Role of vindesine as neoadjuvant chemotherapy for non-small cell lung and head and neck cancers.
Although surgery is the only therapeutic intervention with potential for cure of non-small cell lung cancer (NSCLC) and head and neck cancer, most patients present with tumors that are too far advanced for resection. For this reason, neoadjuvant chemotherapy is being increasingly used to down-stage primary tumor burden before surgery. The procedure offers the possibility of enhancing resectability and thereby improves the chances of achieving complete eradication. In NSCLC, the most successful results have been obtained in patients with disease that is localized to the thorax and in those achieving complete responses to chemotherapy. A number of different combination regimens have been studied with cisplatin as the key component. Response rates of up to 88% have been reported together with complete sections in up to 74% of patients. The impact on survival is still to be determined. Although there is ample data showing that combination regimens containing vindesine have a favorable effect on survival in patients with inoperable NSCLC, relatively few of the studies have evaluated these regimens for use as neoadjuvant therapy. New studies should focus on increasing the complete response rate above the 20% level that is currently attainable. The results using neoadjuvant chemotherapy in head and neck cancer are disappointing with no survival benefit demonstrated. However, neoadjuvant chemotherapy may help preserve organ function and thus improve quality of life of patients.
Cvitkovic
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E
Hopital Paul Brousse, Villejuif, France.
Wasserman
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E
D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000601:surgery; D014751:Vindesine / Q000008:administration & dosage / Q000627:therapeutic use*
D000972:Antineoplastic Agents, Phytogenic; D014751:Vindesine