Drug Improves Induction Chemo for Head and Neck Cancers
For patients with advanced head and neck cancers who receive an initial treatment of chemotherapy prior to other therapies, three drugs appear to be better than two. Patients who received docetaxel (Taxotere) in addition to the standard combination of cisplatin and fluorouracil had better outcomes than those taking cisplatin and fluorouracil alone, according to findings in the October 25 New England Journal of Medicine.
The results are from two randomized clinical trials that evaluated the addition of docetaxel to standard chemotherapy for patients receiving induction (or neoadjuvant) treatment. This treatment is given before radiation-based therapy, as was the case in the two reported clinical trials, and/or surgery.
Although the trials differed in their designs, drug doses, and patient populations, each found that the addition of docetaxel improved survival and reduced mortality without adding significant toxicity compared with the treatment arm that used the standard induction chemotherapy regimen.
"The take-home message of these studies is that despite the grim prognosis associated with head and neck cancer, we are making significant progress in treating the disease," said Dr. Marshall Posner of the Dana-Farber Cancer Institute, who led one of the trials, called TAX 324.
The major surprise of the studies was that a third chemotherapy drug seemed to make treatment more tolerable for patients rather than less, noted Dr. Posner. Survival in the docetaxel group was 71 months on average versus 30 months in the other group.
The second study was conducted by the European Organization for Research and Treatment of Cancer. After 32 months, median survival in the docetaxel group was 18.8 months, compared with 14.5 months in the other group. Fewer patients treated with docetaxel suffered side effects such as nausea, vomiting, and mouth sores.
Previous studies have suggested that for patients with advanced head and neck cancers, chemotherapy is most effective when administered at the same time as radiation therapy. The two new trials were not designed to address the question of whether induction chemotherapy prior to concurrent chemotherapy and radiation offers advantages over concurrent chemotherapy and radiation alone, and if so, for which patients.
Answers may come soon because at least five randomized trials are testing induction chemotherapy followed by radiation and chemotherapy for these cancers.
—Edward R. Winstead