Three-drug Combination Increases Rates of Larynx Preservation

Three-drug Combination Increases Rates of Larynx Preservation

Among patients with locally advanced cancer of the larynx or hypopharynx, induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (5-FU) resulted in higher rates of larynx preservation than induction chemotherapy with only cisplatin and 5-FU. These results were published in the Journal of the National Cancer Institute.

The larynx contains the vocal cords, which vibrate to make sound when air is directed against them. Each year in the United States, there are more than 12,000 new diagnoses of larynx cancer.

Conventional treatment of patients with advanced, non-metastatic larynx cancer involves removal of the larynx (total laryngectomy). This eliminates the ability of the patient to speak. An advance in the treatment of larynx cancer has been the development of larynx-preserving therapies. Combinations of chemotherapy and radiation therapy, for example, allow some patients to avoid larynx removal without compromising survival.

Researchers in France recently conducted a study to determine whether a three-drug induction chemotherapy regimen resulted in higher rates of larynx preservation than a two-drug regimen. The study enrolled more than 200 people with operable, locally advanced cancer of the larynx or hypopharynx.

Half the patients received initial chemotherapy with a two-drug regimen (cisplatin and 5-FU) and half received initial chemotherapy with a three-drug regimen (docetaxel, cisplatin, and 5-FU). Patients who responded to initial chemotherapy were given additional treatment with radiation therapy with or without additional chemotherapy. Patients who did not respond to initial chemotherapy underwent surgical removal of the larynx followed by radiation therapy with or without additional chemotherapy.

  • Three-year rates of larynx preservation were 70.3% among patients treated with the three-drug chemotherapy regimen and 57.5% among patients treated with the two-drug regimen.
  • Neutropenia was more common among patients treated with the three-drug regimen. Stomatitis, thrombocytopenia, and creatinine elevation were more common among patients treated with the two-drug regimen.

The researchers concluded that the addition of docetaxel to induction chemotherapy with cisplatin and 5-FU increased rates of larynx preservation among patients with locally advanced cancer of the larynx or hypopharynx. The researchers recommend that future studies compare the three-drug induction regimen with another approach to larynx preservation—concomitant chemotherapy and radiation therapy.

Reference:

Pointreau Y, Garaud P, Chapet S et al. Randomized trial of induction chemotherapy with cisplatin and 5-fluorouracil with or without docetaxel for larynx preservation. Journal of the National Cancer Institute. 2009;101:498-506.

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