Paclitaxel Plus Cetuximab as Induction Chemotherapy for Patients With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma Unfit for Cisplatin-Based Chemotherapy.

Objectives: Induction chemotherapy (ICT) followed by definitive treatment is an accepted non-surgical approach for locoregionally advanced head and neck squamous cell carcinoma (LA-HNSCC). However, ICT remains a challenge for cisplatin-unfit patients. We evaluated paclitaxel and cetuximab (P-C) as ICT in a cohort of LA-HNSCC patients unfit for cisplatin. Materials and Methods: This is a retrospective analysis of patients with newly diagnosed LA-HNSCC considered unfit for cisplatin-based chemotherapy (age >70 and/or ECOG≥2 and/or comorbidities) treated with weekly P-C followed by definitive radiotherapy and cetuximab (RT-C) between 2010 and 2017. Toxicity and objective response rate (ORR) to ICT and RT-C were collected. Median overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. Cox regression analysis was performed to determine baseline predictors of OS and PFS. Results: A total of 57 patients were included. Grade 3-4 toxicity rate to ICT was 54.4%, and there was a death deemed treatment-related (G5). P-C achieved an ORR of 66.7%, including 12.3% of complete responses (CR). After P-C, 45 patients (78.9%) continued with concomitant RT-C. Twenty-six patients (45.6%) achieved a CR after definitive treatment. With a median follow-up of 21.7 months (range 1.2-94.6), median OS and PFS were 22.9 months and 10.7 months, respectively. The estimated 2-year OS and PFS rates were 48.9% and 33.7%, respectively. Disease stage had a negative impact on OS (stage IVb vs. III-IVa: HR = 2.55 [1.08-6.04], p = 0.03), with a trend towards worse PFS (HR = 1.92 [0.91-4.05], p = 0.09). Primary tumor in the larynx was associated with improved PFS but not OS (HR = 0.45 [0.22-0.92], p = 0.03, and HR = 0.69 [0.32-1.54], p = 0.37, respectively). Conclusion: P-C was a well-tolerated and active ICT regimen in this cohort of LA-HNSCC patients unfit for cisplatin-based chemotherapy. P-C might represent a valid ICT option for unfit patients and may aid patient selection for definitive treatment.

Response to immunotherapy rechallenge after interval chemotherapy in a patient with head and neck cancer.

Patients with metastatic squamous cell cancer of the head and neck (SCCHN) have a poor prognosis, with most patients surviving less than a year. Immunotherapy (IO) is changing the natural history of the disease and programmed death-ligand 1 (PD-L1) inhibitors are showing notable improvements in survival with a more favourable toxicity profile than chemotherapy. To our knowledge, there are no data regarding how checkpoint blockade inhibitors may behave at rechallenge in SCCHN. We present the case of a metastatic hypopharyngeal cancer patient who after progressing clinically and radiologically to PD-L1-based IO and then to second-line cetuximab-based chemotherapy, achieved a partial response to third-line nivolumab. Our case shows that PD(L)1 rechallenge after interval chemotherapy may be worth considering in SCCHN. Studies should try to address which is the optimal treatment sequence in the era of IO in SCCHN.

Predictive value of PET-CT for pathological response in stages II and III breast cancer patients following neoadjuvant chemotherapy with docetaxel / Valor predictivo de la PET-TC en la respuesta a la quimioterapia neoadyuvante en el cáncer de mama en estadios II y III

Purpose. To prospectively study the value of PET-CT with fluorine-18 fluorodeoxyglucose (FDG) to predict neoadjuvant chemotherapy (NAC) response of locoregional disease of stages II and III breast cancer patients. Material and methods. A written informed consent and approval were obtained from the Ethics Committee. PET-CT accuracy in the prediction of pathologic complete response (pCR) after NAC was studied in primary tumors and lymph node metastasis in 43 women (mean age: 50 years: range: 27-71 years) with histologically proven breast cancer between December 2009 and January 2011. PET-CT was performed at baseline and after NAC. SUVmax percentage changes (ΔSUVmax) were compared with pathology findings at surgery. Receiver-operator characteristic (ROC) analysis was used to discriminate between locoregional pCR and non-pCR. In patients not achieving pCR, it was investigated if ΔSUVmax could accurately identify the residual cancer burden (RCB) classes: RCB-I (minimal residual disease (MRD)), RCB-II (moderate RD), and RCB-III (extensive RD). Results. pCR was obtained in 11 patients (25.6%). Residual disease was found in 32 patients (74.4%): 16 (37.2%) RCB-I, 15 (35.6%) RCB-II and 2 (4.7%) RCB-III. Sensitivity, specificity, and accuracy to predict pCR were 90.9%, 90.6%, and 90.7%, respectively. Specificity was 94.1% in the identification of a subset of patients who had either pCR or MRD. Conclusion. Accuracy of ΔSUVmax in the locoregional disease of stages II and III breast cancer patients after NAC is high for the identification of pCR cases. Its specificity is potentially sufficient to identify a subgroup of patients who could be managed with conservative surgery (AU)

