Head and neck cancer

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36 regimens on this page
50 variants on this page

Contents


Guidelines

ESMO

NCCN

Adjuvant chemotherapy & radiation therapy

Cisplatin & RT

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RT: Radiation Therapy

Regimen #1

Study Evidence Comparator Efficacy
Cooper et al. 2004 (RTOG 9501, ECOG R9501, SWOG 9515) Phase III Radiation therapy Seems to have superior DFS

Patients "had undergone macroscopically complete resection of disease" and at least one high-risk characteristic: "histologic evidence of invasion of two or more regional lymph nodes, extracapsular extension of nodal disease, and microscopically involved mucosal margins of resection."

Chemoradiotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV once per day on days 1, 22, 43
  • Concurrent radiation therapy, 2 Gy fractions x 30 fractions (total dose: 60 Gy), given 5 times per week over 6 weeks, with optional boost of 2 Gy fractions x 3 fractions (boost dose: 6 Gy) to high-risk sites

Supportive medications

  • Hydration before and after treatment
  • Antiemetics per physician choice
  • Optional use of feeding tubes

7-week course

Regimen #2

Study Evidence Comparator Efficacy
Bernier et al. 2004 (EORTC 22931) Phase III Radiation therapy Seems to have superior OS

Chemoradiotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV once per day on days 1, 22, 43
  • Concurrent radiation therapy, 2 Gy fractions x 27 fractions (total dose: 54 Gy), given 5 times per week over 5.5 weeks, with boost to areas at "high risk for malignant dissemination or that had inadequate resection margins" of 2 Gy fractions x 6 fractions (boost dose: 12 Gy)

Supportive medications

7-week course

Regimen #3

Study Evidence Comparator Efficacy
Bachaud et al. 1991 Phase III Radiation therapy Superior OS

Chemoradiotherapy

  • Cisplatin (Platinol) 50 mg/m2 IV bolus once per week on the first day of radiation
  • Concurrent radiation therapy, 1.7 Gy fractions x ~32 fractions (total dose: 54 Gy), given 5 times per week, with boost to "primary site and/or cervical lymph nodes" with 1.8 to 2 Gy fractions for an additional boost dose of 11 to 16 Gy to close (<5 mm) or positive margin areas of (overall dose to these sites: 65 to 70 Gy). A boost of 11 to 20 Gy was given to metastatic nodal sites (overall dose to these sites: 65 to 74 Gy); see Bachaud et al. 1996 for details.

Supportive medications

7 to 9-week course, depending on duration of radiation therapy

References

  1. Bachaud JM, David JM, Boussin G, Daly N. Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced squamous cell carcinoma of the head and neck: preliminary report of a randomized trial. Int J Radiat Oncol Biol Phys. 1991 Feb;20(2):243-6. link to original article PubMed
    1. Update: Bachaud JM, Cohen-Jonathan E, Alzieu C, David JM, Serrano E, Daly-Schveitzer N. Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced head and neck carcinoma: final report of a randomized trial. Int J Radiat Oncol Biol Phys. 1996 Dec 1;36(5):999-1004. link to original article contains verified protocol PubMed
  2. Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK; Radiation Therapy Oncology Group 9501/Intergroup. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med. 2004 May 6;350(19):1937-44. link to original article contains verified protocol PubMed
    1. Update: Cooper JS, Zhang Q, Pajak TF, Forastiere AA, Jacobs J, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Lustig R, Ensley JF, Thorstad W, Schultz CJ, Yom SS, Ang KK. Long-term follow-up of the RTOG 9501/intergroup phase III trial: postoperative concurrent radiation therapy and chemotherapy in high-risk squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys. 2012 Dec 1;84(5):1198-205. Epub 2012 Jun 30. link to original article contains verified protocol PubMed
  3. Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M; European Organization for Research and Treatment of Cancer Trial 22931. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004 May 6;350(19):1945-52. link to original article contains verified protocol PubMed
  4. Posthoc analysis: Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, Ozsahin EM, Jacobs JR, Jassem J, Ang KK, Lefèbvre JL. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck. 2005 Oct;27(10):843-50. link to original article PubMed

Radiation therapy

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Regimen

Study Evidence Comparator Efficacy
Bachaud et al. 1991 Phase III Cisplatin & RT Inferior OS
Cooper et al. 2004 (RTOG 9501, ECOG R9501, SWOG 9515) Phase III Cisplatin & RT Seems to have inferior DFS
Bernier et al. 2004 (EORTC 22931) Phase III Cisplatin & RT Seems to have inferior OS

Used as a comparator arm; included for reference purposes only.

References

  1. Bachaud JM, David JM, Boussin G, Daly N. Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced squamous cell carcinoma of the head and neck: preliminary report of a randomized trial. Int J Radiat Oncol Biol Phys. 1991 Feb;20(2):243-6. link to original article PubMed
    1. Update: Bachaud JM, Cohen-Jonathan E, Alzieu C, David JM, Serrano E, Daly-Schveitzer N. Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced head and neck carcinoma: final report of a randomized trial. Int J Radiat Oncol Biol Phys. 1996 Dec 1;36(5):999-1004. link to original article contains verified protocol PubMed
  2. Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK; Radiation Therapy Oncology Group 9501/Intergroup. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med. 2004 May 6;350(19):1937-44. link to original article contains verified protocol PubMed
    1. Update: Cooper JS, Zhang Q, Pajak TF, Forastiere AA, Jacobs J, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Lustig R, Ensley JF, Thorstad W, Schultz CJ, Yom SS, Ang KK. Long-term follow-up of the RTOG 9501/intergroup phase III trial: postoperative concurrent radiation therapy and chemotherapy in high-risk squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys. 2012 Dec 1;84(5):1198-205. Epub 2012 Jun 30. link to original article contains verified protocol PubMed
  3. Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M; European Organization for Research and Treatment of Cancer Trial 22931. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004 May 6;350(19):1945-52. link to original article contains verified protocol PubMed
  4. Posthoc analysis: Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, Ozsahin EM, Jacobs JR, Jassem J, Ang KK, Lefèbvre JL. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck. 2005 Oct;27(10):843-50. link to original article PubMed

Locally advanced disease, chemotherapy & radiation therapy

Carboplatin & RT -> Carboplatin & Fluorouracil

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RT: Radiation Therapy

Regimen

Study Evidence Comparator Efficacy
Chitapanarux et al. 2007 Phase III Cisplatin & RT -> CF Seems not superior

This study only involved patients with locally advanced nasopharyngeal cancer.

Chemoradiotherapy

  • Carboplatin (Paraplatin) 100 mg/m2 IV over 1 hour once per day on days 1, 8, 15, 22, 29, 36
  • Concurrent radiation therapy to the primary tumor, 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 5 times per week over 7 weeks

7-week course, followed by chemotherapy as described below

Chemotherapy

Chemotherapy starts 4 weeks after the end of radiation therapy.

28-day cycle for 3 cycles

References

  1. Chitapanarux I, Lorvidhaya V, Kamnerdsupaphon P, Sumitsawan Y, Tharavichitkul E, Sukthomya V, Ford J. Chemoradiotherapy comparing cisplatin versus carboplatin in locally advanced nasopharyngeal cancer: randomised, non-inferiority, open trial. Eur J Cancer. 2007 Jun;43(9):1399-406. Epub 2007 Apr 27. link to original article contains verified protocol PubMed

Carboplatin, Fluorouracil, RT

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RT: Radiation Therapy

Regimen

Study Evidence Comparator Efficacy
Denis et al. 2004 (GORTEC 94-01) Phase III Radiation therapy Seems to have superior OS
Bourhis et al. 2012 (GORTEC 99-02) Phase III Carboplatin, Fluorouracil, accelerated concurrent RT Seems not superior
Very accelerated radiation therapy Seems to have superior PFS

Chemoradiotherapy

  • Carboplatin (Paraplatin) 70 mg/m2 IV once per day on days 1 to 4, 22 to 25, 43 to 46
  • Fluorouracil (5-FU) 600 mg/m2/day IV continuous infusion on days 1 to 4, 22 to 25, 43 to 46 (total dose for each 4-day continuous infusion: 2400 mg/m2)
  • Concurrent radiation therapy, 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 5 times per week over 7 weeks

7-week course of therapy

References

  1. Denis F, Garaud P, Bardet E, Alfonsi M, Sire C, Germain T, Bergerot P, Rhein B, Tortochaux J, Calais G. Final results of the 94-01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol. 2004 Jan 1;22(1):69-76. Epub 2003 Dec 2. link to original article contains verified protocol PubMed
  2. Bourhis J, Sire C, Graff P, Grégoire V, Maingon P, Calais G, Gery B, Martin L, Alfonsi M, Desprez P, Pignon T, Bardet E, Rives M, Geoffrois L, Daly-Schveitzer N, Sen S, Tuchais C, Dupuis O, Guerif S, Lapeyre M, Favrel V, Hamoir M, Lusinchi A, Temam S, Pinna A, Tao YG, Blanchard P, Aupérin A. Concomitant chemoradiotherapy versus acceleration of radiotherapy with or without concomitant chemotherapy in locally advanced head and neck carcinoma (GORTEC 99-02): an open-label phase 3 randomised trial. Lancet Oncol. 2012 Feb;13(2):145-53. Epub 2012 Jan 18. link to original article contains verified protocol PubMed

Carboplatin, Paclitaxel, RT

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RT: Radiation Therapy

Regimen #1, accelerated hyperfractionated RT

Study Evidence
Carter et al. 2008 Phase II

Chemoradiotherapy

6-week course of therapy

Regimen #2, standard RT

Study Evidence
Conley et al. 1997 Pilot, <20 patients
Suntharalingam et al. 2000 Phase II

Chemoradiotherapy

  • Carboplatin (Paraplatin) 100 mg/m2 IV once per week, given prior to radiation therapy
  • Paclitaxel (Taxol) 40 mg/m2 IV once per week, given prior to radiation therapy
    • According to Conley et al. 1997, the initial dose of paclitaxel was 45 mg/m2, but 40 mg/m2 was subsequently used
  • Concurrent radiation therapy, 1.8 Gy fractions x 39 fractions (total dose: 70.2 Gy), given 5 times per week

