Induction chemotherapy (IC) with EXTREME study regimen for locally advanced head and neck cancer (LAHNC) frail patients.

Abstract

Listen

Translate article

e17564 Background: IC with TPF (docetaxel, cisplatin, 5FU) in LAHNC is limited to fit patients (pts). We conducted a retrospective cohort study to evaluate the use of EXTREME regimen (platinum, 5FU, cetuximab) as IC in LAHNC frail pts. Methods: Retrospective analysis of all consecutive pts with unresectable LAHNC treated with EXTREME regimen with or without 5FU as IC from two French centers from 2008 to 2015. We evaluated the rate of realization of the complete sequence (at least 2 cycles of IC and all radiation courses). Tolerance and efficacy, including clinical benefice, median progression free survival (PFS) and median overall survival (OS) were estimated. Results: We included 34 pts with average age of 56 years [46-70] (Table). Patients presented decreased weight (10% in one month or 15% in 6 months): 74% (n=25), pain: 76% (n=26), feeding tube: 82% (n=28), tracheotomy: 15% (n=4), fistula: 15% (n=4) and low albumin <35g/l: 41% (n=14), <25g/l: 12% (n=4). Six pts (17%) not received 5FU (cardiovascular history). Grade 3 toxicities were seen in 50% pts principally due to cisplatin. 5FU dose was decreased in 9% (n=3) and cisplatin switched to carboplatin in 15% (n=4). The sequence was achieved for 76% (n=26) of pts and 80% (n=27) presented clinical response with improvement of symptoms (increased weight: 32%, n=11). Six pts (17%) have a progression disease (PD) under IC, one patient (3%) died during bioradiotherapy (BRT) (stomach perforation) and one (3%) stopped IC after one cycle (infection) but achieved BRT. BRT with cetuximab was used in 85% (n=23) (average of 6 cycles [2-8]). PET-FDG at 3 months showed 9% (n=3) of complete response (CR) and 44% (n=15) of PD. Median PFS and OS were 5.7 and 15.5 months respectively. PD at 3 months was associated with decreased median OS: 21.9 versus 13.6 months, p=0.01. Conclusions: This is the first report of use of the EXTREME regimen as IC. This IC was used in a very frail population and the majority achieved sequence with significant clinical benefice. [Table: see text]