According to a recent article published in the Journal of Clinical Oncology, the addition of the chemotherapy agent Taxol® (paclitaxel) to Platinol® (cisplatin) and 5-fluorouracil (5-FU) improves outcomes compared to cisplatin/5-FU in patients with locally advanced head and neck cancer.
Approximately 40,000 people in the U.S. are diagnosed with head and neck cancer every year. Cancers of the head and neck comprise several types of cancer affecting the nasal cavity, sinuses, oral cavity, nasopharynx, oropharynx, and other sites throughout the head and neck. The American Cancer Society estimates that 11,000 people will die from head and neck cancer in 2005.
Standard treatment for head and neck cancer is largely determined by the stage (extent to which the cancer has spread) and by specific locations within the head or neck area where the cancer has spread. The patient’s overall medical condition is also a consideration. Treatment typically consists of radiation therapy, chemotherapy with surgery, or surgery alone.
Once head and neck cancer has spread from its site of origin, long-term outcomes are generally suboptimal. Locally advanced head and neck cancer refers to cancer that has spread from its site of origin, but has not spread to distant sites in the body.
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Researchers from Spain recently conducted a phase III trial to evaluate the effects of the addition of Taxol as part of a chemotherapy regimen for the treatment of locally advanced head and neck cancer. This trial included 382 patients; approximately half were treated with Taxol/cisplatin/5-FU (PCF), while the other half was treated with cisplatin/5-FU (CF). Patients were then treated with radiation therapy and additional cisplatin.
Overall, the addition of Taxol to the treatment regimen improved outcomes:
- Complete disappearances of detectable cancer occurred in 14% of patients treated with CF, compared with 33% of patients treated with PCF.
- Median time to treatment failure (time until cancer progressed, second cancer, withdrawal from trial due to side effects of therapy, or death) was 12 months for patients treated with CF, compared with 20 months for patients treated with PCF.
- Median duration of overall survival was 37 months for patients treated with CF, compared with 43 months for those treated with PCF.
- Among patients whose cancer was considered unresectable (not able to be removed by surgery), median duration of survival was improved by 10 months for those treated with PCF over those treated with CF (36 months versus 26 months, respectively).
- Treatment with PCF was actually better tolerated than treated with CF.
The researchers concluded that the addition of Taxol to cisplatin/5-FU followed by radiation therapy in the treatment of locally advanced head and neck cancer improves outcomes compared to cipsplatin/5-FU followed by radiation therapy, particularly in patients with unresectable cancer. However, future trials are necessary to determine the true benefits of initial chemotherapy compared to chemotherapy/radiation therapy. Additional trials are also needed to compare the effectiveness of chemotherapy to targeted therapies in the treatment of head and neck cancers.
Reference: Hitt R, Lopez-Pousa A, Martinez-Trufero J, et al. Phase III Study Comparing Cisplatin Plus Fluorouracil to Paclitaxel, Cisplatin, and Fluorouracil Induction Chemotherapy Followed by Chemoradiotherapy in Locally Advanced Head and Neck Cancer. Journal of Clinical Oncology. 2005; 23: 8636-8645.