Skip to main content
SpringerLink
Log in

Induction chemotherapy with the EXTREME regimen in frail patients with locally advanced head and neck squamous cell carcinoma

  • Short Communication
  • Published:
Targeted Oncology Aims and scope Submit manuscript

Abstract

Background

Induction chemotherapy (IC) with TPF (docetaxel, cisplatin, 5FU) for locally advanced head and neck squamous cell carcinoma (LAHNSCC) is limited to fit patients.

Objective

We conducted a retrospective cohort study to assess the use of the EXTREME regimen (platinum-based therapy, 5FU, cetuximab) as IC in frail patients with LAHNSCC.

Patients and methods

Retrospective analysis of all consecutive patients with unresectable LAHNSCC treated with the EXTREME regimen, with or without 5FU as IC, from two French centers from 2008 to 2015. We assessed the rate of completed sequence defined as at least two cycles of IC and definitive radiation therapy.

Results

We included 34 patients with a median age of 56 years [44-70]. The primary site of tumor development was the oropharynx (67%, n=23, all HPV negative), hypopharynx (21%, n=7) and the oral cavity (12%, n=4). At inclusion, patients presented: T4 76, 5% (n=26), N2c 41% (n=14), N3 26% (n=9), stage disease IVa 62% (n=21), IVb 38% (n=13), ECOG PS2 38% (n=13), decreased weight (10% in one month or 15% in 6 months) 74% (n=25). The sequence was achieved for 76% (n=26) of patients and 80% (n=27) presented a clinical response after the chemotherapy course with notably increased weight (40%, n=11) or general status (75%, n=26). Median PFS and OS were 5.7 and 15.5 months, respectively. Disease progression at 3 months was significantly associated with decreased median overall survival (13.6 versus 21.9 months, p=0.01).

Conclusion

This is the first study to report the use of the EXTREME regimen as induction chemotherapy, and although this IC was used in a very frail population, the majority completed the sequence with significant clinical benefit.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67(1):7–30.

    Article  PubMed  Google Scholar 

  2. Ma J, Liu Y, Huang X-L, Zhang Z-Y, Myers JN, Neskey DM et al. Induction chemotherapy decreases the rate of distant metastasis in patients with head and neck squamous cell carcinoma but does not improve survival or locoregional control: a meta-analysis. Oral Oncol. 2012;48:1076–84.

    Article  CAS  PubMed  Google Scholar 

  3. Pignon J-P, le Maître A, Maillard E, Bourhis J, MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol. 2009;92:4–14.

    Article  PubMed  Google Scholar 

  4. Blanchard P, Bourhis J, Lacas B, Posner MR, Vermorken JB, Hernandez JJC et al. Taxane-cisplatin-fluorouracil as induction chemotherapy in locally advanced head and neck cancers: an individual patient data meta-analysis of the meta-analysis of chemotherapy in head and neck cancer group. J Clin Oncol. 2013;31:2854–60.

    Article  CAS  PubMed  Google Scholar 

  5. Geoffrois L, Martin L, Garaud P, Raucourt DD, Miny J, Maingon P et al. Induction docetaxel platinum 5-FU (TPF) followed by cetuximab-radiotherapy (cetux-RT) versus concurrent chemo-radiotherapy (CT/RT) in patients with N2b/c-N3 non operated stage III-IV squamous cell cancer of the head and neck (SCCHN): results of the GORTEC 2007-02 phase III randomized trial. J Clin Oncol. 2016;34(15_suppl):6000.

    Google Scholar 

  6. 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 Med. 2007;357:1695–704.

    Article  CAS  PubMed  Google Scholar 

  7. Vermorken JB, Mesia R, Rivera F, Remenar E, Kawecki A, Rottey S et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med. 2008;359:1116–27.

    Article  CAS  PubMed  Google Scholar 

  8. Adelstein DJ, Li Y, Adams GL, Wagner H, Kish JA, Ensley JF et al. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol. 2003;21:92–8.

    Article  PubMed  Google Scholar 

  9. Kies MS, Holsinger FC, Lee JJ, William WN, Glisson BS, Lin HY et al. Induction chemotherapy and cetuximab for locally advanced squamous cell carcinoma of the head and neck: results from a phase II prospective trial. J Clin Oncol. 2010;28:8–14.

    Article  CAS  PubMed  Google Scholar 

  10. Argiris A, Heron DE, Smith RP, Kim S, Gibson MK, Lai SY et al. Induction docetaxel, cisplatin, and cetuximab followed by concurrent radiotherapy, cisplatin, and cetuximab and maintenance cetuximab in patients with locally advanced head and neck cancer. J Clin Oncol. 2010;28:5294–300.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Wanebo HJ, Lee J, Burtness BA, Ridge JA, Ghebremichael M, Spencer SA et al. Induction cetuximab, paclitaxel, and carboplatin followed by chemoradiation with cetuximab, paclitaxel, and carboplatin for stage III/IV head and neck squamous cancer: a phase II ECOG-ACRIN trial (E2303). Ann Oncol. 2014;25:2036–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Posner MR, Hershock DM, Blajman CR, Mickiewicz E, Winquist E, Gorbounova V et al. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med. 2007;357:1705–15.

