Paclitaxel, Carboplatin and Radiotherapy as Induction Therapy in Locally Advanced Head and Neck Cancer
Cancers of the head and neck (H&N) comprise 5% of all cancers, with 40,000 new cases
diagnosed annually. Surgery followed by irradiation or irradiation alone has been the
standard of care for locally advanced Stage III and IV patients. With this approach, fewer
than 30% of patients achieve long-term remission, and most recur locoregionally.
Neoadjuvant chemotherapy has been administered prior to definitive therapy with response
rates ranging from 60-90%; with pathologic CR rates documented in 30-70% of clinical
responders. However, large randomized trials have shown no improvement in overall survival.
Because induction chemotherapy alone does not appear to improve long-term disease free
survival in advanced head and neck cancers, concomitant chemotherapy and radiation has been
pursued in patients with locally advanced head and neck cancers. Improved disease-free
survival has been demonstrated with a variety of agents. The concept of synergy between
radiation and chemotherapy is well established in vitro. Various schedules of radiation and
chemotherapy have been utilized including weekly chemotherapy during radiation, chemotherapy
given every three weeks during hyperfractionated radiation and alternating chemotherapy and
radiation.
One exciting new chemotherapeutic agent, Paclitaxel has been shown to radiosensitize cancer
cell lines in vitro. Recent studies have added Carboplatin to Paclitaxel in tandem or
concurrently with radiation in hopes of improving response rates. From in-vitro data, it
appears that the optimum schedule for the combination of Paclitaxel and radiation is to
first induce G2/M arrest with Paclitaxel and follow this with radiation therapy. In a
recent study by Chendil, et al, a novel radiation scheme appeared to enhance the response of
both p53 wild type and p53 mutant cancer cell lines to chemotherapy. In vitro data with
Carboplatin also indicates an additive effect when given prior to irradiation using various
cell lines. What has not been evaluated, is whether a neoadjuvant regimen of Paclitaxel and
Carboplatin followed by 4 small fractions of radiation can be given safely and effect an
improved response rate in patients with bulky T2, Stage III and IV H&N cancer. We propose
the use of two cycles of Paclitaxel and Carboplatin followed by four small fractions of
radiation, prior to definitive treatment (surgery or radiation). It is hoped that using
radiation as a chemoenhancer will increase the response rate to induction therapy in this
population of patients.
Interventional
Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Response rate to induction chemotherapy prior to definitive therapy (surgery or radiation)
assessed pre-study and once between days 36-57
No
Susanne Arnold, MD
Principal Investigator
University of Kentucky
United States: Institutional Review Board
00-H&N-11-BMS
NCT00176254
May 2000
October 2012
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