Supportive medications

7.5-week course of therapy

References

  1. Conley B, Jacobs M, Suntharalingam M, Zacharski D, Ord RA, Gray W, Aisner J. A pilot trial of paclitaxel, carboplatin, and concurrent radiotherapy for unresectable squamous cell carcinoma of the head and neck. Semin Oncol. 1997 Feb;24(1 Suppl 2):S2-78-S2-80. contains protocol PubMed
  2. Suntharalingam M, Haas ML, Conley BA, Egorin MJ, Levy S, Sivasailam S, Herman JM, Jacobs MC, Gray WC, Ord RA, Aisner JA, Van Echo DA. The use of carboplatin and paclitaxel with daily radiotherapy in patients with locally advanced squamous cell carcinomas of the head and neck. Int J Radiat Oncol Biol Phys. 2000 Apr 1;47(1):49-56. link to original article contains verified protocol PubMed
  3. Carter DL, Asmar L, Barrera D, Caracandas J, Dakhil JS, McCracken D, O'Rourke MA, Rosenberg RK, Boehm KA, Ilegbodu D, Reid RL. Favorable survival observed after carboplatin, paclitaxel, and concurrent accelerated hyperfractionated radiotherapy for treatment of locally advanced head and neck carcinoma. Invest New Drugs. 2008 Oct;26(5):473-81. Epub 2008 May 13. link to original article contains protocol PubMed

Cetuximab & RT

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RT: Radiation Therapy

Regimen

Study Evidence Comparator Efficacy
Bonner et al. 2006 (IMCL-9815) Phase III Radiation therapy Seems to have superior OS

Chemoradiotherapy

  • Cetuximab (Erbitux) 400 mg/m2 IV over 2 hours once 1 week before radiation therapy begins; then 250 mg/m2 IV over 1 hour once per week during course of radiation therapy
    • A test dose of 20 mg IV over 10 minutes, followed by 30 minutes of observation, was given prior to the first full dose of cetuximab
  • Concurrent radiation therapy with one of the following regimens:
    • "Once per day" regimen: Concurrent radiation therapy, 2 Gy fractions x 35 fractions (total dose: 70 Gy), given once per day 5 times per week over 7 weeks
    • "Twice per day" regimen: Concurrent radiation therapy, 1.2 Gy fractions x 60 to 64 fractions (total dose: 72 to 76.8 Gy), given twice per day for a total of 10 times per week over 6 to 6.5 weeks
    • "Concomitant boost" regimen: Concurrent radiation therapy, 1.8 Gy fractions x 18 fractions (total dose: 32.4 Gy), given once per day 5 times per week for 3.6 weeks; and twice per day fractions:
      • Morning dose: 1.8 Gy fractions x 12 fractions (total dose: 21.6 Gy), given 5 days per week over 2.4 weeks
      • Afternoon dose: 1.5 Gy fractions x 12 fractions (total dose: 18 Gy), given 5 days per week over 2.4 weeks
      • Total dose for concomitant boost regimen: 72 Gy

Supportive medications

References

  1. Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, Jones CU, Sur R, Raben D, Jassem J, Ove R, Kies MS, Baselga J, Youssoufian H, Amellal N, Rowinsky EK, Ang KK. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med. 2006 Feb 9;354(6):567-78. link to original article contains verified protocol PubMed
    1. QoL Analysis: Curran D, Giralt J, Harari PM, Ang KK, Cohen RB, Kies MS, Jassem J, Baselga J, Rowinsky EK, Amellal N, Comte S, Bonner JA. Quality of life in head and neck cancer patients after treatment with high-dose radiotherapy alone or in combination with cetuximab. J Clin Oncol. 2007 Jun 1;25(16):2191-7. link to original article contains partial protocol PubMed
    2. Update: Bonner JA, Harari PM, Giralt J, Cohen RB, Jones CU, Sur RK, Raben D, Baselga J, Spencer SA, Zhu J, Youssoufian H, Rowinsky EK, Ang KK. Radiotherapy plus cetuximab for locoregionally advanced head and neck cancer: 5-year survival data from a phase 3 randomised trial, and relation between cetuximab-induced rash and survival. Lancet Oncol. 2010 Jan;11(1):21-8. Epub 2009 Nov 10. link to original article contains partial protocol PubMed
    3. Retrospective subgroup analysis: Rosenthal DI, Harari PM, Giralt J, Bell D, Raben D, Liu J, Schulten J, Ang KK, Bonner JA. Association of Human Papillomavirus and p16 Status With Outcomes in the IMCL-9815 Phase III Registration Trial for Patients With Locoregionally Advanced Oropharyngeal Squamous Cell Carcinoma of the Head and Neck Treated With Radiotherapy With or Without Cetuximab. J Clin Oncol. 2016 Apr 20;34(12):1300-8. Epub 2015 Dec 28. link to original article PubMed

CF -> Carboplatin & RT

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CF -> Carboplatin & RT: Cisplatin and Fluorouracil followed by Carboplatin and Radiation Therapy

Regimen

Study Evidence Comparator Efficacy
Posner et al. 2007 (TAX 324) Phase III TPF -> Carboplatin & RT Inferior OS

Chemotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV over 30 to 180 minutes once on day 1, given first
  • Fluorouracil (5-FU) 1000 mg/m2/day IV continuous infusion over 96 hours on days 1 to 4 (total dose per cycle: 4000 mg/m2)

21-day cycle for 3 cycles; then start chemoradiotherapy 3 to 8 weeks after the start of cycle 3:

Chemoradiotherapy

  • Carboplatin (Paraplatin) AUC 1.5 IV over 1 hour once per day on days 1, 8, 15, 22, 29, 36, 43
  • Concurrent radiation therapy, 2 Gy fractions x 35 to 37 fractions (total dose: 70 to 74 Gy), given 5 times per week over 7 to 7.5 weeks

7 to 7.5-week course; surgery "performed 6 to 12 weeks after completion of chemoradiotherapy for patients who had an initial nodal stage of N2 and a partial response to induction chemotherapy, N3 disease, or residual disease after chemoradiotherapy."

References

  1. Posner MR, Hershock DM, Blajman CR, Mickiewicz E, Winquist E, Gorbounova V, Tjulandin S, Shin DM, Cullen K, Ervin TJ, Murphy BA, Raez LE, Cohen RB, Spaulding M, Tishler RB, Roth B, Viroglio Rdel C, Venkatesan V, Romanov I, Agarwala S, Harter KW, Dugan M, Cmelak A, Markoe AM, Read PW, Steinbrenner L, Colevas AD, Norris CM Jr, Haddad RI; TAX 324 Study Group. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med. 2007 Oct 25;357(17):1705-15. link to original article contains verified protocol PubMed

CF -> Cisplatin & RT

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CF -> Cisplatin & RT: Cisplatin and Fluorouracil followed by Cisplatin and Radiation Therapy

Regimen

Study Evidence Comparator Efficacy
Hitt et al. 2005 Phase III PCF -> Cisplatin & RT Inferior CR rate

Chemotherapy

3-week cycle for 3 cycles

Patients then undergo ENT evaluation and CT imaging of the primary tumor and neck. Patients with complete response (CR) or partial response of greater than 80% in the primary tumor and no evidence of progression in neck lymph nodes proceeded to chemoradiotherapy. "Patients with a PR of less than 80% or stable disease in the neck lymph nodes (especially if N2 or N3 disease) after induction CT were referred to surgery for neck dissection, if the surgeons were in agreement, before the administration of CRT." Patients with no response or progression of disease were taken off study.

Chemoradiotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV once per day on days 1, 22, 43
  • Concurrent radiation therapy to primary tumor, 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 5 times per week over 7 weeks. Nodal areas not involved by tumor received 50 Gy.

References

  1. Hitt R, López-Pousa A, Martínez-Trufero J, Escrig V, Carles J, Rizo A, Isla D, Vega ME, Martí JL, Lobo F, Pastor P, Valentí V, Belón J, Sánchez MA, Chaib C, Pallarés C, Antón A, Cervantes A, Paz-Ares L, Cortés-Funes H. Phase III study comparing cisplatin plus fluorouracil to paclitaxel, cisplatin, and fluorouracil induction chemotherapy followed by chemoradiotherapy in locally advanced head and neck cancer. J Clin Oncol. 2005 Dec 1;23(34):8636-45. Epub 2005 Nov 7. link to original article contains verified protocol PubMed

CF & RT

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CF & RT: Cisplatin and Fluorouracil with concurrent Radiation Therapy

Regimen #1

Study Evidence Comparator Efficacy
Taylor et al. 1994 Phase III CF -> RT Superior ORR

Chemotherapy

2-week cycle for 7 cycles given together with the following concurrent radiation therapy:

Radiotherapy

  • Concurrent radiation therapy, 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 5 times per week on weeks 1, 3, 5, 7, 9, 11, 13

Regimen #2

Study Evidence Comparator Efficacy
Garden et al. 2004 (RTOG 97-03) Randomized Phase II Cisplatin, Paclitaxel, RT Seems not superior
5-FU, Hydroxyurea, RT Seems not superior

Note: Garden et al. 2004 described this regimen in an unclear way, and it is not clear exactly how many doses or when each chemotherapy is given. Specifically, it's confusing how people would "receive their treatments every week for 7 consecutive weeks," yet fluorouracil (and maybe also cisplatin) would be given "daily for the final 10 days of radiation treatment."

