NEW YORK (Reuters Health) Jul 17 - Pooled data on patients with locoregionally advanced head and neck cancers show better outcomes after induction with taxane-cisplatin-fluorouracil (Tax-PF) instead of cisplatin plus fluorouracil (PF).
As reported July 8 online in the Journal of Clinical Oncology, Dr. Jean-Pierre Pignon of Institut Gustave Roussy, Villejuif, France, and colleagues analyzed updated patient data from five trials involving 1,772 patients.
At a median follow-up of 4.9 years, the hazard ratio of death was 0.79 with Tax-PF. At five years, Tax-PF induction improved overall survival by 7.4%.
After excluding one trial with significant heterogeneity, the hazard ratio of death was 0.72.
Tax-PF was also associated with significant reduction in the risk of progression (HR, 0.78), locoregional failure (HR, 0.79), and distant failure (HR, 0.63).
However, say the investigators, "concomitant chemoradiotherapy (CRT) has been shown to improve survival and is considered a standard of care in these patients."
Therefore, they add, although induction Tax-PF is superior to PF in a variety of outcome measures, "its precise role compared with upfront CRT... remains to be defined."
In an editorial, Dr. Arlene A. Forastiere and colleagues agree, pointing out that "neither the multiple phase III trials nor their meta-analysis are able to establish a new treatment standard from a comparison of two nonstandard regimens."
In fact, Dr. Forastiere of Johns Hopkins University and Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, told Reuters Health by email, "The meta-analysis confirmed what we already knew from the individual randomized trials, which is that the three-drug regimen... is better than the two-drug combination."
"The analysis does not bring us any closer to knowing the appropriate clinical context for using induction chemotherapy and whether adding it to existing best therapy will improve survival."
"We do know," she concluded, "that it is a high cost and high toxicity regimen."
Dr. Pignon was unable to respond to requests for comment.
SOURCE: http://bit.ly/16Jyo2n
J Clin Oncol 2013.
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