Objetivo. Estudiar de forma prospectiva el valor de la PET-TC con fluor-18-desoxiglucosa (FDG) para predecir la respuesta a la quimioterapia neoadyuvante (NAC) de la enfermedad locoregional en pacientes con cáncer de mama en estadios II y III.Material y métodos. Se obtuvo un consentimiento informado por escrito y la aprobación del Comité Ético. Se estudió la precisión de la PET-TC para predecir la respuesta completa patológica (pCR) tras la NAC en los tumores y en los ganglios de 43 mujeres (edad media: 50 años; rango: 27-71 años) que presentaban cáncer de mama diagnosticado por histología entre diciembre del 2009 y Enero del 2011. Los estudios PET-TC se realizaron al diagnóstico y tras la NAC. Los cambios en el porcentaje del SUVmax (delta-SUVmax) se compararon con los hallazgos de la anatomía patológica de la pieza quirúrgica. Se realizaron análisis de Característica Operativa del Receptor (ROC) para discriminar entre pCR y no-pCR en la enfermedad locoregional. En las pacientes que no alcanzaron la pCR, se investigó si el delta-SUVmax podía identificar de forma precisa las siguientes categorías de carga tumoral residual: RCB-I (enfermedad mínima residual (MRD)), RCB-II (moderada RD), y RCB-III (extensa RD).Resultados. Se obtuvo pCR en 11 pacientes (25,6%). Se encontró enfermedad residual en 32 pacientes (74,4%): 16 (37,2%) RCB-I, 15 (35,6%) RCB-II y 2 (4,7%) RCB-III. La sensibilidad, especificidad y precisión para predecir la pCR fueron 90,9%, 90,6%, y 90,7%, respectivamente. En la identificación del subgrupo de pacientes con pCR o MRD la especificidad fue del 94,1%.Conclusión. El delta-SUVmax identifica con elevada precisión la pCR en la enfermedad locoregional de las pacientes con cáncer de mama en estadios II y III tras la NAC. La especificidad es potencialmente suficiente para identificar un subgrupo de pacientes que podrían ser candidatas a cirugía conservadora (AU)

Predictive value of PET-CT for pathological response in stages II and III breast cancer patients following neoadjuvant chemotherapy with docetaxel.

PURPOSE: To prospectively study the value of PET-CT with fluorine-18 fluorodeoxyglucose (FDG) to predict neoadjuvant chemotherapy (NAC) response of locoregional disease of stages II and III breast cancer patients. MATERIAL AND METHODS: A written informed consent and approval were obtained from the Ethics Committee. PET-CT accuracy in the prediction of pathologic complete response (pCR) after NAC was studied in primary tumors and lymph node metastasis in 43 women (mean age: 50 years: range: 27-71 years) with histologically proven breast cancer between December 2009 and January 2011. PET-CT was performed at baseline and after NAC. SUV(max) percentage changes (ΔSUV(max)) were compared with pathology findings at surgery. Receiver-operator characteristic (ROC) analysis was used to discriminate between locoregional pCR and non-pCR. In patients not achieving pCR, it was investigated if ΔSUV(max) could accurately identify the residual cancer burden (RCB) classes: RCB-I (minimal residual disease (MRD)), RCB-II (moderate RD), and RCB-III (extensive RD). RESULTS: pCR was obtained in 11 patients (25.6%). Residual disease was found in 32 patients (74.4%): 16 (37.2%) RCB-I, 15 (35.6%) RCB-II and 2 (4.7%) RCB-III. Sensitivity, specificity, and accuracy to predict pCR were 90.9%, 90.6%, and 90.7%, respectively. Specificity was 94.1% in the identification of a subset of patients who had either pCR or MRD. CONCLUSION: Accuracy of ΔSUV(max) in the locoregional disease of stages II and III breast cancer patients after NAC is high for the identification of pCR cases. Its specificity is potentially sufficient to identify a subgroup of patients who could be managed with conservative surgery.