title: Carboplatin-pemetrexed in treatment of patients with recurrent/metastatic cancers of the head and neck; superior outcomes in oropharyngeal primaries.
abstract: BACKGROUND
  Platinum-based therapy in combination with 5-fluorouracil with cetuximab has shown the best survival in pts with recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). The purpose of this study is to evaluate the efficacy and tolerability of carboplatin, pemetrexed and to assess differential outcomes in patients with oropharyngeal primary and HPV related disease.
  
  
  METHODS
  The charts of consecutive patients with R/M SCCHN were reviewed. All patients receiving at least one cycle of the two-drug regimen (pemetrexed 500 mg/m(2), carboplatin area under the curve of five intravenously), were included for assessment of response, safety, toxicity, and survival.
  
  
  RESULTS
  A total of 86 patients received this regimen between January 2008 and December 2012, of which, 63 were included in this analysis. Forty-one percent (26) of the patients had cancers of the oropharynx, and of those, 50% had HPV-positive disease, 32% (20) had cancers of the larynx, and 24% (15) of the oral cavity. Median number of cycles administered was 4 (range 1-14 cycles) with 50% of the patients receiving four or more cycles. Half the patients achieved stable disease as their best response, 8% (5) attained a partial response, 24% progressed on therapy, and the remaining patients (12) could not have their response assessed. On the basis of Kaplan-Meier analysis, median progression-free survival (PFS) was 5.1 months (95% CI 3.2, 6.2) and median overall survival (OS) was 9.4 months (95% CI 4.3, 13.1). Among pts with oropharyngeal primary (n = 26), median PFS was 6.4 months (95% CI 2.8, 7.9) and median OS was 16.6 months (95% CI 9.6, 19.5). Among HPV+ pts (n = 13), median PFS was 7.0 months (95% CI 4.8, ne) and median OS was 17.1 months (95% CI 11.2, 21.7).
  
  
  CONCLUSIONS
  Combination carboplatin-pemetrexed is an effective and well-tolerated treatment, associated with a median PFS of 5.1 months and a clinical benefit in at least 57% of the patients treated.
authors: Division of Hematology Oncology, Department of Medicine, University of Michigan , Ann Arbor, MI , USA.
authors: Binu
authors: B
authors: Malhotra
authors: Department of Public Health, University of Michigan , Ann Arbor, MI , USA.
authors: Emily Light
authors: EL
authors: Bellile
authors: Department of Otolaryngology, Kresge Hearing Research Institute (KHRI), University of Michigan , Ann Arbor, MI , USA.
authors: Nghia Pham Trung
authors: NP
authors: Nguyen
authors: University of Michigan , Ann Arbor, MI , USA.
authors: Vicki Kay
authors: VK
authors: Fung
authors: University of Michigan , Ann Arbor, MI , USA.
authors: Matthew
authors: M
authors: Slack
authors: University of Michigan , Ann Arbor, MI , USA.
authors: Rebecca
authors: R
authors: Bilich
authors: Department of Otolaryngology, University of Michigan , Ann Arbor, MI , USA.
authors: Silvana
authors: S
authors: Papagerakis
authors: Division of Hematology Oncology, Department of Medicine, University of Michigan , Ann Arbor, MI , USA.
authors: Francis
authors: F
authors: Worden
keywords: carboplatin; head and neck cancer; metastatic; oropharyngeal neoplasms; pemetrexed; recurrent