Phase 1 study of nab-paclitaxel, cisplatin and 5-fluorouracil as induction chemotherapy followed by concurrent chemoradiotherapy in locoregionally advanced squamous cell carcinoma of the oropharynx
Mené sur 17 patients atteints d'un carcinome épidermoïde de l'oropharynx de stade loco-régionalement avancé (âge : 44 à 65 ans ; 14 hommes et 3 femmes), cet essai de phase I évalue la toxicité d'une chimiothérapie d'induction par nab-paclitaxel-cisplatine-5-fluorouracile suivie d'un traitement combinant de manière concomitante une chimiothérapie par carboplatine et une radiothérapie
Background : Induction chemotherapy followed by concurrent chemoradiation (CRT) (sequential therapy) has been evaluated in the treatment of locoregionally-advanced squamous cell cancer of the head and neck (LA-SCCHN), with docetaxel, cisplatin (P) and 5-flurouracil (F) shown to be superior to PF doublet. Nab-paclitaxel (A) is a novel albumin-bound paclitaxel with a superior therapeutic index to docetaxel. Methods : A phase I trial [Clinical trials.gov identifier NCT00731380] to assess the safety and efficacy of nab-paclitaxel + cisplatin + 5-fluorouracil (APF) as induction chemotherapy for three cycles, followed by concurrent carboplatin (area-under-curve (AUC) 1.5 weekly) with radiation therapy (RT) (70 Gy/35 fractions), was conducted using a 3+3 design in patients with previously untreated LA-SCCHN. Dose-limiting toxicities (DLTs) included: standard haematologic and non-haematologic toxicities, treatment delays, inability to complete ⩾95% of RT and skin/mucosal toxicity related to RT assessed from day 1 of treatment to 8 weeks after completion of CRT. Results : 17 patients with oropharyngeal cancer were enrolled in three dose levels, with 15 patients evaluable for DLT. The median age was 54 years (range, 44–65 years), 14 patients were male, and 11 patients’ tumours were p16 positive and four negative. Grade 3/4 adverse events during APF (%total number of cycles) were hyponatraemia (14%) neutropenia (10%), lymphopaenia (4%) and thrombocytopenia (2%) during 49 evaluable APF cycles. Febrile neutropenia occurred during one cycle of treatment. Conclusion : The recommended phase 2 dose of APF is nab-paclitaxel 100 mg/m2 days 1 and 8, cisplatin 75 mg/mg2 day 1 and 5-fluorouracil 1000 mg/m2/day × 96 h days 1–4, every 3 weeks, for three cycles prior to CRT.