    Article  CAS  PubMed  Google Scholar 

  13. Cohen EEW, Karrison TG, Kocherginsky M, Mueller J, Egan R, Huang CH et al. Phase III randomized trial of induction chemotherapy in patients with N2 or N3 locally advanced head and neck cancer. J Clin Oncol. 2014;32:2735–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Haddad R, O’Neill A, Rabinowits G, Tishler R, Khuri F, Adkins D et al. Induction chemotherapy followed by concurrent chemoradiotherapy (sequential chemoradiotherapy) versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer (PARADIGM): a randomised phase 3 trial. Lancet Oncol. 2013;14:257–64.

    Article  CAS  PubMed  Google Scholar 

  15. Mesía R, Vázquez S, Grau JJ, García-Sáenz JA, Lozano A, García C et al. A phase 2 open label, single-arm trial to evaluate the combination of cetuximab plus taxotere, cisplatin, and 5-flurouracil as an induction regimen in patients with unresectable squamous cell carcinoma of the head and neck. Int J Radiat Oncol. 2016;94:289–96.

    Article  Google Scholar 

  16. Lee K-W, Koh Y, Kim S-B, Shin S-W, Kang J-H, Wu H-G et al. A randomized, multicenter, phase II study of cetuximab with docetaxel and cisplatin as induction chemotherapy in unresectable, locally advanced head and neck cancer. Oncologist. 2015;20:1119–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Fayette J, Fontaine-Delaruelle C, Ambrun A, Daveau C, Poupart M, Ramade A et al. Neoadjuvant modified TPF (docetaxel, cisplatin, fluorouracil) for patients unfit to standard TPF in locally advanced head and neck squamous cell carcinoma: a study of 48 patients. Oncotarget. 2016;7:37297–304.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bonner JA, Harari PM, Giralt J, Cohen RB, Jones CU, Sur RK et al. Radiotherapy plus cetuximab for locoregionally advanced head and neck cancer: 5-year survival data from a phase 3 randomised trial, and relation between cetuximab-induced rash and survival. Lancet Oncol. 2010;11:21–8.

    Article  CAS  PubMed  Google Scholar 

  19. Hitt R, López-Pousa A, Martínez-Trufero J, Escrig V, Carles J, Rizo A et al. Phase III study comparing cisplatin plus fluorouracil to paclitaxel, cisplatin, and fluorouracil induction chemotherapy followed by chemoradiotherapy in locally advanced head and neck cancer. J Clin Oncol. 2005;23:8636–45.

    Article  PubMed  Google Scholar 

  20. Sagardoy T, Fernandez P, Ghafouri A et al. Accuracy of (18) FDG PET-CT for treatment evaluation 3 months after completion of chemoradiotherapy for head and neck squamous cell carcinoma: 2-year minimum follow-up. Head Neck. 2016;38(Suppl 1):E1271–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital-CHU Bordeaux, 1 Rue Jean Burguet, 33000, Bordeaux, France

    Valérie Cochin, Laurence Digue & Amaury Daste

  2. University of Bordeaux, Bordeaux, France

    Valérie Cochin, Claire Majoufre & Philipe Fernandez

  3. Department of Otolaryngology - Head and Neck Surgery, Pellegrin Hospital, University Hospital, CHU Bordeaux, Bordeaux, France

    Erwan de Mones

  4. Department of Radiation Therapy, Robert-Boulin Hospital, Libourne, France

    Muriel Garcia-Ramirez

  5. Department of Radiation Therapy, Haut Leveque Hospital, University Hospital, CHU Bordeaux, Bordeaux, France

    Charles Dupin

  6. Department of Oral and Maxillofacial Surgery, Pellegrin Hospital, University Hospital, CHU Bordeaux, Bordeaux, France

    Claire Majoufre

  7. Nuclear Medicine Department, Pellegrin Hospital, University Hospital, CHU Bordeaux, Bordeaux, France

    Philipe Fernandez

Authors
  1. Valérie Cochin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erwan de Mones
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laurence Digue
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Muriel Garcia-Ramirez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Charles Dupin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Claire Majoufre
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Philipe Fernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Amaury Daste
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amaury Daste.

Ethics declarations

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cochin, V., de Mones, E., Digue, L. et al. Induction chemotherapy with the EXTREME regimen in frail patients with locally advanced head and neck squamous cell carcinoma. Targ Oncol 13, 247–252 (2018). https://doi.org/10.1007/s11523-018-0552-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11523-018-0552-7

Search

Navigation