Safety and efficacy of weekly versus three-weekly paclitaxel plus platinum neoadjuvant chemotherapy in patients with locally advanced squamous cell head and neck carcinoma: A pilot study

Abstract

Background: Squamous cell carcinoma of head and neck (SCCHN) is one of the most common cancers seen in India and also the world. Majority of patients present in locally advanced (LA) disease where neoadjuvant combination chemotherapy with a taxane plus platinum with/without 5-Fluorouracil is the standard of care treatment. There are no/few prospective trials of weekly paclitaxel in SCCHN in spite of convincing evidence regarding safety and tolerability in other solid tumors such as breast, ovary, and lung carcinoma. In the present study, we prospectively assessed the safety and efficacy of weekly versus three-weekly paclitaxel plus platinum neoadjuvant chemotherapy in patients with LA-SCCHN. Materials and Methods: We included 50 newly diagnosed patients of LA-SCCHN in the study and randomized them into two groups to receive either low-dose weekly (80 mg/sq. m) or standard three-weekly (175 mg/sq. m) paclitaxel along with standard dose carboplatin (AUC 5) and assessed response rates and toxicities. Results: Age and sex were evenly matched in both groups. Oral and oropharyngeal cancers were the most common sites. Hematological toxicities were significantly more in the three-weekly group. Nonhematological toxicities, especially neuropathy, were also more in this group. The overall response rate (complete response + partial response) in the three-weekly arm was 36% versus 52% in the weekly arm. Conclusion: Data from our small study suggest that weekly paclitaxel plus platinum neoadjuvant chemotherapy may be superior to the standard every 3 weeks' administration in terms of safety as well as efficacy in patients with LA-SCCHN.

Key words

Head and neck malignancies - neoadjuvant chemotherapy - paclitaxel - squamous cell carcinoma of the head and neck

• References

• 1 Sharma RG, Kapoor R, Bang BA, Gurjar K. Spectrum of malignancies in Jaipur region (2004-2008). Indian J Cancer 2014;51:45-53.
• 2 Vokes EE. Induction chemotherapy for head and neck cancer: Recent data. Oncologist 2010;15 Suppl 3:3-7.
• 3 Green MC, Buzdar AU, Smith T, Ibrahim NK, Valero V, Rosales MF, et al. Weekly paclitaxel improves pathologic complete remission in operable breast cancer when compared with paclitaxel once every 3 weeks. J Clin Oncol 2005;23:5983-92.
• 4 Shimizu T, Yokoi T, Tamaki T, Kibata K, Inagaki N, Nomura S, et al. Comparative analysis of carboplatin and paclitaxel combination chemotherapy schedules in previously untreated patients with advanced non-small cell lung cancer. Oncol Lett 2013;5:761-7.
• 5 Harano K, Terauchi F, Katsumata N, Takahashi F, Yasuda M, Takakura S, et al. Quality-of-life outcomes from a randomized phase III trial of dose-dense weekly paclitaxel and carboplatin compared with conventional paclitaxel and carboplatin as a first-line treatment for stage II-IV ovarian cancer: Japanese Gynecologic Oncology Group Trial (JGOG3016). Ann Oncol 2014;25:251-7.
• 6 Polee MB, Sparreboom A, Eskens FA, Hoekstra R, van de Schaaf J, Verweij J, et al. Aphase I and pharmacokinetic study of weekly paclitaxel and carboplatin in patients with metastatic esophageal cancer. Clin Cancer Res 2004;10:1928-34.
• 7 Symmans FW. Breast cancer response to paclitaxel in vivo. Drug Resist Updat 2001;4:297-302.
• 8 Glaze S, Teitelbaum L, Chu P, Ghatage P, Nation J, Nelson G, et al. Dose-dense paclitaxel with carboplatin for advanced ovarian cancer: A feasible treatment alternative. J Obstet Gynaecol Can 2013;35:61-7.
• 9 El-Shenshawy H, Taema S, El-Zahaf E, El-Beshbeshi W, Sharaf Eldeen D, Fathy A. Advanced non-small cell lung cancer in elderly patients: The standard every 3-weeks versus weekly paclitaxel with carboplatin. Egypt J Chest Dis Tuberc 2012;61:485-93.
• 10 Pignata S, Scambia G, Katsaros D, Gallo C, Pujade-Lauraine E, De Placido S, et al. Carboplatin plus paclitaxel once a week versus every 3 weeks in patients with advanced ovarian cancer (MITO-7): A randomised, multicentre, open-label, phase 3 trial. Lancet Oncol 2014;15:396-405.
• 11 Belani CP, Ramalingam S, Perry MC, LaRocca RV, Rinaldi D, Gable PS, et al. Randomized, phase III study of weekly paclitaxel in combination with carboplatin versus standard every-3-weeks administration of carboplatin and paclitaxel for patients with previously untreated advanced non-small-cell lung cancer. J Clin Oncol 2008;26:468-73.
• 12 D'Addario G, Morant R, Boehme C, Cerny T. Feasibility and toxicity of weekly paclitaxel-carboplatin in 131 patients with pretreated and non-pretreated solid tumors. Onkologie 2002;25:152-7.
• 13 Mohanti BK, Nachiappan P, Pandey RM, Sharma A, Bahadur S, Thakar A, et al. Analysis of 2167 head and neck cancer patients' management, treatment compliance and outcomes from a regional cancer centre, Delhi, India. J Laryngol Otol 2007;121:49-56.