title: Induction chemotherapy with cetuximab, carboplatin and paclitaxel for the treatment of locally advanced squamous cell carcinoma of the head and neck.
abstract: Although controversy exists in the management of locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN), clinicians often use induction chemotherapy for treatment of the most advanced cases. One promising regimen combines weekly cetuximab (400 mg/m2loading dose followed by 250 mg/m2) with carboplatin (AUC of 2) and paclitaxel (90 mg/m2). We retrospectively evaluated patients treated with this regimen prior to definitive chemoradiation or surgery between May 2008 and December 2011. The primary endpoint used for this retrospective analysis was feasibility. Thirty consecutive, unselected patients were included. Median follow-up was 13.7 months (range, 5.0-38.7 months). All but one patient had stage IV SCCHN. Dose intensity was high for carboplatin (92%), paclitaxel (93%) and cetuximab (85%). Grade 3-4 toxicities occurred in <7% of the study population and were limited to rash, neutropenia and infusion reactions. Response rate (RR) to induction chemotherapy was 97% (30% complete response, 67% partial response). All patients completed subsequent chemoradiotherapy or surgery. Nineteen patients (63%) demonstrated a complete response and 11 patients (37%) demonstrated a partial response. Median overall survival and progression-free survival data are not yet mature. The RR to therapy in our off-protocol experience is at least comparable to that observed in the two phase II studies of this regimen and appears superior to that observed with docetaxel, cisplatin and fluorouracil (TPF).
authors.affiliation: Division of Hematology and Oncology, Dana-Farber Cancer Institute, Boston, MA 02215;
authors.forename: Jessica
authors.initials: J
authors.lastname: Bauman
authors.forename: Corey
authors.initials: C
authors.lastname: Langer
authors.forename: Harry
authors.initials: H
authors.lastname: Quon
authors.forename: Kenneth
authors.initials: K
authors.lastname: Algazy
authors.forename: Alexander
authors.initials: A
authors.lastname: Lin
authors.forename: Arati
authors.initials: A
authors.lastname: Desai
authors.forename: Faith
authors.initials: F
authors.lastname: Mutale
authors.forename: Jared
authors.initials: J
authors.lastname: Weiss
keywords: chemoradiotherapy; head and neck cancer; induction chemotherapy; locally advanced squamous cell carcinoma of the head and neck