紫杉醇联合西妥昔单抗用于不适合铂类化疗的局部晚期头颈部鳞状细胞癌患者的诱导化疗
Paclitaxel Plus Cetuximab as Induction Chemotherapy for Patients With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma Unfit for Cisplatin-Based Chemotherapy.
作者信息
Marín-Jiménez Juan A, Oliva Marc, Peinado Martín Paloma, Cabezas-Camarero Santiago, Plana Serrahima Maria, Vázquez Masedo Gonzalo, Lozano Borbalas Alicia, Cabrera Martín María N, Esteve Anna, Iglesias Moreno María C, Vilajosana Altamis Esther, Arribas Hortigüela Lorena, Taberna Sanz Miren, Pérez-Segura Pedro, Mesía Ricard
机构信息
Head and Neck Cancer Unit, Department of Medical Oncology, Catalan Institute of Oncology (ICO - L'Hospitalet de Llobregat), Barcelona, Spain.
Oncobell Program - Bellvitge Biomedical Research Institute (Institut d'Investigació Biomèdica de Bellvitge), Barcelona, Spain.
出版信息
Front Oncol. 2022 Jul 22;12:953020. doi: 10.3389/fonc.2022.953020. eCollection 2022.
OBJECTIVES
Induction chemotherapy (ICT) followed by definitive treatment is an accepted non-surgical approach for locoregionally advanced head and neck squamous cell carcinoma (LA-HNSCC). However, ICT remains a challenge for cisplatin-unfit patients. We evaluated paclitaxel and cetuximab (P-C) as ICT in a cohort of LA-HNSCC patients unfit for cisplatin.
MATERIALS AND METHODS
This is a retrospective analysis of patients with newly diagnosed LA-HNSCC considered unfit for cisplatin-based chemotherapy (age >70 and/or ECOG≥2 and/or comorbidities) treated with weekly P-C followed by definitive radiotherapy and cetuximab (RT-C) between 2010 and 2017. Toxicity and objective response rate (ORR) to ICT and RT-C were collected. Median overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. Cox regression analysis was performed to determine baseline predictors of OS and PFS.
RESULTS
A total of 57 patients were included. Grade 3-4 toxicity rate to ICT was 54.4%, and there was a death deemed treatment-related (G5). P-C achieved an ORR of 66.7%, including 12.3% of complete responses (CR). After P-C, 45 patients (78.9%) continued with concomitant RT-C. Twenty-six patients (45.6%) achieved a CR after definitive treatment. With a median follow-up of 21.7 months (range 1.2-94.6), median OS and PFS were 22.9 months and 10.7 months, respectively. The estimated 2-year OS and PFS rates were 48.9% and 33.7%, respectively. Disease stage had a negative impact on OS (stage IVb vs. III-IVa: HR = 2.55 [1.08-6.04], = 0.03), with a trend towards worse PFS (HR = 1.92 [0.91-4.05], = 0.09). Primary tumor in the larynx was associated with improved PFS but not OS (HR = 0.45 [0.22-0.92], = 0.03, and HR = 0.69 [0.32-1.54], = 0.37, respectively).
CONCLUSION
P-C was a well-tolerated and active ICT regimen in this cohort of LA-HNSCC patients unfit for cisplatin-based chemotherapy. P-C might represent a valid ICT option for unfit patients and may aid patient selection for definitive treatment.
目的
诱导化疗（ICT）后进行确定性治疗是局部晚期头颈部鳞状细胞癌（LA-HNSCC）公认的非手术治疗方法。然而，对于不适合使用顺铂的患者，ICT仍然是一项挑战。我们评估了紫杉醇和西妥昔单抗（P-C）作为不适合使用顺铂的LA-HNSCC患者队列中的ICT。
材料和方法
这是一项对2010年至2017年间新诊断为LA-HNSCC且被认为不适合基于顺铂化疗（年龄>70岁和/或东部肿瘤协作组体能状态≥2分和/或合并症）的患者进行的回顾性分析，这些患者接受每周一次的P-C治疗，随后进行确定性放疗和西妥昔单抗（RT-C）治疗。收集了ICT和RT-C的毒性和客观缓解率（ORR）。使用Kaplan-Meier方法估计中位总生存期（OS）和无进展生存期（PFS）。进行Cox回归分析以确定OS和PFS的基线预测因素。
结果
共纳入57例患者。ICT的3-4级毒性率为54.4%，有1例死亡被认为与治疗相关（5级）。P-C的ORR为66.7%，包括12.3%的完全缓解（CR）。P-C治疗后，45例患者（78.9%）继续接受同步RT-C治疗。26例患者（45.6%）在确定性治疗后达到CR。中位随访21.7个月（范围1.2-94.6个月），中位OS和PFS分别为22.9个月和10.7个月。估计的2年OS和PFS率分别为48.9%和33.7%。疾病分期对OS有负面影响（IVb期与III-IVa期：风险比[HR]=2.55[1.08-6.04]，P=0.03），PFS有恶化趋势（HR=1.92[0.91-4.05]，P=0.09）。喉原发性肿瘤与PFS改善相关，但与OS无关（HR分别为0.45[0.22-0.92]，P=0.03和HR为0.69[0.32-1.54]，P=0.37）。
结论
在这个不适合基于顺铂化疗的LA-HNSCC患者队列中，P-C是一种耐受性良好且有效的ICT方案。P-C可能是不适合患者的有效ICT选择，并且可能有助于确定性治疗的患者选择。
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