Induction chemotherapy demonstrates no survival benefit for head and neck cancer

Induction chemotherapy failed to prolong survival compared with concurrent chemotherapy and radiation therapy among patients with head and neck cancer, according to study results presented at the Multidisciplinary Head and Neck Cancer Symposium.

Further, patients who received induction chemotherapy instead of concurrent chemoradiation appeared less likely to receive a full course of radiation.

Daniel W. Bowles, MD

Although induction chemotherapy failed to extend survival in randomized trials, the lack of benefit may have been influenced by slow trial accrual or the inclusion of patients with less-advanced nodal disease.

Daniel W. Bowles, MD, assistant professor in the department of medical oncology at University of Colorado School of Medicine and director of cancer research and staff physician at the Denver VA Medical Center, and colleagues sought to further identify the value of induction chemotherapy for patients with head and neck cancers.

Researchers used the National Cancer Data Base to identify 8,003 patients diagnosed with head or neck cancer — excluding those with cancer in the oral cavity, for which concurrent chemoradiation is not a standard treatment — between 2003 and 2011.

Patients who received induction chemotherapy (n = 1,917) appeared more likely to be younger, had more oropharynx primary tumors and had higher T and N stages (P < .01 for all).

A greater proportion of patients who underwent induction chemotherapy received a radiation dosage of 66 Gy or lower than those who had concurrent chemoradiation (20.9% vs. 14.9%; P < .01).

Further, patients who received induction chemotherapy had shorter median OS (52.1 months; 95% CI, 45.7-58.6) than those on the standard treatment (64.9 months; 95% CI, 60.1-69.7). However, this association did not persist on multivariate or propensity score-matched analyses.

Results of subgroup analyses showed induction chemotherapy did not improve outcomes among patients with the most advanced disease, including those with T4 or N3 status (HR = 0.99), N3 status (HR = 0.98) or T4N3 status (HR = 0.91).

A multivariate analysis showed radiation dose remained an important independent risk factor for OS. Patients who received guideline-consistent radiation demonstrated improved OS, whereas radiation receipt of less than 66 Gy increased risk for mortality (HR = 1.88; 95% CI, 1.73-2.04).

“While we suspected that induction chemotherapy would not have an impact on our entire study population, we thought it might prolong survival for the most advanced cancers,” Bowles said in a press release. “Our finding from this large database that induction chemotherapy is not associated with improved overall survival over chemoradiation, even for these patients, will continue to dampen enthusiasm for routine use of induction chemotherapy.

“In cancer care, sometimes more is less,” Bowles added. “If adding induction chemotherapy fails to improve survival over the current standard of care, then we should reconsider its use.” – by Anthony SanFilippo

Reference:

Stokes W, et al. Abstract 109. Presented at: Multidisciplinary Head and Neck Cancer Symposium; Feb. 18-19, 2016; Scottsdale, Ariz.

Disclosure: The researchers report no relevant financial disclosures.