title: Serum vascular endothelial growth factor as a predictive factor in metronomic (weekly) Paclitaxel treatment for advanced head and neck cancer.
abstract: OBJECTIVE
  To evaluate serum vascular endothelial growth factor (VEGF) as a prognostic factor in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck treated with metronomic (weekly) paclitaxel.
  
  
  METHODS
  Before-and-after trial.
  
  
  METHODS
  A total of 33 consecutive patients were enrolled. Patients with recurrent and/or metastatic cancer of the head and neck refractory to platinum-based chemotherapy met inclusion criteria.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Patients were treated weekly with 80 mg/m(2) of paclitaxel for 6 weeks.
  
  
  METHODS
  Blood samples were collected after each dose and analyzed for serum VEGF using enzyme-linked immunosorbent assay kits. Nonparametric tests were used to analyze serum VEGF levels.
  
  
  RESULTS
  In 33 patients, complete response was achieved in 1 (3%) and partial response in 20 (61%). No differences were found between responders and nonresponders with different levels of serum VEGF at any of the measurement times (baseline, after the first dose, and after the sixth dose). In responders, the median level of serum VEGF decreased after the first dose compared with baseline, but by the sixth dose, the median serum VEGF level had returned to baseline levels in all groups. The intensity of the serum VEGF level decrease (simple decrease, a decrease of at least 30%, or a decrease of at least 70%) was not related to response. The progression-to-disease time increased in the patients with a serum VEGF level reduction of at least 30% (P = .01) after 6 doses and decreased in patients with initially high levels, which remained high after the sixth dose (P = .03).
  
  
  CONCLUSIONS
  Serum VEGF levels after the first dose of paclitaxel may predict response to weekly paclitaxel in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck. Initially high serum VEGF levels that persist after the sixth dose predict a shorter period until tumor progression.
authors.affiliation: Department of Otorhinolaryngology, Hospital Clínic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain. mcaba@clinic.ub.es
authors.forename: Miguel
authors.initials: M
authors.lastname: Caballero
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Grau
authors.forename: Jose Luís
authors.initials: JL
authors.lastname: Blanch
authors.forename: Jose
authors.initials: J
authors.lastname: Domingo-Domenech
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Auge
authors.forename: Wladimiro
authors.initials: W
authors.lastname: Jimenez
authors.forename: Manuel
authors.initials: M
authors.lastname: Bernal-Sprekelsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000097:blood* / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000097:blood*
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D015415:Biomarkers; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D017239:Paclitaxel