Is taxane/platinum/5 fluorouracil superior to taxane/platinum alone and does docetaxel trump paclitaxel in induction therapy for locally advanced oral cavity cancers.

BACKGROUND: Cisplatin and 5 fluorouracil drug combination is inferior to the combination of taxane with these 2 drugs. However, often in clinical practice at our center giving TPF (docetaxel, cisplatin, 5 fluorouracil) is difficult in view of logistics and tolerance issues. In such a scenario, we prefer to use the 2 drugs combination of platinum and taxane. However, no study has addressed whether a 2 drugs combination, which includes taxane is inferior to the 3 drugs combination and which the taxane of choice is in the 2 drugs combination of taxane and platinum. METHODS: This is a retrospective analysis of prospectively collected data of patients undergoing induction chemotherapy (IC) in oral cavity cancers from 2010 to 2012. We chose for analysis those patients who had a baseline scan done within 4 weeks of starting therapy and a follow‑up scan done within 2 weeks of completion of the second cycle of IC. Response was scored in accordance with RECIST version 1.1. Chi‑square analysis was done to compare response rates (RRs) between regimens. RESULTS: Two hundred and forty‑five patients were identified. The median age was 45 years (24–70 years), 208 (84.9%) were male patients, and 154 patients (62.9%) had primary in the Buccal mucosa. The regimens received were TPF 22 (9%), docetaxel + cisplatin 97 (39.6%), paclitaxel + cisplatin 89 (36.3%), docetaxel + carboplatin 16 (6.5%) and paclitaxel + carboplatin 21 (8.6%). The overall RRs were complete response, partial response, stable disease and progressive disease in 4 (1.6%), 56 (22.9%), 145 (59.2%) and 40 (16.3%). The 3 drugs regimen (TPF) had 50% RR as compared to 22% RR with 2 drugs regimen (P = 0.004). Docetaxel containing regimens had 30.3% RR as compared to 17.2% RR with paclitaxel containing regimens (P = 0.094). CONCLUSIONS: TPF has better RR than a 2 drugs taxane‑containing regimen and docetaxel leads to a better RR than paclitaxel for IC in locally advanced oral cavity cancers.

Neo-adjuvant chemotherapy by using methotrexate prior to radiation therapy in the treatment of advanced oral cancers.

One hundred and forty-one advanced squamous sell carcinomas of the oral cavity (T3,4; NO-3;MO) were treated with neoadjuvant chemotherapy by using methotrexate 50 mg. administered intravenously, once weekly for 3-5 injections and then followed by radiation therapy 6000 – 6500 cGy in 6-6.5 weeks. Seventy patients with the same tumour extent, receiving radiation therapy alone were randomized numerically for the control group. The result of combined treatment showed 86 percent effective on the basis of objective primary tumour response with MTX alone, and 46 percent showed CR. For the nodal status, only 53 percent showed effective and only 10 percent was CR. After radiation therapy, the response of both primary and lymph node in the study group showed definitely more effective than the control group. Seventy-two percent of patient in the study group showed CR, while only 20 percent of the radiation alone group showed CR. The patients in the study group also showed better survival rate with 14 percent of 5-year survival rate, while none of the control group survived more than 5 years after treatment. All the patients tolerated methotrexate and radiation treatment very well. Only grad 1 and 2 toxicities were found.