Induction chemotherapy with docetaxel preserves larynx function in squamous cell carcinoma

Issue: July 10, 2015

CHICAGO — The addition of docetaxel to induction chemotherapy with cisplatin and 5-fluorouracil prolonged larynx preservation and larynx dysfunction-free survival in a cohort of patients with squamous cell carcinoma in the larynx or pharynx, according to study results presented at the ASCO Annual Meeting.

Perspective from Lisa Licitra, MD

Guillaume Janoray, MD, of Centre Hospitalier et Régional Universitaire, Henry S. Kaplan Center, Clinique d’Oncologie et de Radiothérapie in Tours, France, and colleagues evaluated data from 213 patients. Eligible participants had operable, untreated stage-III or -IV larynx or hypopharynx invasive disease and underwent treatment with cisplatin and 5-fluorouracil with or without docetaxel.

“Our objective was to compare two regimens of induction chemotherapy,” Janoray said.

Patients in arm A treated received 100 mg/m² cisplatin and 750 mg/m² 5-flourouracil per day for 5 days. Patients in arm B received 75 mg/m² cisplatin on day 1, 750 mg/m² 5-flourouracil daily for 5 days and 75 mg/m² docetaxel on day 1.

Patients required total laryngectomy and received three cycles of the regimen. Responders also underwent radiation therapy.

Larynx preservation rate at 3 years served as the primary outcome measure. Larynx dysfunction-free survival, OS, DFS, locoregional control rate, cause of mortality and late toxicity served as secondary outcomes.

Median follow-up for surviving patients was 8.75 years.

More patients in the docetaxel arm achieved larynx preservation at 5 years (74%; 95% CI, 0.64–0.82 vs. 58.1%; 95% CI, 0.47–0.68) and 10 years (70.3%; 95% CI, 0.58–0.8 vs. 46.5%; 95% CI, 0.31–0.63) compared with patients in the non-docetaxel arm.

Larynx dysfunction-free survival rates at 5 years were 67.2% (95% CI, 0.57–0.76) in the triple-therapy group and 46.5% (95% CI, 0.36–0.57) for non-docetaxel. More patients who received docetaxel also achieved 10-year larynx dysfunction-free survival (63.7% vs. 37.2%).

The researchers were unable to demonstrate a benefit of induction chemotherapy with docetaxel in terms of OS or DFS.

Janoray reported lower toxicity in the salivary glands and the larynx in the docetaxel arm. He speculated that the lower cisplatin dose in the docetaxel arm may have led to the reduced toxicity.

“When a larynx preservation approach using induction chemotherapy is chosen, the [docetaxel, cisplatin and 5-fluoracil] regimen should be recommended followed by radiation therapy,” Janoray said. – by Rob Volansky

For more information:

Janoray G, et al. Abstract 6002. Presented at: ASCO Annual Meeting; May 29-June 2, 2015; Chicago.

Disclosure: The researchers report no relevant financial disclosures.

Perspective

Lisa Licitra, MD

This study proved that docetaxel, cisplatin and 5-fluoracil followed by radiation in responsive patients preserved larynx function. It also provides interesting data about functional outcome in the larynx, although OS was similar.

These reassuring results in terms of late outcomes are good for believers in induction chemotherapy. This is a good and safe way to approach this. But we still need a common language to determine the suitable evaluation criteria. Now it is quite clear that hospital volumes and expertise are critical to achieving the same results as those in clinical trials.

Lisa Licitra, MD

Instituto Nazionale Tumori

Disclosures: Licitra reports associations with a number of device and pharmaceutical companies.