Induction chemotherapy cuts metastasis risk in resectable HNSCC
medwireNews: Induction chemotherapy offers significant benefits in the management of resectable squamous cell carcinoma of the head and neck (HNSCC), Chinese researchers believe.
Results of their meta-analysis indicate that induction chemotherapy reduces the risk for distant metastasis and in some cases allows subsequent surgery to spare the larynx.
"Further research on non-laryngeal organ preservation is encouraged using optimized induction chemotherapy protocols," write Zhi-yuan Zhang (Shanghai Jiao Tong University School of Medicine) and co-authors in the World Journal of Surgical Oncology.
The researchers searched the literature for randomized trials conducted between 1965 and 2011 examining the impact of induction chemotherapy in patients with locally advanced and resectable HNSCC.
They identified 14 trials (2099 patients) that were suitable for meta-analysis. The trials compared induction chemotherapy with various permutations of surgery, radiotherapy, and chemotherapy.
Zhang et al report that induction chemotherapy did not significantly impact the risk for disease-specific survival or overall survival, at hazard ratios of 1.01 and 0.97, respectively. Similarly, induction chemotherapy did not impact risk for locoregional recurrence.
This was true for both induction chemotherapy overall and for specific induction protocols, such as cisplatin and 5-fluorouracil, other platin-containing combinations, or multiple agents without platin.
However, induction chemotherapy was associated with a significant 8% relative reduction in risk for distant metastasis as well as a 21% increased likelihood for preservation of the larynx in patients with laryngeal or hypopharyngeal cancer, without compromising overall or disease-free survival.
With regard to safety outcomes, the most common toxicity associated with induction therapy was vomiting (prevalence of 8.5-24.5%), followed by leukopenia (5.1-7.6%), mucositis (0.2-8.2%), and thrombocytopenia (1.7-7.7%). Mortality associated with induction chemotherapy ranged from 0% to 5%.
These frequencies are "acceptable for further surgery, or radiotherapy or chemoradiotherapy," say the researchers.
Noting that the different response to induction chemotherapy "could lead to different survival," Zhang et al call for the evaluation of "molecular biomarkers that could help to identify those patients most likely, or unlikely to benefit from the addition of induction chemotherapy to their treatment regimen."
By Joanna Lyford, Senior medwireNews Reporter