Novel Neoadjuvant Chemotherapy Regimen Improves Responses in Head & Neck Cancer

Novel Neoadjuvant Chemotherapy Regimen Improves Responses in Locally Advanced Head and Neck Cancer

According to a recent article published in the journal Cancer, the treatment regimen consisting of neoadjuvant paclitaxel (Taxol®), Ifex® (ifosfamide) and carboplatin (Paraplatin®) appears to improve anti-cancer activity in locally advanced head and neck cancers.

Locally advanced cancers of the mouth and pharynx, or throat, refer to cancer that has spread locally outside the site of cancer origin. Treatment for locally advanced cancers of the mouth and pharynx often includes surgery with or without radiation therapy. However, cure rates following this type of therapy vary according to the completeness of the surgical removal and/or the extent of cancer spread to local lymph nodes. Often, the extensive surgery negatively affects a patient’s quality of life through disfigurement or making it difficult to speak or swallow. Researchers are evaluating therapies to improve upon the overall cancer-free survival and quality of life for patients with locally advanced cancers of the mouth and pharynx.

Locally advanced head and neck cancers are difficult to treat, with the standard approach being extensive surgery and radiation therapy. More recently, researchers have been evaluating neoadjuvant therapy in these patients in order to improve responses. Neoadjuvant therapy refers to treatment that is used prior to surgery, in an attempt to reduce the cancer size to allow for more complete surgical removal and/or kill any undetectable cancer cells that may have spread from the site of origin.

Researchers from the M.D. Anderson Cancer Center recently conducted a clinical trial evaluating a new neoadjuvant chemotherapy regimen in 52 patients with locally advanced head and neck cancer. Patients received paclitaxel, Ifex® and Paraplatin® as initial therapy. A complete disappearance of cancer, or complete response (CR), in the site of origin (primary site) occurred in 60% of patients, and a CR in the local lymph nodes occurred in 40% of patients. Over 30% of patients achieved a CR in both the primary site and local lymph nodes. Patients who achieved CR following neoadjuvant therapy were then treated with radiation therapy. Patients who achieved a partial disappearance of cancer following neoadjuvant therapy underwent either radiation alone or surgery plus radiation.

Cancer recurrence rates at one and two years following therapy were 12% and 23%, respectively. Cancer-free survival rates at one and two years following therapy were 88% and 77%, respectively. Overall survival at one and two years was 88% and 82%, respectively. In addition, organ preservation of the head and neck was achieved in 81% of patients. There was one treatment-related death; however, the majority of patients tolerated the treatment regimen relatively well.

These researchers concluded that the neoadjuvant treatment regimen consisting of paclitaxel, Ifex® and Paraplatin® may significantly improve anti-cancer responses and cancer-free survival compared to standard therapies for patients with locally advanced head and neck cancer. The researchers speculate that continued use of chemotherapy, radiation and/or biological therapies may further improve survival.

Reference: Dong M, Shin DM, Glisson BS, et al Phase II study of induction chemotherapy with paclitaxel, ifosfamide, and carboplatin (TIC) for patients with locally advanced squamous cell carcinoma of the head and neck.

Cancer. 2002;95: 322-330.

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