 weeks followed by radical BRT (IMRT with concurrent anti-EGFR therapy). Overall survival (OS) and progression free survival (PFS) were estimated by Kaplan-Meier method.
A total of 44 pts were evaluated: median age 72 years-old (50-83), male 42; tumor location, pts (%): larynx 14 (32), oropharynx 10 (23) (HPV+ 0), hypopharynx 9 (21), oral cavity 7 (16), cervical unknown primary 4 (9); 7thed TNM stage, pts (%): EIII 11 (25), EIVa 19 (43) and EIVb 14 (32). ECOG status 0/1/2: 1/38/5 pts. Response rate to ICT: 32 pts (73%); 5 complete responses (CR) and 27 partial responses (PR). During ICT 5 pts (11%) presented grade 3/4 adverse events, and 1 patient (2%) died due to febrile neutropenia. 37 pts (84%) continued with radical BRT: 20 pts (45%) achieved CR, and 6 of them recurred. Median follow-up: 13.5 (1-52) months. For the whole cohort, median OS and PFS were 15.6 (95% CI 4.7-26.6) and 10.4 (95% CI 7.0-13.7) months, respectively. For the 35 pts who completed ≥6 weeks of ICT, median OS and PFS were 22.2 (95% IC 7.2-37.2) and 15.6 (95% IC 8.4-22.9) months, respectively. Larynx pts showed better outcome in comparison with other locations: median OS not reached (NR) vs 10.7 (p = 0.003) and median PFS NR vs 0 (p = 0.001); 9 pts (64%) preserved a functioning larynx and were alive by the time of the analysis.
Paclitaxel plus anti-EGFR therapy was well-tolerated and might be an effective ICT regimen for LA-HNSCC pts unfit for cisplatin. In our cohort, larynx pts obtained the greatest benefit from this regimen.
Clinical trial identification
Legal entity responsible for the study
Institut Catala de Oncologia.
Has not received any funding.
All authors have declared no conflicts of interest.