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nab-Paclitaxel-based induction chemotherapy followed by cisplatin and radiation therapy for human papillomavirus-unrelated head and neck squamous-cell carcinoma

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Abstract

In patients with locally advanced human papillomavirus (HPV)-unrelated head and neck squamous-cell carcinoma (HNSCC), cisplatin and radiation therapy (CisRT) resulted in a local–regional recurrence (LRR) rate of 35%, progression-free survival (PFS) of 49%, and overall survival (OS) of 60%. We, and others, showed that nab-paclitaxel is an active agent in metastatic and locally advanced HNSCC. The aim of this report was to assess the efficacy of nab-paclitaxel-based induction chemotherapy and CisRT in HPV-unrelated HNSCC. We performed a retrospective single-institution analysis of patients treated with nab-paclitaxel-based chemotherapy and CisRT. Key inclusion criteria included stage III–IV HPV-unrelated HNSCC. Induction chemotherapy included nab-paclitaxel and cisplatin (AP), AP + 5-fluorouracil (APF), or APF + Cetuximab (APF-C). Endpoints included LRR, overall relapse, PFS, and OS. Thirty-eight patients were the subject of this analysis. Patient characteristics included median age 59 years (IQR: 54–64) and smoking history in 36 patients (95%). Primary tumor sites included larynx/hypopharynx (27), p16 negative oropharynx (10), and oral cavity (1). Most patients had bulky disease: 82% T3–4 (n = 31) and 74% N2b–3 (n = 28). Median follow-up was 44 months (IQR: 23–59). The three-year LRR rate was 16% (95% confidence interval [CI] 7–34) and the overall relapse rate was 22% (95% CI 11–41). The three-year PFS was 64% (95% CI 46–77) and OS was 72% (95% CI 54–84). Among patients with HPV-unrelated HNSCC, nab-paclitaxel-based induction chemotherapy and CisRT resulted in a lower-than-expected rate of LRR and more favorable PFS and OS compared to historical results with CisRT.

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Acknowledgements

We recognize the support of the Alvin J. Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, Missouri. The Siteman Cancer Center is supported in part by NCI Cancer Center Support Grant #P30 CA91842.

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Authors and Affiliations

  1. Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Kai C. C. Johnson, Peter Oppelt & Douglas R. Adkins

  2. Division of Medical Oncology, Washington University School of Medicine, 660 South Euclid, Campus Box 8056, St. Louis, MO, 63110, USA

    Jessica Ley, Peter Oppelt & Douglas R. Adkins

  3. Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA

    Peter Oppelt, Jingxia Lu, Hiram A. Gay, Mackenzie Daly, Ryan Jackson, Jason Rich, Patrik Pipkorn, Randal C. Paniello, Jose Zevallos, Wade Thorstad & Douglas R. Adkins

  4. Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA

    Jingxia Lu

  5. Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA

    Hiram A. Gay, Mackenzie Daly & Wade Thorstad

  6. Department of Otolaryngology, Washington University School of Medicine, St. Louis, MO, USA

    Ryan Jackson, Jason Rich, Patrik Pipkorn, Randal C. Paniello & Jose Zevallos

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  1. Kai C. C. Johnson
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Correspondence to Douglas R. Adkins.

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Douglas R. Adkins has received research grants from Celgene. All remaining authors have declared no conflicts of interest.

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Johnson, K.C.C., Ley, J., Oppelt, P. et al. nab-Paclitaxel-based induction chemotherapy followed by cisplatin and radiation therapy for human papillomavirus-unrelated head and neck squamous-cell carcinoma. Med Oncol 36, 93 (2019). https://doi.org/10.1007/s12032-019-1318-5

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