The addition of docetaxel to an induction chemotherapy regiment in patients with locally advanced head and neck cancer improved five-year survival rates from 42 percent to 52 percent and nearly doubled median survival time, leading researchers to recommend the three-drug regiment for eligible patients, with the findings published Jan. 12 in The Lancet Oncology.
More than 40,000 people in the U.S. are diagnosed with squamous-cell carcinoma of the head and neck (SCCHN) each year, with the cancer accounting for 8 percent of all cancers worldwide. The TAX 324 trial compared the survival of SCCHN patients treated with induction chemotherapy regiments of docetaxel, cisplatin and fluorouracil (TPF) with those patients given just cisplatin and fluorouracil (PF). Initial results released in 2007 showed significant improvements in survival for the TPF group.
Median overall six-year survival among the 255 patients treated with TPF was 70.6 months, compared with 34.8 months in the 246 patients treated with PF. Estimated five-year survival was 52 percent for the TPF group compared with 42 percent for the PF group.
The TPF group also experienced a significantly longer progression-free survival, with a median time of 38.1 months, compared with 13.2 months in patients who received PF. No significant differences in toxicity, measured as dependence on gastric feeding tubes or tracheostomies, were observed between the two groups.
"Patients with hypopharyngeal and laryngeal cancer also had significantly longer progression-free survival with TPF than with PF, and those with oropharyngeal primary tumors in the TPF group had an overall survival advantage," wrote Jochen H. Lorch, MD, of Dana-Farber Cancer Institute in Boston, and colleagues.
The authors pointed out that reliable data about gastric feeding tubes and tracheostomies were difficult to obtain, with no data available about patients' qualities of life. In addition, an accompanying editorial commented: "One concern is that the inclusion of both HPV-positive and HPV-negative head and neck cancer in these trials, without stratification by HPV status, might confound interpretation of the results," according to June Corry, MD, and Danny Rischin, MD, of the Peter Maccallum Cancer Centre in Melbourne, Australia.
Still, the authors concluded that "[i]nduction chemotherapy with TPF provides long-term survival benefit compared with PF in locally advanced head and neck cancer. Patients who are candidates for induction chemotherapy should be treated with TPF."