Chemoradiotherapy

  • Cisplatin (Platinol) 10 mg/m2 IV once per day (unable to discern what days this is given on based on the paper)
  • Fluorouracil (5-FU) 400 mg/m2/day IV continuous infusion over 10 days on the last 10 days of radiation treatments
  • Concurrent radiation therapy, 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 5 times per week over 7 weeks

7-week course of therapy

References

  1. Taylor SG 4th, Murthy AK, Vannetzel JM, Colin P, Dray M, Caldarelli DD, Shott S, Vokes E, Showel JL, Hutchinson JC et al. Randomized comparison of neoadjuvant cisplatin and fluorouracil infusion followed by radiation versus concomitant treatment in advanced head and neck cancer. J Clin Oncol. 1994 Feb;12(2):385-95. link to original article contains verified protocol PubMed
  2. Adelstein DJ, Li Y, Adams GL, Wagner H Jr, Kish JA, Ensley JF, Schuller DE, Forastiere AA. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol. 2003 Jan 1;21(1):92-8. link to original article PubMed
  3. Garden AS, Harris J, Vokes EE, Forastiere AA, Ridge JA, Jones C, Horwitz EM, Glisson BS, Nabell L, Cooper JS, Demas W, Gore E. Preliminary results of Radiation Therapy Oncology Group 97-03: a randomized phase ii trial of concurrent radiation and chemotherapy for advanced squamous cell carcinomas of the head and neck. J Clin Oncol. 2004 Jul 15;22(14):2856-64. link to original article contains verified protocol--see comment above PubMed

CF -> RT

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CF -> RT: Cisplatin and Fluorouracil followed by Radiation Therapy

Regimen #1

Study Evidence Comparator Efficacy
Forastiere et al. 2003 (RTOG 91-11) Phase III Cisplatin & RT Not reported
Radiation therapy Seems to have superior DFS

Chemotherapy

21-day cycle for 2 cycles

After cycle 2, patients are evaluated by indirect laryngoscopy and CT neck. Patients with complete or partial response receive a third cycle of induction chemotherapy as described above, followed by radiation therapy. Patients with worse than a partial response underwent laryngectomy and adjuvant radiation therapy.

Radiotherapy

  • Radiation therapy, 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 5 times per week over 7 weeks

Regimen #2

Study Evidence Comparator Efficacy
Taylor et al. 1994 Phase III CF & RT Inferior ORR

Chemotherapy

21-day cycle for 3 cycles, followed by:

Radiotherapy

  • Radiation therapy, 1.8 to 2 Gy fractions to a total dose of 70 Gy, given 5 times per week over 7 to 8 weeks

Regimen #3

Study Evidence Comparator Efficacy
Pointreau et al. 2009 (GORTEC) Phase III TPF -> RT Inferior ORR

Chemotherapy

Supportive medications

  • Normal saline (use of mannitol, KCl, and magnesium sulfate per institutional protocol) 1000 mL IV given twice, before and after Cisplatin (Platinol)

21-day cycle for 3 cycles

Patients who responded to induction chemotherapy proceeded to radiation therapy within 3 to 7 weeks of finishing chemotherapy. Patients who did not respond to induction chemotherapy proceeded to surgery and postoperative radiotherapy (see Pointreau et al. 2009 for details).

Radiotherapy

  • Radiation therapy to the primary tumor and involved lymph nodes, 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 5 times per week over 7 weeks. Prophylactic radiation to the volume at risk for microscopic disease, 2 Gy fractions x 25 to 27 fractions (total dose: 50 to 54 Gy), given 5 times per week.
  • "Chemotherapy (cisplatin, carboplatin, and 5-fluorouracil or a combination of two drugs) during radiotherapy was allowed for all patients who were treated at the same institute, according to its practice." No further details available.

Regimen #4

Study Evidence Comparator Efficacy
Vermorken et al. 2007 (EORTC 24971/TAX 323) Phase III TPF -> RT Seems to have inferior OS

Chemotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV over 1 hour once on day 1, given first before fluorouracil
  • Fluorouracil (5-FU) 1000 mg/m2/day IV continuous infusion over 5 days on days 1 to 5 (total dose per cycle: 5000 mg/m2)

Supportive medications

  • "Adequate antiemetic medications during chemotherapy"
  • Prophylactic granulocyte colony-stimulating factor only allowed for patients who had "febrile neutropenia or infection, a delay in recovery of the absolute neutrophil count at day 28, or grade 4 neutropenia persisting for 7 days or more."

21-day cycle for 4 cycles

Patients without progressive disease and who had recovery of marrow function, resolution of mucositis, and healed from any dental procedures started radiation therapy within 4 to 7 weeks of finishing chemotherapy:

Radiotherapy

  • Radiation therapy over 7 weeks with one of the following (further details not provided):
    • Conventional fractionation, total dose 66 to 70 Gy
    • Accelerated fractionation, total dose 70 Gy
    • Hyperfractionated, total dose 74 Gy

References

  1. Taylor SG 4th, Murthy AK, Vannetzel JM, Colin P, Dray M, Caldarelli DD, Shott S, Vokes E, Showel JL, Hutchinson JC et al. Randomized comparison of neoadjuvant cisplatin and fluorouracil infusion followed by radiation versus concomitant treatment in advanced head and neck cancer. J Clin Oncol. 1994 Feb;12(2):385-95. link to original article contains verified protocol PubMed
  2. Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, Glisson B, Trotti A, Ridge JA, Chao C, Peters G, Lee DJ, Leaf A, Ensley J, Cooper J. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003 Nov 27;349(22):2091-8. link to original article contains verified protocol PubMed
    1. Update: Forastiere AA, Zhang Q, Weber RS, Maor MH, Goepfert H, Pajak TF, Morrison W, Glisson B, Trotti A, Ridge JA, Thorstad W, Wagner H, Ensley JF, Cooper JS. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol. 2013 Mar 1;31(7):845-52. Epub 2012 Nov 26. link to original article contains partial protocol PubMed
  3. Vermorken JB, Remenar E, van Herpen C, Gorlia T, Mesia R, Degardin M, Stewart JS, Jelic S, Betka J, Preiss JH, van den Weyngaert D, Awada A, Cupissol D, Kienzer HR, Rey A, Desaunois I, Bernier J, Lefebvre JL; EORTC 24971/TAX 323 Study Group. Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med. 2007 Oct 25;357(17):1695-704. link to original article contains verified protocol PubMed
    1. QoL Analysis: van Herpen CM, Mauer ME, Mesia R, Degardin M, Jelic S, Coens C, Betka J, Bernier J, Remenar E, Stewart JS, Preiss JH, van den Weyngaert D, Bottomley A, Vermorken JB; EORTC Head and Neck Group. Short-term health-related quality of life and symptom control with docetaxel, cisplatin, 5-fluorouracil and cisplatin (TPF), 5-fluorouracil (PF) for induction in unresectable locoregionally advanced head and neck cancer patients (EORTC 24971/TAX 323). Br J Cancer. 2010 Oct 12;103(8):1173-81. Epub 2010 Sep 14. link to original article contains verified protocol PubMed
  4. Pointreau Y, Garaud P, Chapet S, Sire C, Tuchais C, Tortochaux J, Faivre S, Guerrif S, Alfonsi M, Calais G. Randomized trial of induction chemotherapy with cisplatin and 5-fluorouracil with or without docetaxel for larynx preservation. J Natl Cancer Inst. 2009 Apr 1;101(7):498-506. Epub 2009 Mar 24. link to original article contains verified protocol PubMed

Cisplatin & RT

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RT: Radiation Therapy

Regimen #1

Study Evidence Comparator Efficacy
Adelstein et al. 2003 Phase III CF & RT Seems not superior
Radiation therapy Seems to have superior OS
Forastiere et al. 2003 (RTOG 91-11) Phase III CF -> RT Not reported
Radiation therapy Superior DFS
Sun et al. 2016 Phase III TPF -> Cisplatin & RT Seems to have inferior FFS
Siu et al. 2016 (CCTG HN.6) Phase III Panitumumab & RT Seems not superior

Chemoradiotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV once per day on days 1, 22, 43
  • Concurrent radiation therapy as follows:
    • Adelstein et al. 2003, RTOG 91-11, and CCTG HN.6: 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 5 times per week over 7 weeks
    • Sun et al. 2016: see paper for details

One course

Regimen #2

Study Evidence Comparator Efficacy
Ang et al. 2014 (RTOG 0522) Phase III Cetuximab, Cisplatin, RT Seems not superior

Chemoradiotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV once per day on days 1 & 22
  • Concurrent radiation therapy by one of the following:
    • IMRT: 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 6 times per week over 6 weeks
    • Accelerated radiotherapy: 42 fractions (total dose: 72 Gy), given twice per day for 12 days then once per day over 6 weeks

One course

Regimen #3

Study Evidence Comparator Efficacy
Chan et al. 2005 Phase III Radiation therapy Might have superior OS

This study only involved patients with locoregionally advanced nasopharyngeal carcinoma.

Chemoradiotherapy

  • Cisplatin (Platinol) 40 mg/m2 in 1 liter normal saline IV over 2 hours once per day on days 1, 8, 15, 22, 29, 36, 43
  • Concurrent radiation therapy, 2 Gy fractions x 33 fractions (total dose: 66 Gy), given 5 times per week over 6.5 weeks. See Chan et al. 2005 for additional information about boost doses.

