Induction chemotherapy before chemoradiotherapy in locally advanced head and neck cancer: the future?

There is increasing interest in the use of induction chemotherapy before concurrent chemotherapy and radiotherapy in the treatment of locally advanced head and neck cancer. A modest but significant improvement in survival has been observed with cisplatin and 5-fluorouracil (PF) induction before radiotherapy over that seen with radiotherapy alone. The addition of docetaxel to the PF regimen (TPF) appears to provide further survival benefits. The phase II part of a phase II/III trial compared three cycles of TPF induction chemotherapy before concomitant PF chemoradiotherapy with PF chemoradiotherapy alone in 101 patients with locally advanced stage III-IV head and neck cancer. The incidences of hematologic and nonhematologic toxicities during concurrent chemoradiotherapy were not higher in the TPF plus chemoradiotherapy group, and the feasibility of chemoradiotherapy was not compromised. Radiologically evaluated complete response rates at 6-8 weeks from the end of chemoradiotherapy (the primary endpoint) were 21% (95% confidence interval [CI], 11%-36%) with chemoradiotherapy alone and 50% (95% CI, 35%-65%; p = .004) with TPF plus chemoradiotherapy. A median overall survival time of 33.3 months and a 1-year survival rate of 78% were observed with chemoradiotherapy alone, whereas the median survival time was 39.6 months in the TPF plus chemoradiotherapy group, with a 1-year survival rate of 86%. To conclude, increasing evidence suggests that TPF induction chemotherapy improves clinical response and does not compromise subsequent chemoradiotherapy. The results of the ongoing phase III part of the phase II/III study should provide further information about the efficacy and safety of this approach for patients with locally advanced head and neck cancer.