According to two articles recently published in the New England Journal of Medicine, the addition of the chemotherapy agent Taxotere® (docetaxel) to Platinol® (cisplatin) and 5-fluorouracil (5-FU) improves survival over cisplatin/5-FU alone in the treatment of head and neck cancer.
Head and neck cancers originate in the oral cavity (lip, mouth, tongue), salivary glands, paranasal sinuses, and nasal cavity, pharynx (upper back part of the throat), larynx (voice box), and lymph nodes in the upper part of the neck. Worldwide, head and neck cancer is diagnosed in approximately 640,000 people annually and is responsible for approximately 350,000 deaths each year.
Advanced head and neck cancer refers to cancer that has spread from its site of origin. Patients are often treated with several different modalities, including chemotherapy, radiation therapy, and/or surgery.
Preoperative therapy including chemotherapy and/or radiation therapy is referred to as neoadjuvant therapy. Neoadjuvant therapy is often used to shrink the size of the cancer prior to the surgical removal, which may allow for a greater chance of complete removal and provide initial systemic (full-body) therapy to kill cancer cells that may have already spread. If treatment is not administered until after surgery, the patient must wait until he/she has healed from surgery; this waiting period may allow cancer cells to grow and spread further.
The first trial was conducted by researchers affiliated with the TAX 324 group. This trial included 501 patients with advanced head and neck cancer who were not considered eligible for surgery. Patients were treated with either Taxotere plus Cisplatin and 5-FU (TPF) or Cisplatin/5-FU (PF) only as initial therapy. All patients then received treatment with the chemotherapy agent Paraplatin® (carboplatin) plus radiation therapy, referred to as chemoradiotherapy. Minimum follow-up was two years.
- At three years overall survival was 63% for patients treated with TPF compared with 48% for patients treated with PF.
- Cancer spread that was at or near the site of the original cancer was significantly reduced among patients treated with TPF versus those treated with PF; however, cancer spread to distant sites in the body did not differ between the two treatment groups.
- Low levels of immune cells (neutropenia) occurred more frequently among patients treated with TPF than among patients treated with PF.
The researchers concluded that patients with “[advanced] head and neck who received docetaxel plus cisplatin and fluorouracil induction chemotherapy plus chemoradiotherapy had a significantly longer survival than did patients who received cisplatin and fluorouracil induction chemotherapy plus chemoradiotherapy.”
The second trial was conducted by researchers affiliated with the EORTC 24971/TAX 323 Study Group. This trial also compared TPF to PF among 358 patients with advanced, inoperable head and neck cancer with no spread to distant sites in the body. Patients were treated with either TPF or PF, and those whose cancer did not progress while receiving chemotherapy were treated with subsequent radiation within four to seven weeks of completing chemotherapy. The median follow-up was 32.5 months.
- Median progression-free survival was 11 months for those treated with TPF compared with 8.2 months for those treated with PF.
- Patients treated with TPF had a 27% reduced risk of death compared with patients treated with PF.
- Median overall survival was 18.8 months for patients treated with TPF compared with 14.5 months for patients treated with PF.
- Death rates from treatment-related side effects occurred in 2.3% of patients treated with TPF compared with 5.5% of patients treated with PF.
The researchers concluded: “As compared with the standard regimen of cisplatin and fluorouracil, induction chemotherapy with the addition of docetaxel significantly improved progression-free and overall survival in patients with [advanced, inoperable] head and neck [cancer].”
Patients diagnosed with advanced head and neck cancer may wish to speak with their physician regarding their individual risks and benefits of treatment that includes Taxotere.