One course

References

  1. Adelstein DJ, Li Y, Adams GL, Wagner H Jr, Kish JA, Ensley JF, Schuller DE, Forastiere AA. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol. 2003 Jan 1;21(1):92-8. link to original article contains verified protocol PubMed
  2. Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, Glisson B, Trotti A, Ridge JA, Chao C, Peters G, Lee DJ, Leaf A, Ensley J, Cooper J. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003 Nov 27;349(22):2091-8. link to original article contains verified protocol PubMed
    1. Update: Forastiere AA, Zhang Q, Weber RS, Maor MH, Goepfert H, Pajak TF, Morrison W, Glisson B, Trotti A, Ridge JA, Thorstad W, Wagner H, Ensley JF, Cooper JS. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol. 2013 Mar 1;31(7):845-52. Epub 2012 Nov 26. link to original article contains partial protocol PubMed
  3. Chan AT, Leung SF, Ngan RK, Teo PM, Lau WH, Kwan WH, Hui EP, Yiu HY, Yeo W, Cheung FY, Yu KH, Chiu KW, Chan DT, Mok TS, Yau S, Yuen KT, Mo FK, Lai MM, Ma BB, Kam MK, Leung TW, Johnson PJ, Choi PH, Zee BC. Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst. 2005 Apr 6;97(7):536-9. link to original article contains verified protocol PubMed
  4. Ang KK, Zhang Q, Rosenthal DI, Nguyen-Tan PF, Sherman EJ, Weber RS, Galvin JM, Bonner JA, Harris J, El-Naggar AK, Gillison ML, Jordan RC, Konski AA, Thorstad WL, Trotti A, Beitler JJ, Garden AS, Spanos WJ, Yom SS, Axelrod RS. Randomized phase III trial of concurrent accelerated radiation plus cisplatin with or without cetuximab for stage III to IV head and neck carcinoma: RTOG 0522. J Clin Oncol. 2014 Sep 20;32(27):2940-50. link to original article contains verified protocol PubMed
  5. Ghosh-Laskar S, Kalyani N, Gupta T, Budrukkar A, Murthy V, Sengar M, Chaukar D, Pai P, Chaturvedi P, D'Cruz A, Agarwal J. Conventional radiotherapy versus concurrent chemoradiotherapy versus accelerated radiotherapy in locoregionally advanced carcinoma of head and neck: Results of a prospective randomized trial. Head Neck. 2016 Feb;38(2):202-7. link to original article PubMed
  6. Sun Y, Li WF, Chen NY, Zhang N, Hu GQ, Xie FY, Sun Y, Chen XZ, Li JG, Zhu XD, Hu CS, Xu XY, Chen YY, Hu WH, Guo L, Mo HY, Chen L, Mao YP, Sun R, Ai P, Liang SB, Long GX, Zheng BM, Feng XL, Gong XC, Li L, Shen CY, Xu JY, Guo Y, Chen YM, Zhang F, Lin L, Tang LL, Liu MZ, Ma J. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial. Lancet Oncol. 2016 Nov;17(11):1509-1520. Epub 2016 Sep 26. link to original article contains verified protocol PubMed
  7. Siu LL, Waldron JN, Chen BE, Winquist E, Wright JR, Nabid A, Hay JH, Ringash J, Liu G, Johnson A, Shenouda G, Chasen M, Pearce A, Butler JB, Breen S, Chen EX, FitzGerald TJ, Childs TJ, Montenegro A, O'Sullivan B, Parulekar WR. Effect of Standard Radiotherapy With Cisplatin vs Accelerated Radiotherapy With Panitumumab in Locoregionally Advanced Squamous Cell Head and Neck Carcinoma: A Randomized Clinical Trial. JAMA Oncol. 2017 Feb;3(2):220-6. Epub 2016 Dec 8. link to original article contains verified protocol PubMed

Cisplatin & RT -> CF

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Cisplatin & RT -> CF: Cisplatin and Radiation Therapy followed by Cisplatin and Fluorouracil

Regimen #1

Study Evidence Comparator Efficacy
Al-Sarraf et al. 1998 (Intergroup 0099) Phase III Radiation therapy Superior OS

This study only involved patients with stage III and IV nasopharynx cancers without evidence of metastases.

Chemoradiotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV over 15 to 20 minutes once per day on days 1, 22, 43
  • Concurrent radiation therapy to the primary tumor, 1.8 to 2 Gy fractions x 35 to 39 fractions (total dose: 70 Gy), given 5 times per week. Minimum total dose to neck nodes is 50 Gy for N0 disease; 66 Gy for nodes less than or equal to 2 cm in size; 70 Gy for nodes greater than 2 cm.

Supportive medications

7 to 8-week course, followed 4 weeks after the last dose of cisplatin used in Chemoradiotherapy by:

Chemotherapy

Supportive medications

  • Al-Sarraf et al. 1998 did not specifically say whether the same hydration and antiemetics were used for this chemotherapy as in Chemoradiotherapy.

28-day cycle for 3 cycles

Regimen #2

Study Evidence Comparator Efficacy
Chitapanarux et al. 2007 Phase III Carboplatin & RT -> Carboplatin & 5-FU Seems not superior

This study only involved patients with locoregionally advanced nasopharyngeal carcinoma.

Chemoradiotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV over 3 hours once per day on days 1, 22, 43
  • Concurrent radiation therapy to the primary tumor, 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 5 times per week over 7 weeks

7-week course, followed 4 weeks after the end of radiation therapy by:

Chemotherapy

28-day cycle for 3 cycles

References

  1. Al-Sarraf M, LeBlanc M, Giri PG, Fu KK, Cooper J, Vuong T, Forastiere AA, Adams G, Sakr WA, Schuller DE, Ensley JF. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. 1998 Apr;16(4):1310-7. link to original article contains verified protocol PubMed
  2. Chitapanarux I, Lorvidhaya V, Kamnerdsupaphon P, Sumitsawan Y, Tharavichitkul E, Sukthomya V, Ford J. Chemoradiotherapy comparing cisplatin versus carboplatin in locally advanced nasopharyngeal cancer: randomised, non-inferiority, open trial. Eur J Cancer. 2007 Jun;43(9):1399-406. Epub 2007 Apr 27. link to original article contains verified protocol PubMed

Cisplatin, Paclitaxel, RT

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RT: Radiation Therapy

Regimen

Study Evidence Comparator Efficacy
Garden et al. 2004 (RTOG 97-03) Randomized Phase II CF & RT Seems not superior
5-FU, Hydroxyurea, RT Seems not superior

Chemoradiotherapy

  • Cisplatin (Platinol) 20 mg/m2 IV once each Tuesday on weeks 1 to 7, given prior to radiation
  • Paclitaxel (Taxol) 30 mg/m2 IV once each Monday on weeks 1 to 7, given prior to radiation
  • Concurrent radiation therapy, 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 5 times per week over 7 weeks

7-week course of therapy

References

  1. Garden AS, Harris J, Vokes EE, Forastiere AA, Ridge JA, Jones C, Horwitz EM, Glisson BS, Nabell L, Cooper JS, Demas W, Gore E. Preliminary results of Radiation Therapy Oncology Group 97-03: a randomized phase ii trial of concurrent radiation and chemotherapy for advanced squamous cell carcinomas of the head and neck. J Clin Oncol. 2004 Jul 15;22(14):2856-64. link to original article contains verified protocol PubMed

Fluorouracil, Hydroxyurea, RT

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RT: Radiation Therapy

Regimen

Study Evidence Comparator Efficacy
Garden et al. 2004 (RTOG 97-03) Randomized Phase II CF & RT Seems not superior
Cisplatin, Paclitaxel, RT Seems not superior

Chemoradiotherapy

  • Fluorouracil (5-FU) 800 mg/m2/day IV continuous infusion given 5 days per week on weeks 1, 3, 5, 7, 9, 11, 13 (total dose per week: 4000 mg/m2)
    • Note: Garden et al. 2004 was not clear about the exact schedule nor duration of the continuous infusion, such as whether each continuous infusion was over 24 hours or not
  • Hydroxyurea (Hydrea) 1000 mg PO every 12 hours x 11 doses per week on weeks 1, 3, 5, 7, 9, 11, 13 (total dose per week: 11,000 mg)
    • Note: Garden et al. 2004 did not clearly specify when the doses of hydroxyurea were to be taken in relation to radiation treatments
  • Concurrent radiation therapy, 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 5 times per week on weeks 1, 3, 5, 7, 9, 11, 13

13-week course of therapy

References

  1. Garden AS, Harris J, Vokes EE, Forastiere AA, Ridge JA, Jones C, Horwitz EM, Glisson BS, Nabell L, Cooper JS, Demas W, Gore E. Preliminary results of Radiation Therapy Oncology Group 97-03: a randomized phase ii trial of concurrent radiation and chemotherapy for advanced squamous cell carcinomas of the head and neck. J Clin Oncol. 2004 Jul 15;22(14):2856-64. link to original article contains verified protocol PubMed

PCF -> Cisplatin & RT

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PCF: Paclitaxel, Cisplatin, Fluorouracil
PPF: Paclitaxel, Platinol (Cisplatin), Fluorouracil
RT: Radiation Therapy

Regimen

Study Evidence Comparator Efficacy
Hitt et al. 2005 Phase III CF -> Cisplatin & RT Superior CR rate

Chemotherapy

Supportive medications

3-week cycle for 3 cycles

Patients then undergo ENT evaluation and CT imaging of the primary tumor and neck. Patients with complete response (CR) or partial response of greater than 80% in the primary tumor and no evidence of progression in neck lymph nodes proceeded to chemoradiotherapy. "Patients with a PR of less than 80% or stable disease in the neck lymph nodes (especially if N2 or N3 disease) after induction CT were referred to surgery for neck dissection, if the surgeons were in agreement, before the administration of CRT." Patients with no response or progression of disease were taken off study.

Chemoradiotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV once per day on days 1, 22, 43
  • Concurrent radiation therapy to primary tumor, 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 5 times per week over 7 weeks. Nodal areas not involved by tumor received 50 Gy.

References

  1. Hitt R, López-Pousa A, Martínez-Trufero J, Escrig V, Carles J, Rizo A, Isla D, Vega ME, Martí JL, Lobo F, Pastor P, Valentí V, Belón J, Sánchez MA, Chaib C, Pallarés C, Antón A, Cervantes A, Paz-Ares L, Cortés-Funes H. Phase III study comparing cisplatin plus fluorouracil to paclitaxel, cisplatin, and fluorouracil induction chemotherapy followed by chemoradiotherapy in locally advanced head and neck cancer. J Clin Oncol. 2005 Dec 1;23(34):8636-45. Epub 2005 Nov 7. link to original article contains verified protocol PubMed

PCF -> Paclitaxel & RT

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PCF: Paclitaxel, Cisplatin, Fluorouracil
PPF: Paclitaxel, Platinol, Fluorouracil
RT: Radiation Therapy

Regimen

Study Evidence
Hitt et al. 2002 Phase II

Chemotherapy

Supportive medications

3-week cycle for 3 cycles

Patients undergo ENT evaluation and CT imaging of the primary tumor and neck during week 3 or 4 of cycle 3. Patients who did not have at least a partial response were recommended for surgery. Patients with bulky nodal disease prior to therapy "and/or suboptimal response to induction chemotherapy" were recommended for neck dissection before radiation therapy. Surgery was performed 4 weeks after cycle 3 day 1. Patients with complete response (CR) or partial response proceeded to chemoradiotherapy; radiation therapy alone was used "if concomitant treatment was not feasible."

