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Taxane, platinum and 5-FU prior to chemoradiotherapy benefits patients with stage IV neck node-positive head and neck cancer and a good performance status

Abstract

Purpose

The benefit of adding docetaxel, cisplatin and 5-fluorouracil (TPF) induction chemotherapy to chemoradiotherapy (CRT) in head and neck squamous cell carcinoma (HNSCC) remains uncertain. We aimed to investigate whether ICT is well tolerated when given with prophylactic treatment against predicted adverse effects and which patients benefit most.

Methods

A single-centre audit identified 132 HNSCC patients with stage IVa/b neck node-positive disease, prescribed TPF followed by CRT. TPF involved three cycles of docetaxel (75 mg/m2 IV) and cisplatin (75 mg/m2 IV) on day 1 plus 5-FU (750 mg/m2 IV) on days 2–5. Planned CRT was 66 Gy in 30 fractions of intensity-modulated radiotherapy with concurrent cisplatin (100 mg/m2 IV) at the beginning of week 1 and 4 (days 1 and 22). All patients received prophylactic antibiotics and granulocyte colony-stimulating factor.

Results

Median follow-up was 39.5 months. 92.4% of patients completed three cycles of TPF; 95.5% of patients started chemoradiotherapy. Grade 3/4 adverse events were low (febrile neutropenia 3.0%), with no toxicity-related deaths. 3-year overall survival was 67.2%; disease-specific survival was 78.7%; locoregional control was 78.3%. Distant metastases rate was 9.8% (3.0% in those without locoregional recurrence). Good performance status (p = 0.002) and poor tumour differentiation (p = 0.018) were associated with improved overall survival on multivariate analysis.

Conclusion

With prophylactic antibiotics and granulocyte colony-stimulating factor TPF was well tolerated with good survival outcomes. TPF should remain a treatment option for stage IV neck node-positive patients with a good performance status. The use of tumour grade to aid patient selection for TPF warrants investigation.

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Acknowledgements

The authors acknowledge Jason Kennedy and Lucy E. Kershaw for help and support on the database management, Clare Hodgson for statistical review and Helen Valentine for p16 immunostaining.

Author information

Correspondence to Natalie M. Lowe.

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Funding

This study was supported by Cancer Research UK Major Centre funding, the Christie NHS Foundation Trust and NIHR Manchester Biomedical Research Centre.

Conflict of interest

All authors report no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors. For this type of study, formal consent is not required. Ethics approval for the staining of tumour samples for p16 was granted by National Research Ethics Service; NRES Committee North West–Greater Manchester East, reference number: 03/TG/076.

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Lowe, N.M., Bernstein, J.M., Mais, K. et al. Taxane, platinum and 5-FU prior to chemoradiotherapy benefits patients with stage IV neck node-positive head and neck cancer and a good performance status. J Cancer Res Clin Oncol 144, 389–401 (2018). https://doi.org/10.1007/s00432-017-2553-9

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Keywords

  • Head and neck
  • Squamous cell carcinoma
  • Induction chemotherapy
  • Outcomes
  • Tolerability