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Increased Toxicity Without Improved Response in Squamous Cell Head and Neck Cancer

David G. Pfister, MD; Dean Bajorin, MD; Robert Motzer, MD; Howard Scher, MD; Carl Louison; Louis Harrison, MD; Jatin Shah, MD; Elliot Strong, MD; George Bosl, MD

Arch Otolaryngol Head Neck Surg. 1994;120(1):89-95.

Abstract
Objective
To evaluate the activity and toxicity of the drug combination cisplatin, fluorouracil by continuous infusion, and high-dose oral leucovorin calcium (PFL) as induction chemotherapy in patients with advanced and untreated squamous cell head and neck (SCHN) cancer.

Design
Nonrandomized, prospective trial.

Setting
Referral center (comprehensive cancer center).

Patients
Twenty-two patients with stage III (n=7) and IV (n=15) MO SCHN cancer of the larynx (n=13), hypopharynx (n=7), and oropharynx (n=2) whose standard treatment would have required total laryngectomy.

Interventions
Three cycles of PFL were administered prior to local-regional therapy (concomitant cisplatin and radiation and/or neck dissection, with total laryngectomy reserved for nonresponse or relapse). Chemotherapy included cisplatin (100 mg/m²) on day 1 by short intravenous infusion; fluorouracil (800 mg/m²) on days 1 through 5 by continuous infusion; and leucovorin (100 mg) every 4 hours by mouth for 30 doses. The PFL combination was administered every 21 days.

Main Outcome Measures
Clinical response to chemotherapy and observed toxic effects during chemotherapy.

Results
Five patients were inevaluable for response, with three early deaths (infection in two and sudden death in one), one cerebrovascular accident, and one patient declining further chemotherapy. Of the remaining 17 patients, 10 had a major response to chemotherapy, but in only five patients (29%) was this complete (95% confidence interval, 8% to 51%). Other significant toxic effects included grade 3 to 4 mucositis in eight patients and grade 3 to 4 neutropenia in 10.

Conclusions
While PFL is active in patients with SCHN cancer, we were unable to reproduce the high complete response rates reported by other centers. Its use can be associated with significant toxic effects. We do not recommend the use of PFL for the treatment of patients with SCHN cancer outside the context of a clinical trial until there is further critical assessment of its activity and toxicity.

(Arch Otolaryngol Head Neck Surg. 1994;120:89-95)

Author Affiliations
From the Division of Solid Tumor Oncology, Department of Medicine (Drs Pfister, Bajorin, Motzer, Scher, and Bosl and Mr Louison), the Brachytherapy Service, Department of Radiation Oncology (Dr Harrison), and the Head and Neck Surgery Service, Department of Surgery (Drs Shah and Strong), Memorial Sloan-Kettering Cancer Center, New York, NY; and the Departments of Medicine (Drs Pfister, Bajorin, Motzer, Scher, and Bosl, and Mr Louison), Radiology (Dr Harrison), and Surgery (Drs Shah and Strong), Cornell University Medical College, New York, NY.

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