Chemoradiotherapy

Chemoradiotherapy starts 4 to 6 weeks after cycle 3 day 1 or as soon as patients recover from surgery (if any).

  • Paclitaxel (Taxol) 25 mg/m2 IV over 1 hour once per week during radiation therapy, starting on day 1
  • Concurrent radiation therapy to primary unresected tumors, 1.8 to 2 Gy fractions (total dose: 65 to 70 Gy). Post-operative areas received 60 Gy. Nodal areas not involved by tumor received at least 45 Gy.

Supportive medications

  • "Usual pre-medication was given before each paclitaxel infusion" (presumably the same ones used during induction chemotherapy).

References

  1. Hitt R, Paz-Ares L, Brandáriz A, Castellano D, Peña C, Millán JM, Calvo F, Ortiz de Urbina D, López E, Alvarez-Vicent JJ, Cortés-Funes H. Induction chemotherapy with paclitaxel, cisplatin and 5-fluorouracil for squamous cell carcinoma of the head and neck: long-term results of a phase II trial. Ann Oncol. 2002 Oct;13(10):1665-73. link to original article contains verified protocol PubMed

Radiation therapy

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Regimen

Study Evidence Comparator Efficacy
Al-Sarraf et al. 1998 (Intergroup 0099) Phase III Cisplatin & RT -> CF Inferior OS
Adelstein et al. 2003 Phase III CF & RT Seems not superior
Cisplatin & RT Seems to have inferior OS
Forastiere et al. 2003 (RTOG 91-11) Phase III CF -> RT Seems to have inferior DFS
Cisplatin & RT Inferior DFS
Denis et al. 2004 (GORTEC 94-01) Phase III Carboplatin, 5-FU, RT Seems to have inferior OS
Chan et al. 2005 Phase III Cisplatin & RT Might have inferior OS
Bonner et al. 2006 (IMCL-9815) Phase III Cetuximab & RT Seems to have inferior OS
Bourhis et al. 2012 (GORTEC 99-02) Phase III Carboplatin, 5-FU, RT Seems to have inferior PFS
Carboplatin, 5-FU, accelerated concurrent RT Might have inferior PFS

Used as a comparator arm; included for reference purposes only.

References

  1. Al-Sarraf M, LeBlanc M, Giri PG, Fu KK, Cooper J, Vuong T, Forastiere AA, Adams G, Sakr WA, Schuller DE, Ensley JF. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. 1998 Apr;16(4):1310-7. link to original article contains verified protocol PubMed
  2. Adelstein DJ, Li Y, Adams GL, Wagner H Jr, Kish JA, Ensley JF, Schuller DE, Forastiere AA. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol. 2003 Jan 1;21(1):92-8. link to original article contains verified protocol PubMed
  3. Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, Glisson B, Trotti A, Ridge JA, Chao C, Peters G, Lee DJ, Leaf A, Ensley J, Cooper J. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003 Nov 27;349(22):2091-8. link to original article contains verified protocol PubMed
    1. Update: Forastiere AA, Zhang Q, Weber RS, Maor MH, Goepfert H, Pajak TF, Morrison W, Glisson B, Trotti A, Ridge JA, Thorstad W, Wagner H, Ensley JF, Cooper JS. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol. 2013 Mar 1;31(7):845-52. Epub 2012 Nov 26. link to original article contains partial protocol PubMed
  4. Denis F, Garaud P, Bardet E, Alfonsi M, Sire C, Germain T, Bergerot P, Rhein B, Tortochaux J, Calais G. Final results of the 94-01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol. 2004 Jan 1;22(1):69-76. Epub 2003 Dec 2. link to original article contains verified protocol PubMed
  5. Chan AT, Leung SF, Ngan RK, Teo PM, Lau WH, Kwan WH, Hui EP, Yiu HY, Yeo W, Cheung FY, Yu KH, Chiu KW, Chan DT, Mok TS, Yau S, Yuen KT, Mo FK, Lai MM, Ma BB, Kam MK, Leung TW, Johnson PJ, Choi PH, Zee BC. Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst. 2005 Apr 6;97(7):536-9. link to original article contains verified protocol PubMed
  6. Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, Jones CU, Sur R, Raben D, Jassem J, Ove R, Kies MS, Baselga J, Youssoufian H, Amellal N, Rowinsky EK, Ang KK. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med. 2006 Feb 9;354(6):567-78. link to original article contains verified protocol PubMed
    1. Update: Bonner JA, Harari PM, Giralt J, Cohen RB, Jones CU, Sur RK, Raben D, Baselga J, Spencer SA, Zhu J, Youssoufian H, Rowinsky EK, Ang KK. Radiotherapy plus cetuximab for locoregionally advanced head and neck cancer: 5-year survival data from a phase 3 randomised trial, and relation between cetuximab-induced rash and survival. Lancet Oncol. 2010 Jan;11(1):21-8. Epub 2009 Nov 10. link to original article contains partial protocol PubMed
    2. QoL Analysis: Curran D, Giralt J, Harari PM, Ang KK, Cohen RB, Kies MS, Jassem J, Baselga J, Rowinsky EK, Amellal N, Comte S, Bonner JA. Quality of life in head and neck cancer patients after treatment with high-dose radiotherapy alone or in combination with cetuximab. J Clin Oncol. 2007 Jun 1;25(16):2191-7. link to original article contains partial protocol PubMed
    3. Retrospective subgroup analysis: Rosenthal DI, Harari PM, Giralt J, Bell D, Raben D, Liu J, Schulten J, Ang KK, Bonner JA. Association of Human Papillomavirus and p16 Status With Outcomes in the IMCL-9815 Phase III Registration Trial for Patients With Locoregionally Advanced Oropharyngeal Squamous Cell Carcinoma of the Head and Neck Treated With Radiotherapy With or Without Cetuximab. J Clin Oncol. 2016 Apr 20;34(12):1300-8. Epub 2015 Dec 28. link to original article PubMed
  7. Bourhis J, Sire C, Graff P, Grégoire V, Maingon P, Calais G, Gery B, Martin L, Alfonsi M, Desprez P, Pignon T, Bardet E, Rives M, Geoffrois L, Daly-Schveitzer N, Sen S, Tuchais C, Dupuis O, Guerif S, Lapeyre M, Favrel V, Hamoir M, Lusinchi A, Temam S, Pinna A, Tao YG, Blanchard P, Aupérin A. Concomitant chemoradiotherapy versus acceleration of radiotherapy with or without concomitant chemotherapy in locally advanced head and neck carcinoma (GORTEC 99-02): an open-label phase 3 randomised trial. Lancet Oncol. 2012 Feb;13(2):145-53. Epub 2012 Jan 18. link to original article contains verified protocol PubMed
  8. Ghosh-Laskar S, Kalyani N, Gupta T, Budrukkar A, Murthy V, Sengar M, Chaukar D, Pai P, Chaturvedi P, D'Cruz A, Agarwal J. Conventional radiotherapy versus concurrent chemoradiotherapy versus accelerated radiotherapy in locoregionally advanced carcinoma of head and neck: Results of a prospective randomized trial. Head Neck. 2016 Feb;38(2):202-7. link to original article PubMed

TPF -> Carboplatin & RT

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DCF: Docetaxel, Cisplatin, Fluorouracil
TPF: Taxotere (Docetaxel), Platinol (Cisplatin), Fluorouracil
RT: Radiation Therapy

Regimen

Study Evidence Comparator Efficacy
Posner et al. 2007 (TAX 324) Phase III CF -> Carboplatin & RT Superior OS

Chemotherapy

  • Docetaxel (Taxotere) 75 mg/m2 IV over 1 hour once on day 1, given first before cisplatin
  • Cisplatin (Platinol) 100 mg/m2 IV over 30 to 180 minutes once on day 1, given second after docetaxel
  • Fluorouracil (5-FU) 1000 mg/m2/day IV continuous infusion over 96 hours on days 1 to 4, given third (total dose per cycle: 4000 mg/m2)

Supportive medications

21-day cycle for 3 cycles; then start chemoradiotherapy 3 to 8 weeks after the start of cycle 3:

Chemoradiotherapy

  • Carboplatin (Paraplatin) AUC 1.5 IV over 1 hour once per day on days 1, 8, 15, 22, 29, 36, 43
  • Concurrent radiation therapy, 2 Gy fractions x 35 to 37 fractions (total dose: 70 to 74 Gy), given 5 times per week over 7 to 7.5 weeks

7 to 7.5-week course; surgery "performed 6 to 12 weeks after completion of chemoradiotherapy for patients who had an initial nodal stage of N2 and a partial response to induction chemotherapy, N3 disease, or residual disease after chemoradiotherapy."

References

  1. Posner MR, Hershock DM, Blajman CR, Mickiewicz E, Winquist E, Gorbounova V, Tjulandin S, Shin DM, Cullen K, Ervin TJ, Murphy BA, Raez LE, Cohen RB, Spaulding M, Tishler RB, Roth B, Viroglio Rdel C, Venkatesan V, Romanov I, Agarwala S, Harter KW, Dugan M, Cmelak A, Markoe AM, Read PW, Steinbrenner L, Colevas AD, Norris CM Jr, Haddad RI; TAX 324 Study Group. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med. 2007 Oct 25;357(17):1705-15. link to original article contains verified protocol PubMed

TPF -> Cisplatin & RT

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DCF: Docetaxel, Cisplatin, Fluorouracil
TPF: Taxotere, Platinol, Fluorouracil
RT: Radiation Therapy

Regimen #1

Study Evidence Comparator Efficacy
Sun et al. 2016 Phase III Cisplatin & concurrent RT Seems to have superior FFS

Chemotherapy

21-day cycle for 3 cycles, followed by:

Chemoradiotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV once per day on days 1, 22, 43
  • Concurrent radiation therapy, see paper for details

One course

Regimen #2

Study Evidence Comparator Efficacy
Lefebvre et al. 2013 (TREMPLIN) Randomized Phase II TPF -> Cetuximab & RT Seems not superior

Chemotherapy

Supportive medications

21-day cycle for 3 cycles

Restaging of disease takes place 2 weeks after finishing cycle 3. Patients who had "at least 50% regression of their primary tumor volume and who recovered larynx mobility" were treated with Chemoradiotherapy. Patients who did not have at least 50% regression had salvage total laryngectomy.

Chemoradiotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV once per day on days 1, 22, 43
  • Concurrent radiation therapy, 2 Gy fractions x 35 fractions (total dose: 70 Gy), given once per day 5 times per week over 7 weeks

Regimen #3

Study Evidence
Adelstein et al. 2010 (SWOG S0216) Phase II

Chemotherapy

Supportive medications

  • Ciprofloxacin (Cipro) prophylaxis for 10 days (dose/route/precise schedule not specified)
  • "Standard anti-emetics, hydration and diuresis"

21-day cycle for 2 cycles

Restaging of disease takes place 3 weeks after finishing cycle 2. Patients with stable or tumors which responded to therapy proceed to concurrent Chemoradiotherapy therapy. Patients with progressive disease are considered--if possible--for surgical resection and post-operative radiation. Patients who could not undergo surgery also received concurrent Chemoradiotherapy therapy.

Chemoradiotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV once per day on days 1 & 22
  • Concurrent radiation therapy, 1.8 Gy fractions x 30 fractions, given 5 times per week (total dose: 54 Gy)
    • The last 12 treatments involved a boost volume, 1.5 Gy fractions x 12 fractions (dose to boost volume: 18 Gy)

Supportive medications

  • "Standard hydration and anti-emetic therapy"

6-week course; "Surgical resection was considered after concomitant chemoradiotherapy for those patients with histologically confirmed residual or recurrent disease at the primary site."

Regimen #4

Study Evidence
Bae et al. 2010 Phase II

This study only involved patients with locoregionally advanced nasopharyngeal cancer.

Chemotherapy

  • Docetaxel (Taxotere) 70 mg/m2 in 300 mL normal saline IV over 1 hour once on day 1, given first
  • Cisplatin (Platinol) 75 mg/m2 IV over 3 hours once on day 1, given second
  • Fluorouracil (5-FU) 1000 mg/m2/day IV continuous infusion over 4 days on days 1 to 4, started after completion of cisplatin (total dose per cycle: 4000 mg/m2)

Supportive medications

21-day cycle for 3 cycles; then proceed to chemoradiotherapy:

Chemoradiotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV once per day on days 1 & 22
  • Concurrent radiation therapy, 1.8 to 2 Gy fractions (total dose: 68.4 Gy), given 5 times per week

References

  1. Adelstein DJ, Moon J, Hanna E, Giri PG, Mills GM, Wolf GT, Urba SG. Docetaxel, cisplatin, and fluorouracil induction chemotherapy followed by accelerated fractionation/concomitant boost radiation and concurrent cisplatin in patients with advanced squamous cell head and neck cancer: A Southwest Oncology Group phase II trial (S0216). Head Neck. 2010 Feb;32(2):221-8. link to PMC article contains verified protocol PubMed
  2. Bae WK, Hwang JE, Shim HJ, Cho SH, Lee JK, Lim SC, Chung WK, Chung IJ. Phase II study of docetaxel, cisplatin, and 5-FU induction chemotherapy followed by chemoradiotherapy in locoregionally advanced nasopharyngeal cancer. Cancer Chemother Pharmacol. 2010 Feb;65(3):589-95. link to original article contains verified protocol PubMed
  3. Lefebvre JL, Pointreau Y, Rolland F, Alfonsi M, Baudoux A, Sire C, de Raucourt D, Malard O, Degardin M, Tuchais C, Blot E, Rives M, Reyt E, Tourani JM, Geoffrois L, Peyrade F, Guichard F, Chevalier D, Babin E, Lang P, Janot F, Calais G, Garaud P, Bardet E. Induction chemotherapy followed by either chemoradiotherapy or bioradiotherapy for larynx preservation: the TREMPLIN randomized phase II study. J Clin Oncol. 2013 Mar 1;31(7):853-9. Epub 2013 Jan 22. link to original article contains verified protocol PubMed
  4. Sun Y, Li WF, Chen NY, Zhang N, Hu GQ, Xie FY, Sun Y, Chen XZ, Li JG, Zhu XD, Hu CS, Xu XY, Chen YY, Hu WH, Guo L, Mo HY, Chen L, Mao YP, Sun R, Ai P, Liang SB, Long GX, Zheng BM, Feng XL, Gong XC, Li L, Shen CY, Xu JY, Guo Y, Chen YM, Zhang F, Lin L, Tang LL, Liu MZ, Ma J. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial. Lancet Oncol. 2016 Nov;17(11):1509-1520. Epub 2016 Sep 26. link to original article contains verified protocol PubMed

TPF -> RT

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DCF: Docetaxel, Cisplatin, Fluorouracil
TPF: Taxotere (Docetaxel), Platinol (Cisplatin), Fluorouracil
RT: Radiation Therapy

Regimen #1

Study Evidence Comparator Efficacy
Vermorken et al. 2007 (EORTC 24971/TAX 323) Phase III CF -> RT Seems to have superior OS

Chemotherapy

  • Docetaxel (Taxotere) 75 mg/m2 IV over 1 hour once on day 1, given first before cisplatin
  • Cisplatin (Platinol) 75 mg/m2 IV over 1 hour once on day 1, given second after docetaxel
  • Fluorouracil (5-FU) 750 mg/m2/day IV continuous infusion over 5 days on days 1 to 5 (total dose per cycle: 3750 mg/m2)

Supportive medications

21-day cycle for 4 cycles

Patients without progressive disease and who had recovery of marrow function, resolution of mucositis, and healed from any dental procedures started radiation therapy within 4 to 7 weeks of finishing chemotherapy:

Radiotherapy

  • Radiation therapy over 7 weeks with one of the following (further details not provided):
    • Conventional fractionation, total dose 66 to 70 Gy
    • Accelerated fractionation, total dose 70 Gy
    • Hyperfractionated, total dose 74 Gy

Regimen #2

Study Evidence Comparator Efficacy
Pointreau et al. 2009 (GORTEC) Phase III CF -> RT Superior ORR

Chemotherapy

Supportive medications

21-day cycle for 3 cycles

Patients who responded to induction chemotherapy proceeded to radiation therapy within 3 to 7 weeks of finishing chemotherapy. Patients who did not respond to induction chemotherapy proceeded to surgery and postoperative radiotherapy (see Pointreau et al. 2009 for details).

Radiotherapy

  • Radiation therapy to the primary tumor and involved lymph nodes, 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 5 times per week over 7 weeks. Prophylactic radiation to the volume at risk for microscopic disease, 2 Gy fractions x 25 to 27 fractions (total dose: 50 to 54 Gy), given 5 times per week.
  • "Chemotherapy (cisplatin, carboplatin, and 5-fluorouracil or a combination of two drugs) during radiotherapy was allowed for all patients who were treated at the same institute, according to its practice." No further details available.

References

  1. Vermorken JB, Remenar E, van Herpen C, Gorlia T, Mesia R, Degardin M, Stewart JS, Jelic S, Betka J, Preiss JH, van den Weyngaert D, Awada A, Cupissol D, Kienzer HR, Rey A, Desaunois I, Bernier J, Lefebvre JL; EORTC 24971/TAX 323 Study Group. Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med. 2007 Oct 25;357(17):1695-704. link to original article contains verified protocol PubMed
    1. QoL Analysis: van Herpen CM, Mauer ME, Mesia R, Degardin M, Jelic S, Coens C, Betka J, Bernier J, Remenar E, Stewart JS, Preiss JH, van den Weyngaert D, Bottomley A, Vermorken JB; EORTC Head and Neck Group. Short-term health-related quality of life and symptom control with docetaxel, cisplatin, 5-fluorouracil and cisplatin (TPF), 5-fluorouracil (PF) for induction in unresectable locoregionally advanced head and neck cancer patients (EORTC 24971/TAX 323). Br J Cancer. 2010 Oct 12;103(8):1173-81. Epub 2010 Sep 14. link to original article contains verified protocol PubMed
  2. Pointreau Y, Garaud P, Chapet S, Sire C, Tuchais C, Tortochaux J, Faivre S, Guerrif S, Alfonsi M, Calais G. Randomized trial of induction chemotherapy with cisplatin and 5-fluorouracil with or without docetaxel for larynx preservation. J Natl Cancer Inst. 2009 Apr 1;101(7):498-506. Epub 2009 Mar 24. link to original article contains verified protocol PubMed content property of HemOnc.org

Recurrent or metastatic disease

Afatinib (Gliotrif)

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Regimen

Study Evidence Comparator Efficacy
Machiels et al. 2015 (LUX-Head & Neck 1) Phase III Methotrexate Seems to have superior PFS

Chemotherapy

References

  1. Machiels JP, Haddad RI, Fayette J, Licitra LF, Tahara M, Vermorken JB, Clement PM, Gauler T, Cupissol D, Grau JJ, Guigay J, Caponigro F, de Castro G Jr, de Souza Viana L, Keilholz U, Del Campo JM, Cong XJ, Ehrnrooth E, Cohen EE; LUX-H&N 1 investigators. Afatinib versus methotrexate as second-line treatment in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck progressing on or after platinum-based therapy (LUX-Head & Neck 1): an open-label, randomised phase 3 trial. Lancet Oncol. 2015 May;16(5):583-94. Epub 2015 Apr 16. link to original article contains protocol PubMed

Carboplatin & Docetaxel

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Regimen

Study Evidence
Samlowski et al. 2007 Phase II

Chemotherapy

21-day cycles

References

  1. Samlowski WE, Moon J, Kuebler JP, Nichols CR, Gandara DR, Ozer H, Williamson SK, Atkins JN, Schuller DE, Ensley JF. Evaluation of the combination of docetaxel/carboplatin in patients with metastatic or recurrent squamous cell carcinoma of the head and neck (SCCHN): a Southwest Oncology Group Phase II study. Cancer Invest. 2007 Apr-May;25(3):182-8. link to original article contains protocol PubMed

