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Robert Haddad, MD; Roy Tishler, MD; Lori Wirth, MD; Charles M. Norris, MD; Laura Goguen, MD; Christopher Sullivan, MD; Lindsay O’Donnell; Yi Li; Marshall Posner, MD

Arch Otolaryngol Head Neck Surg. 2006;132:678-681.

Objective  To report the rate of pathological complete response after induction chemotherapy with the docetaxel, cisplatin, and fluorouracil (TPF) combination.

Design  Retrospective cohort analysis.

Setting  Tertiary care academic cancer center, between June 1999 and May 2004.

Patients  Seventy-two patients with newly diagnosed squamous cell carcinoma of the head and neck; 68 (95%) of the patients had stage IV, locally advanced disease.

Interventions  Three cycles of induction chemotherapy followed by a biopsy of the primary site. All patients subsequently underwent chemotherapy with 3 cycles of TPF.

Main Outcome Measure  Rate of pathological complete response at the primary site after induction chemotherapy with 3 cycles of TPF.

Results  Biopsy results were negative for cancer in 64 patients (89%) and positive in 8 patients (11%). The median follow-up was 2 years. In the positive biopsy result group, 2 (25%) of 8 patients died of disease vs 3 (4%) of 64 patients in the negative biopsy result group. Twenty-nine neck dissections were performed; results were positive in 7 patients (all alive with no evidence of disease) and negative in 22 patients (21 alive with no evidence of disease). The overall 2- and 5-year progression-free survival is currently projected at 85% and 85%, respectively; the overall 2- and 5-year survival, at 95% and 90%, respectively. Importantly, T4 presentation did not predict a positive biopsy result at the primary site or a positive neck dissection result (P = .60 and P = .56, respectively). N3 presentation (12 patients) did not predict a positive biopsy result at the primary site (P = .87) but did correlate with positive neck dissection results in 6 of 12 patients (P<.001).

Conclusions  Induction chemotherapy with the TPF regimen results in a high pathological complete response rate (89%). This rate is higher than with the cisplatin plus fluorouracil combination therapy, which was reported to be between 25% and 50% in previous studies. Chemoradiotherapy is currently an accepted standard of care, but induction chemotherapy continues to be investigated. Based on recent phase 3 trial results and the data presented herein, we propose that the 3-drug combination be used as the new platform when administering induction chemotherapy.

Author Affiliations: Departments of Medical Oncology (Drs Haddad, Wirth, and Posner), Radiation Oncology (Dr Tishler), and Biostatistics and Computational Biology (Mr Li), Dana-Farber Cancer Institute (Ms O’Donnell), Boston, Mass; Departments of Surgery and Otolaryngology (Drs Norris and Goguen), Brigham and Women's Hospital, Boston; and Department of Otolaryngology, Wake Forest University Health Sciences, Winston-Salem, NC (Dr Sullivan).

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