Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital-CHU Bordeaux, 1 Rue Jean Burguet, 33000, Bordeaux, France.
University of Bordeaux, Bordeaux, France.
Target Oncol. 2018 Apr;13(2):247-252. doi: 10.1007/s11523-018-0552-7.
Induction chemotherapy (IC) with TPF (docetaxel, cisplatin, 5FU) for locally advanced head and neck squamous cell carcinoma (LAHNSCC) is limited to fit patients.
We conducted a retrospective cohort study to assess the use of the EXTREME regimen (platinum-based therapy, 5FU, cetuximab) as IC in frail patients with LAHNSCC.
Retrospective analysis of all consecutive patients with unresectable LAHNSCC treated with the EXTREME regimen, with or without 5FU as IC, from two French centers from 2008 to 2015. We assessed the rate of completed sequence defined as at least two cycles of IC and definitive radiation therapy.
We included 34 patients with a median age of 56 years [44-70]. The primary site of tumor development was the oropharynx (67%, n=23, all HPV negative), hypopharynx (21%, n=7) and the oral cavity (12%, n=4). At inclusion, patients presented: T4 76, 5% (n=26), N2c 41% (n=14), N3 26% (n=9), stage disease IVa 62% (n=21), IVb 38% (n=13), ECOG PS2 38% (n=13), decreased weight (10% in one month or 15% in 6 months) 74% (n=25). The sequence was achieved for 76% (n=26) of patients and 80% (n=27) presented a clinical response after the chemotherapy course with notably increased weight (40%, n=11) or general status (75%, n=26). Median PFS and OS were 5.7 and 15.5 months, respectively. Disease progression at 3 months was significantly associated with decreased median overall survival (13.6 versus 21.9 months, p=0.01).
This is the first study to report the use of the EXTREME regimen as induction chemotherapy, and although this IC was used in a very frail population, the majority completed the sequence with significant clinical benefit.
对于局部晚期头颈部鳞状细胞癌（LAHNSCC）患者，含多西紫杉醇、顺铂、5FU 的诱导化疗（IC）仅限于适合的患者。
我们进行了一项回顾性队列研究，以评估 EXTREME 方案（基于铂类的治疗、5FU、西妥昔单抗）作为 LAHNSCC 虚弱患者的 IC 的应用。
对 2008 年至 2015 年期间来自法国两个中心的接受 EXTREME 方案治疗的不可切除的 LAHNSCC 患者进行回顾性分析，这些患者接受了或未接受 EXTREME 方案作为 IC 的 5FU 治疗。我们评估了定义为至少接受两个周期 IC 和确定性放射治疗的完成序列的比例。
我们纳入了 34 例中位年龄为 56 岁[44-70]的患者。肿瘤发生的主要部位是口咽（67%，n=23，均为 HPV 阴性）、下咽（21%，n=7）和口腔（12%，n=4）。入组时，患者表现为：T4 占 76%，5%（n=26），N2c 占 41%（n=14），N3 占 26%（n=9），IVa 期疾病占 62%（n=21），IVb 期疾病占 38%（n=13），ECOG PS2 占 38%（n=13），体重减轻（1 个月内 10%或 6 个月内 15%）占 74%（n=25）。76%（n=26）的患者完成了序列，80%（n=27）的患者在化疗后表现出临床反应，表现为体重显著增加（40%，n=11）或一般状态显著改善（75%，n=26）。中位 PFS 和 OS 分别为 5.7 和 15.5 个月。3 个月时疾病进展与中位总生存期显著缩短相关（13.6 个月比 21.9 个月，p=0.01）。
这是第一项报告 EXTREME 方案作为诱导化疗的研究，尽管该 IC 用于非常虚弱的人群，但大多数患者完成了序列，并获得了显著的临床获益。