Carboplatin & Fluorouracil

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Regimen

Study Evidence Comparator Efficacy
Forastiere et al. 1992 Phase III CF Not reported
MTX Seems to have superior ORR
Vermorken et al. 2008 Phase III Carboplatin, Fluorouracil, Cetuximab Seems to have inferior OS

Chemotherapy

Supportive medications

  • "Standard antiemetic regimens"

28-day cycles

References

  1. Forastiere AA, Metch B, Schuller DE, Ensley JF, Hutchins LF, Triozzi P, Kish JA, McClure S, VonFeldt E, Williamson SK et al. Randomized comparison of cisplatin plus fluorouracil and carboplatin plus fluorouracil versus methotrexate in advanced squamous-cell carcinoma of the head and neck: a Southwest Oncology Group study. J Clin Oncol. 1992 Aug;10(8):1245-51. link to original article contains verified protocol PubMed
  2. Vermorken JB, Mesia R, Rivera F, Remenar E, Kawecki A, Rottey S, Erfan J, Zabolotnyy D, Kienzer HR, Cupissol D, Peyrade F, Benasso M, Vynnychenko I, De Raucourt D, Bokemeyer C, Schueler A, Amellal N, Hitt R. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med. 2008 Sep 11;359(11):1116-27. link to original article contains verified protocol PubMed

Carboplatin, Fluorouracil, Cetuximab

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Regimen

Study Evidence Comparator Efficacy
Vermorken et al. 2008 Phase III Carboplatin & Fluorouracil Seems to have superior OS

Chemotherapy

  • Carboplatin (Paraplatin) AUC 5 IV over 1 hour once on day 1
  • Fluorouracil (5-FU) 1000 mg/m2/day IV continuous infusion over 4 days on days 1 to 4 (total dose per cycle: 4000 mg/m2)
  • Cetuximab (Erbitux) given first before chemotherapy and ending at least 1 hour before chemotherapy starts, as follows:
    • Cycle 1: 400 mg/m2 IV over 2 hours once on day 1, then 250 mg/m2 IV over 1 hour once per day on days 8 & 15
    • Cycle 2 onwards: 250 mg/m2 IV over 1 hour once per day on days 1, 8, 15

21-day cycle for up to 6 cycles

References

  1. Vermorken JB, Mesia R, Rivera F, Remenar E, Kawecki A, Rottey S, Erfan J, Zabolotnyy D, Kienzer HR, Cupissol D, Peyrade F, Benasso M, Vynnychenko I, De Raucourt D, Bokemeyer C, Schueler A, Amellal N, Hitt R. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med. 2008 Sep 11;359(11):1116-27. link to original article contains verified protocol PubMed

Cetuximab (Erbitux)

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Regimen

Study Evidence
Vermorken et al. 2007 Phase II

Chemotherapy

  • Cetuximab (Erbitux) 400 mg/m2 (includes 20 mg IV once as a test dose) IV over 120 minutes once on day 1; then starting 1 week later, 250 mg/m2 IV over 1 hour once per week

References

  1. Vermorken JB, Trigo J, Hitt R, Koralewski P, Diaz-Rubio E, Rolland F, Knecht R, Amellal N, Schueler A, Baselga J. Open-label, uncontrolled, multicenter phase II study to evaluate the efficacy and toxicity of cetuximab as a single agent in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck who failed to respond to platinum-based therapy. J Clin Oncol. 2007 Jun 1;25(16):2171-7. link to original article contains verified protocol PubMed
  2. Ferris RL, Blumenschein G Jr, Fayette J, Guigay J, Colevas AD, Licitra L, Harrington K, Kasper S, Vokes EE, Even C, Worden F, Saba NF, Iglesias Docampo LC, Haddad R, Rordorf T, Kiyota N, Tahara M, Monga M, Lynch M, Geese WJ, Kopit J, Shaw JW, Gillison ML. Nivolumab for Recurrent Squamous-Cell Carcinoma of the Head and Neck. N Engl J Med. 2016 Nov;375(19):1856-67. Epub 2016 Oct 8. link to original article PubMed

CF

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CF: Cisplatin and Fluorouracil

Regimen #1

Study Evidence Comparator Efficacy
Zhang et al. 2016 Phase III Cisplatin & Gemcitabine Inferior PFS

Note: this regimen was intended for recurrent or metastatic nasopharyngeal carcinoma.

Chemotherapy

21-day cycle for up to 6 cycles

Regimen #2

Study Evidence Comparator Efficacy
Forastiere et al. 1992 Phase III Carboplatin & Fluorouracil Not reported
MTX Superior ORR
Gibson et al. 2005 (ECOG E1395) Phase III CP Seems not superior
Vermorken et al. 2008 Phase III Cisplatin, Fluorouracil, Cetuximab Seems to have inferior OS
Vermorken et al. 2013 (SPECTRUM) Phase III Cisplatin, Fluorouracil, Panitumumab Inferior PFS

Chemotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV once on day 1
    • ECOG E1395: Carboplatin (Paraplatin) AUC 6 IV once on day 1 could be substituted in patients who developed at least grade 2 neuropathy or renal impairment (creatinine clearance less than 50 mL/min; note: later in Gibson et al. 2005, it says that carboplatin was used for patients who had creatinine clearance ≤50 mL/min)
  • Fluorouracil (5-FU) 1000 mg/m2/day IV continuous infusion on days 1 to 4 (total dose per cycle: 4000 mg/m2)

Supportive medications

  • Details vary per reference
  • Pretreatment and posttreatment hydration and mannitol diuresis with Cisplatin (Platinol)
  • "Standard antiemetic regimens"

21-day cycle for up to 6 cycles (SPECTRUM) or indefinitely, see note below

In ECOG E1395, patients with complete response (CR) received at least 6 cycles or 2 cycles past the point at which CR was documented, whichever came later; patients with partial response (PR) continued on treatment until there was evidence of CR or progression disease; patients with stable disease (SD) could discontinue treatment after six cycles.

References

  1. Forastiere AA, Metch B, Schuller DE, Ensley JF, Hutchins LF, Triozzi P, Kish JA, McClure S, VonFeldt E, Williamson SK et al. Randomized comparison of cisplatin plus fluorouracil and carboplatin plus fluorouracil versus methotrexate in advanced squamous-cell carcinoma of the head and neck: a Southwest Oncology Group study. J Clin Oncol. 1992 Aug;10(8):1245-51. link to original article contains verified protocol PubMed
  2. Gibson MK, Li Y, Murphy B, Hussain MH, DeConti RC, Ensley J, Forastiere AA; Eastern Cooperative Oncology Group. Randomized phase III evaluation of cisplatin plus fluorouracil versus cisplatin plus paclitaxel in advanced head and neck cancer (E1395): an intergroup trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2005 May 20;23(15):3562-7. link to original article contains verified protocol PubMed
  3. Vermorken JB, Mesia R, Rivera F, Remenar E, Kawecki A, Rottey S, Erfan J, Zabolotnyy D, Kienzer HR, Cupissol D, Peyrade F, Benasso M, Vynnychenko I, De Raucourt D, Bokemeyer C, Schueler A, Amellal N, Hitt R. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med. 2008 Sep 11;359(11):1116-27. link to original article contains verified protocol PubMed
  4. Vermorken JB, Stöhlmacher-Williams J, Davidenko I, Licitra L, Winquist E, Villanueva C, Foa P, Rottey S, Skladowski K, Tahara M, Pai VR, Faivre S, Blajman CR, Forastiere AA, Stein BN, Oliner KS, Pan Z, Bach BA; SPECTRUM investigators. Cisplatin and fluorouracil with or without panitumumab in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck (SPECTRUM): an open-label phase 3 randomised trial. Lancet Oncol. 2013 Jul;14(8):697-710. Epub 2013 Jun 6. link to original article contains protocol PubMed
  5. Zhang L, Huang Y, Hong S, Yang Y, Yu G, Jia J, Peng P, Wu X, Lin Q, Xi X, Peng J, Xu M, Chen D, Lu X, Wang R, Cao X, Chen X, Lin Z, Xiong J, Lin Q, Xie C, Li Z, Pan J, Li J, Wu S, Lian Y, Yang Q, Zhao C. Gemcitabine plus cisplatin versus fluorouracil plus cisplatin in recurrent or metastatic nasopharyngeal carcinoma:a multicentre, randomised, open-label, phase 3 trial. Lancet. 2016 Aug 23. [Epub ahead of print] link to original article contains protocol PubMed

Cisplatin (Platinol)

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Regimen

Study Evidence Comparator Efficacy
Burtness et al. 2005 Phase III Cisplatin & Cetuximab Seems not superior

Chemotherapy

28-day cycles

Per physician discretion, patients with complete response (CR) could have treatment discontinued 2 cycles past the point at which CR was attained. Patients with partial response (PR) continued on treatment until there was evidence of CR or progression disease. Patients with stable disease (SD) could discontinue treatment after 6 cycles. Patients with progressive disease discontinued therapy.

References

  1. Burtness B, Goldwasser MA, Flood W, Mattar B, Forastiere AA; Eastern Cooperative Oncology Group. Phase III randomized trial of cisplatin plus placebo compared with cisplatin plus cetuximab in metastatic/recurrent head and neck cancer: an Eastern Cooperative Oncology Group study. J Clin Oncol. 2005 Dec 1;23(34):8646-54. link to original article contains verified protocol PubMed

Cisplatin & Cetuximab

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Regimen

Study Evidence Comparator Efficacy
Burtness et al. 2005 Phase III Cisplatin Seems not superior

Chemotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV once on day 1
  • Cetuximab (Erbitux) as follows:
    • Cycle 1: 200 mg/m2 IV over 120 minutes once on day 1, then 125 mg/m2 IV over 60 minutes once per day on days 8, 15, 22
    • Subsequent cycles: 125 mg/m2 IV over 60 minutes once per day on days 1, 8, 15, 22

28-day cycles

Per physician discretion, patients with complete response (CR) could have treatment discontinued 2 cycles past the point at which CR was attained. Patients with partial response (PR) continued on treatment until there was evidence of CR or progression disease. Patients with stable disease (SD) could discontinue treatment after 6 cycles. Patients with progressive disease discontinued therapy.

