Induction Chemotherapy Followed by Either Chemoradiotherapy or Bioradiotherapy for Larynx Preservation: The TREMPLIN Randomized Phase II Study
Mené en France sur 153 patients atteints d'un carcinome épidermoïde du larynx et de l'hypopharynx de stade III ou IV, cet essai randomisé de phase II compare, du point de vue de la préservation du larynx et de la survie globale à 18 mois, l'efficacité et la toxicité de deux protocoles thérapeutiques comportant une chimiothérapie d'induction par docétaxel-cisplatine-fluorouracile suivie d'une chimioradiothérapie à base de cisplatine ou par cetuximab
Purpose To compare the efficacy and safety of induction chemotherapy (ICT) followed by chemoradiotherapy (CRT) or bioradiotherapy (BRT) for larynx preservation (LP).Patients and Methods Previously untreated patients with stage III to IV larynx/hypopharynx squamous cell carcinoma received three cycles of ICT—docetaxel and cisplatin 75 mg/m2 each on day 1 and fluorouracil 750 mg/m2 per day on days 1 through 5. Poor responders (< 50% response) underwent salvage surgery. Responders (≥ 50% response) were randomly assigned to conventional radiotherapy (RT; 70 Gy) with concurrent cisplatin 100 mg/m2 per day on days 1, 22, and 43 of RT (arm A) or concurrent cetuximab 400 mg/m2 loading dose and 250 mg/m2 per week during RT (arm B). Primary end point was LP at 3 months. Secondary end points were larynx function preservation (LFP) and overall survival (OS) at 18 months.Results Of the 153 enrolled patients, 116 were randomly assigned after ICT (60, arm A; 56, arm B). Overall toxicity of both CRT and BRT was substantial following ICT. However, treatment compliance was higher in the BRT arm. In an intent-to-treat analysis, there was no significant difference in LP at 3 months between arms A and B (95% and 93%, respectively), LFP (87% and 82%, respectively), and OS at 18 months (92% and 89%, respectively). There were fewer local treatment failures in arm A than in arm B; salvage surgery was feasible in arm B only.Conclusion There is no evidence that one treatment was superior to the other or could improve the outcome reported with ICT followed by RT alone (French Groupe Oncologie Radiothérapie Tête et Cou [GORTEC] 2000-01 trial [Induction CT by Cisplatin, 5FU With or Without Docetaxel in Patients With T3 and T4 Larynx and Hypopharynx Carcinoma]). The protocol that can best compare with RT alone after ICT is still to be determined.
Journal of Clinical Oncology , résumé, 2013