Comparison of response and toxicity of induction chemotherapy with cisplatin and 5-fluorouracil versus cisplatin and paclitaxel followed by concurrent chemoradiotherapy in advanced head and neck cancer
DOI:
https://doi.org/10.18203/2349-3933.ijam20241008Keywords:
Advanced head and neck cancer, Cisplatin 5-fluorouracil, Induction chemotherapy, Paclitaxel, ToxicityAbstract
Background: Head and neck cancer poses a prevalent oncological challenge in Bangladesh, often diagnosed in advanced stages. Standard treatment for inoperable cases involves concurrent chemo-radiotherapy, but induction chemotherapy has shown significant benefits. This study aimed to compare the response and toxicity of induction chemotherapy with cisplatin and 5-fluorouracil versus cisplatin and paclitaxel followed by concurrent chemo-radiotherapy in advanced head and neck cancer.
Methods: From January 2019 to June 2020, a multicenter study enrolled 150 cases with inoperable squamous cell carcinomas in the head and neck. Ethical approval was obtained from Bangabandhu Sheikh Mujib Medical University. Divided into two arms, Arm A had 75 patients receiving cisplatin and 5-fluorouracil, while Arm B had 75 patients receiving cisplatin and paclitaxel for three cycles.
Results: After 24 weeks of treatment, complete response rates were 53.33% in Arm A and 56.0% in Arm B, with partial response rates of 29.33% and 32.0% respectively. Overall response was 82.66% in Arm A and 88.0% in Arm B, showing no statistically significant difference (p>0.05). Arm A exhibited more anemia, oral mucositis, skin toxicity, and hand- foot syndrome, while Arm B had higher neuropathy. Hematological and non-hematologic toxicities during concurrent chemo-radiotherapy were similar in both arms.
Conclusions: Induction chemotherapy with cisplatin and paclitaxel, followed by concurrent chemo-radiotherapy, is equally effective as induction chemotherapy with cisplatin and 5-fluorouracil, followed by concurrent chemo-radiotherapy, in treating advanced head and neck squamous cell carcinoma. However, the former regimen demonstrates significantly fewer toxicities, indicating a safer treatment option.
References
Symonds P, Deehan C, Mills J, Meredith C. (eds.). Walter and Miller's textbook of radiotherapy. 6th ed. Churchil Livingstone;2012:343.
Chao K. Perez C, Brady L (eds.). Radiation Oncology: Management Decisions. 3rd ed. Philadelphia: Wolters Kluwer; 2011:81-3.
World Health Organization. International Agency for Research on Cancer. (2018a) Population fact sheets, 2018. Available at: http://gco.iarc.fr/today/data/factsheets/populations/900-world-fact- sheets.pdf. Accessed 6 March 2019.
United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2017 Revision, Volume II: Demographic Profiles (ST/ESA/SER.A/400), 2017.
Hussain, S. A. (2013). Comprehensive update on cancer scenario of Bangladesh. South Asian Journal of Cancer, 2(4), p. 279. https://doi.org/10.4103/2278- 330x.119901.
Kalam MA, Ahmed T. Cancer, Cancer Control and Bangladesh. Bangla J Plastic Surg. 2013;3(1):1-2.
Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, et al. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer, 2018. Available at: https://gco.iarc.fr/today. Accessed 29 March 2013.
National Institute of Cancer Research and Hospital. Cancer Registry Report, 2005-2007. Available at: https://www.researchgate.net/profile/Md-Habibullah-Talukder/publication/275351867_Cancer_registry_report_National_Institute_of_Cancer_research_and_Hospital_2005_-_2007/links/6003d669299bf140889ed2c5/Cancer-registry-report-National-Institute-of-Cancer-research-and-Hospital-2005-2007.pdf?_tp=eyJjb250ZXh0Ijp7ImZpcnN0UGFnZSI6InB1YmxpY2F0aW9uIiwicGFnZSI6InB1YmxpY2F0aW9uIn19. Accessed 29 March 2013.
Kurumatani N, Kirita T, Zheng Y, Sugimura M, Yonemasu K. Time trends in the mortality rates for tobacco-and alcohol-related cancers within the oral cavity and pharynx in Japan, 1950-94. J Epidemiolo 1999;9(1):46-52.
DeVita VT, Lawrence TS, Rosenberg SA (eds.). Cancer principles & practice of oncology, Cancer of the Head and Neck, 10th ed. Philadelphia, United States of America: Lippincott-Raven Publishers; 2015:422.
Pazdur R, Wagman L, Camhausen K, Hoskins W (eds.). Cancer Management: A Multidisciplinary Approach. 13th ed. Norwalk, CT: UBM Medica; 2010.
de Souza Viana L, de Aguiar Silva FC, Andrade dos Anjos Jacome A, Calheiros Campelo Maia D, Duarte de Mattos M, et al. Efficacy and safety of a cisplatin and paclitaxel induction regimen followed by chemoradiotherapy for patients with locally advanced head and neck squamous cell carcinoma. Head Neck. 2016;38(S1):E970-80.
Ghi MG, Paccagnella A, Ferrari D, Foa P, Alterio D, Codecà C, Nolè F, et al. Induction TPF followed by concomitant treatment versus concomitant treatment alone in locally advanced head and neck cancer. A phase II–III trial. Annal Oncol. 2017;28(9):2206-12.
Bari MA, Alam S, ShArmin S, Nahar S, Uddin J, Alam N. Outcome of concurrent chemo-radiotherapy and radiotherapy alone following induction chemotherapy in locally advanced squamous cell carcinoma of head and neck. Bangl Medi Research Council Bullet. 2018;44(2):93-7.
Barone C, Grillo R, Dongiovanni D, Birocco N, Rampino M, Redda MR, et al. Induction chemotherapy followed by concurrent chemoradiotherapy in advanced head and neck squamous cell carcinoma. Anticancer Res. 2008;28(2B):1285-91.
Hitt R, Hornedo J, Colomer R, Mendiola C, Brandariz A, Sevilla E, et al. A phase I/II study of paclitaxel plus cisplatin as first-line therapy for head and neck cancers: preliminary results. InSeminars in oncology 1995;22(Suppl 15):50-4.
Liu L, Fei Z, Chen M, Zhao L, Su H, Gu D, et al. Induction chemotherapy plus concurrent chemoradiotherapy versus induction chemotherapy plus volumetric modulated arc therapy alone in the treatment of stage II-IVB nasopharyngeal carcinoma patients: a retrospective controlled study. Radiat Oncol. 2018;13:1-9.
de Souza Viana L, de Aguiar Silva FC, Andrade dos Anjos Jacome A, Calheiros Campelo Maia D, Duarte de Mattos M, Arthur Jacinto A, et al. Efficacy and safety of a cisplatin and paclitaxel induction regimen followed by chemoradiotherapy for patients with locally advanced head and neck squamous cell carcinoma. Head neck. 2016;38(S1):E970-80.
Nikam BM, Singh KK, Kharde R, Nagshet S, Borade D, Moosa Z. The effect of induction chemotherapy followed by chemoradiotherapy in advanced head and neck cancer: a prospective study. Int J Res Medi Sci. 2014;2(2):476.
Vermorken JB, Remenar E, Van Herpen C, Gorlia T, Mesia R, Degardin M, et al. Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Medi. 2007;357(17):1695-704.