References

  1. Burtness B, Goldwasser MA, Flood W, Mattar B, Forastiere AA; Eastern Cooperative Oncology Group. Phase III randomized trial of cisplatin plus placebo compared with cisplatin plus cetuximab in metastatic/recurrent head and neck cancer: an Eastern Cooperative Oncology Group study. J Clin Oncol. 2005 Dec 1;23(34):8646-54. link to original article contains verified protocol PubMed

Cisplatin, Fluorouracil, Cetuximab

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Regimen

Study Evidence Comparator Efficacy
Vermorken et al. 2008 Phase III CF Seems to have superior OS

Chemotherapy

  • Cisplatin (Platinol) 100 mg/m2 IV over 1 hour once on day 1
  • Fluorouracil (5-FU) 1000 mg/m2/day IV continuous infusion over 4 days on days 1 to 4 (total dose per cycle: 4000 mg/m2)
  • Cetuximab (Erbitux) given first before chemotherapy and ending at least 1 hour before chemotherapy starts, as follows:
    • Cycle 1: 400 mg/m2 IV over 2 hours once on day 1, then 250 mg/m2 IV over 1 hour once per day on days 8 & 15
    • Cycle 2 onwards: 250 mg/m2 IV over 1 hour once per day on days 1, 8, 15

21-day cycle for up to 6 cycles

References

  1. Vermorken JB, Mesia R, Rivera F, Remenar E, Kawecki A, Rottey S, Erfan J, Zabolotnyy D, Kienzer HR, Cupissol D, Peyrade F, Benasso M, Vynnychenko I, De Raucourt D, Bokemeyer C, Schueler A, Amellal N, Hitt R. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med. 2008 Sep 11;359(11):1116-27. link to original article contains verified protocol PubMed

Cisplatin, Fluorouracil, Panitumumab

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Regimen

Study Evidence Comparator Efficacy
Vermorken et al. 2013 (SPECTRUM) Phase III CF Superior PFS

Chemotherapy

21-day cycle for up to 6 cycles

Patients could choose to continue panitumumab maintenance.

References

  1. Vermorken JB, Stöhlmacher-Williams J, Davidenko I, Licitra L, Winquist E, Villanueva C, Foa P, Rottey S, Skladowski K, Tahara M, Pai VR, Faivre S, Blajman CR, Forastiere AA, Stein BN, Oliner KS, Pan Z, Bach BA; SPECTRUM investigators. Cisplatin and fluorouracil with or without panitumumab in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck (SPECTRUM): an open-label phase 3 randomised trial. Lancet Oncol. 2013 Jul;14(8):697-710. Epub 2013 Jun 6. link to original article contains protocol PubMed

Cisplatin & Gemcitabine

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Regimen

Study Evidence Comparator Efficacy
Zhang et al. 2016 Phase III CF Superior PFS

Note: this regimen was intended for recurrent or metastatic nasopharyngeal carcinoma.

Chemotherapy

21-day cycle for up to 6 cycles

References

  1. Zhang L, Huang Y, Hong S, Yang Y, Yu G, Jia J, Peng P, Wu X, Lin Q, Xi X, Peng J, Xu M, Chen D, Lu X, Wang R, Cao X, Chen X, Lin Z, Xiong J, Lin Q, Xie C, Li Z, Pan J, Li J, Wu S, Lian Y, Yang Q, Zhao C. Gemcitabine plus cisplatin versus fluorouracil plus cisplatin in recurrent or metastatic nasopharyngeal carcinoma:a multicentre, randomised, open-label, phase 3 trial. Lancet. 2016 Aug 23. [Epub ahead of print] link to original article contains protocol PubMed

CP

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CP: Cisplatin and Paclitaxel

Regimen

Study Evidence Comparator Efficacy
Gibson et al. 2005 (ECOG E1395) Phase III CF Seems not superior

Chemotherapy

  • Cisplatin (Platinol) 75 mg/m2 IV once on day 1
    • Carboplatin (Paraplatin) AUC 6 IV once on day 1 could be used in patients who developed at least grade 2 neuropathy or renal impairment (creatinine clearance less than 50 mL/min; note: later in Gibson et al. 2005, it says that carboplatin was used for patients who had creatinine clearance ≤50 mL/min)
  • Paclitaxel (Taxol) 175 mg/m2 IV over 3 hours once on day 1

Supportive medications

21-day cycles

Patients with complete response (CR) received at least 6 cycles or 2 cycles past the point at which CR was documented, whichever came later. Patients with partial response (PR) continued on treatment until there was evidence of CR or progression disease. "Patients with stable disease (SD) could discontinue treatment after six cycles."

References

  1. Gibson MK, Li Y, Murphy B, Hussain MH, DeConti RC, Ensley J, Forastiere AA; Eastern Cooperative Oncology Group. Randomized phase III evaluation of cisplatin plus fluorouracil versus cisplatin plus paclitaxel in advanced head and neck cancer (E1395): an intergroup trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2005 May 20;23(15):3562-7. link to original article contains verified protocol PubMed

Gemcitabine (Gemzar)

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Regimen

Study Evidence
Zhang et al. 2008 Phase II

This study only involved patients with advanced (stage IV) or metastatic nasopharyngeal cancer who had already received previous platinum-based chemotherapy.

Chemotherapy

  • Gemcitabine (Gemzar) 1000 mg/m2 in 100 mL normal saline IV over 30 minutes once per day on days 1, 8, 15

Supportive medications

28-day cycles, given until progression of disease

References

  1. Zhang L, Zhang Y, Huang PY, Xu F, Peng PJ, Guan ZZ. Phase II clinical study of gemcitabine in the treatment of patients with advanced nasopharyngeal carcinoma after the failure of platinum-based chemotherapy. Cancer Chemother Pharmacol. 2008 Jan;61(1):33-8. Epub 2007 Mar 20. link to original article contains verified protocol PubMed

Methotrexate (MTX)

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Regimen

Study Evidence Comparator Efficacy
Forastiere et al. 1992 Phase III Carboplatin & Fluorouracil Seems to have inferior ORR
CF Inferior ORR
Machiels et al. 2015 (LUX-Head & Neck 1) Phase III Afatinib Seems to have inferior PFS

Chemotherapy

Supportive medications

  • "Standard antiemetic regimens"

References

  1. Forastiere AA, Metch B, Schuller DE, Ensley JF, Hutchins LF, Triozzi P, Kish JA, McClure S, VonFeldt E, Williamson SK et al. Randomized comparison of cisplatin plus fluorouracil and carboplatin plus fluorouracil versus methotrexate in advanced squamous-cell carcinoma of the head and neck: a Southwest Oncology Group study. J Clin Oncol. 1992 Aug;10(8):1245-51. link to original article contains verified protocol PubMed
  2. Machiels JP, Haddad RI, Fayette J, Licitra LF, Tahara M, Vermorken JB, Clement PM, Gauler T, Cupissol D, Grau JJ, Guigay J, Caponigro F, de Castro G Jr, de Souza Viana L, Keilholz U, Del Campo JM, Cong XJ, Ehrnrooth E, Cohen EE; LUX-H&N 1 investigators. Afatinib versus methotrexate as second-line treatment in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck progressing on or after platinum-based therapy (LUX-Head & Neck 1): an open-label, randomised phase 3 trial. Lancet Oncol. 2015 May;16(5):583-94. Epub 2015 Apr 16. link to original article contains protocol PubMed
  3. Ferris RL, Blumenschein G Jr, Fayette J, Guigay J, Colevas AD, Licitra L, Harrington K, Kasper S, Vokes EE, Even C, Worden F, Saba NF, Iglesias Docampo LC, Haddad R, Rordorf T, Kiyota N, Tahara M, Monga M, Lynch M, Geese WJ, Kopit J, Shaw JW, Gillison ML. Nivolumab for Recurrent Squamous-Cell Carcinoma of the Head and Neck. N Engl J Med. 2016 Nov;375(19):1856-67. Epub 2016 Oct 8. link to original article PubMed

Nivolumab (Opdivo)

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Regimen

Study Evidence ORR Comparator Comparator ORR Efficacy Pt Population
Ferris et al. 2016 (CheckMate 141) Phase III 13% (95% CI 9-18) Investigators' choice of:
Methotrexate
Docetaxel
Cetuximab
6% (95% CI 2-12) Superior OS Recurrent disease, previously treated

Immunotherapy

14-day cycles, given until progression of disease or unacceptable toxicity

References

  1. Ferris RL, Blumenschein G Jr, Fayette J, Guigay J, Colevas AD, Licitra L, Harrington K, Kasper S, Vokes EE, Even C, Worden F, Saba NF, Iglesias Docampo LC, Haddad R, Rordorf T, Kiyota N, Tahara M, Monga M, Lynch M, Geese WJ, Kopit J, Shaw JW, Gillison ML. Nivolumab for Recurrent Squamous-Cell Carcinoma of the Head and Neck. N Engl J Med. 2016 Nov;375(19):1856-67. Epub 2016 Oct 8. link to original article contains verified protocol PubMed

Pembrolizumab (Keytruda)

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Regimen

Study Evidence
Seiwert et al. 2016 (KEYNOTE-012) Phase Ib, >20 pts

Immunotherapy

2-week cycles until progression, intolerance, or maximum of 24 months

References

  1. Seiwert TY, Burtness B, Mehra R, Weiss J, Berger R, Eder JP, Heath K, McClanahan T, Lunceford J, Gause C, Cheng JD, Chow LQ. Safety and clinical activity of pembrolizumab for treatment of recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-012): an open-label, multicentre, phase 1b trial. Lancet Oncol. 2016 Jul;17(7):956-65. Epub 2016 May 27. link to original article contains verified protocol PubMed