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Open Access Highly Accessed Research article

An effective and well-tolerated strategy in recurrent and/or metastatic head and neck cancer: successive lines of active chemotherapeutic agents

Julien Péron123*, Valentine Polivka4, Sylvie Chabaud4, Marc Poupart5, Philippe Ceruse67, Antoine Ramade7, Didier Girodet8, Philippe Zrounba8 and Jérôme Fayette1

Author Affiliations

1 Department of Medical Oncology, Centre Léon Bérard, University of Lyon, Lyon, France

2 Hospices Civils de Lyon, Service de Biostatistique, F-69003 Lyon, France

3 CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France

4 Department of Biostatistics, University of Lyon, Centre Léon Bérard, Lyon, France

5 University of Lyon, Department of Otorhinolaryngology, Hôpital de la Croix-Rousse, Lyon, France

6 Department of Otorhinolaryngology, Centre Hospitalier Lyon Sud, University of Lyon, Pierre-Bénite, Lyon, France

7 Department of Otorhinolaryngology, Hôpital E Herriot, University of Lyon, Lyon, France

8 Department of Otorhinolaryngology, Centre Léon Bérard, University of Lyon, Lyon, France

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BMC Cancer 2014, 14:504  doi:10.1186/1471-2407-14-504

Published: 10 July 2014

Abstract

Background

The combination platinum, 5-fluorouracil (5-FU) and cetuximab is the standard first-line regimen of recurrent and/or metastatic head and neck squamous cell carcinoma (HNSCC). Due to the toxicity of this treatment, alternative therapies are often offered to patients. The aim of this study was to evaluate the overall survival obtained with a first line chemotherapy adapted to patients functional status and the administration of all active drugs within successive lines of chemotherapy.

Methods

This series included a total of 194 patients with recurrent and/or metastatic HNSCC treated from 2006 to 2011 in a single institution where the administration of successive lines of chemotherapies has been the standard clinical approach. Treatment was administered according to clinical practice guidelines.

Results

Most patients received at least two treatment lines. Only 11 patients (6%) were treated with a combination of cisplatin, 5-FU and cetuximab in front line, but most patients received at least one platinum-based regimen (n = 154 patients, 78%); 162 (82%) received taxanes, 36 (18%) received 5-FU, 27 (14%) received capecitabine, 67 (34%) received methotrexate and 134 (68%) received cetuximab. The median overall survival was 9.8 months (95% CI: 8.1-11.4 months) and reached 13.1 months among the subgroup of 131 patients eligible for inclusion in a clinical trial.

Conclusion

The survival outcomes of patients treated in the first-line setting with chemotherapy regimens adapted to their functional status, followed by several subsequent regimens were comparable with published outcomes of patients treated by platinum, 5-FU and cetuximab.

Keywords:
Recurrent and/or metastatic head and neck squamous cell carcinoma; Chemotherapy; Survival analysis; Treatment outcome; Drug administration schedule