Targeted Oncology

, Volume 13, Issue 2, pp 247–252 | Cite as

Induction chemotherapy with the EXTREME regimen in frail patients with locally advanced head and neck squamous cell carcinoma

  • Valérie Cochin
  • Erwan de Mones
  • Laurence Digue
  • Muriel Garcia-Ramirez
  • Charles Dupin
  • Claire Majoufre
  • Philipe Fernandez
  • Amaury Daste
Short Communication



Induction chemotherapy (IC) with TPF (docetaxel, cisplatin, 5FU) for locally advanced head and neck squamous cell carcinoma (LAHNSCC) is limited to fit patients.


We conducted a retrospective cohort study to assess the use of the EXTREME regimen (platinum-based therapy, 5FU, cetuximab) as IC in frail patients with LAHNSCC.

Patients and methods

Retrospective analysis of all consecutive patients with unresectable LAHNSCC treated with the EXTREME regimen, with or without 5FU as IC, from two French centers from 2008 to 2015. We assessed the rate of completed sequence defined as at least two cycles of IC and definitive radiation therapy.


We included 34 patients with a median age of 56 years [44-70]. The primary site of tumor development was the oropharynx (67%, n=23, all HPV negative), hypopharynx (21%, n=7) and the oral cavity (12%, n=4). At inclusion, patients presented: T4 76, 5% (n=26), N2c 41% (n=14), N3 26% (n=9), stage disease IVa 62% (n=21), IVb 38% (n=13), ECOG PS2 38% (n=13), decreased weight (10% in one month or 15% in 6 months) 74% (n=25). The sequence was achieved for 76% (n=26) of patients and 80% (n=27) presented a clinical response after the chemotherapy course with notably increased weight (40%, n=11) or general status (75%, n=26). Median PFS and OS were 5.7 and 15.5 months, respectively. Disease progression at 3 months was significantly associated with decreased median overall survival (13.6 versus 21.9 months, p=0.01).


This is the first study to report the use of the EXTREME regimen as induction chemotherapy, and although this IC was used in a very frail population, the majority completed the sequence with significant clinical benefit.


Compliance with Ethical Standards


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Valérie Cochin
    • 1
    • 2
  • Erwan de Mones
    • 3
  • Laurence Digue
    • 1
  • Muriel Garcia-Ramirez
    • 4
  • Charles Dupin
    • 5
  • Claire Majoufre
    • 2
    • 6
  • Philipe Fernandez
    • 2
    • 7
  • Amaury Daste
    • 1
  1. 1.Department of Medical Oncology, Hôpital Saint-AndréBordeaux University Hospital-CHU BordeauxBordeauxFrance
  2. 2.University of BordeauxBordeauxFrance
  3. 3.Department of Otolaryngology - Head and Neck Surgery, Pellegrin HospitalUniversity Hospital, CHU BordeauxBordeauxFrance
  4. 4.Department of Radiation TherapyRobert-Boulin HospitalLibourneFrance
  5. 5.Department of Radiation Therapy, Haut Leveque HospitalUniversity Hospital, CHU BordeauxBordeauxFrance
  6. 6.Department of Oral and Maxillofacial Surgery, Pellegrin HospitalUniversity Hospital, CHU BordeauxBordeauxFrance
  7. 7.Nuclear Medicine Department, Pellegrin HospitalUniversity Hospital, CHU BordeauxBordeauxFrance

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