TREATMENT OF RECURRENT AND OR METASTATIC SQUAMOUS-CELL HEAD AND NECK-CARCINOMA WITH A COMBINATION OF VINORELBINE, CISPLATIN, AND 5-FLUOROURACIL - A MULTICENTER PHASE-II TRIAL/

Purpose: Vinorelbine has been demonstrated to be active against squamo us cell carcinomas of the head/neck (SCHNC) and lung. This multicenter phase II trial was carried out to evaluate the activity and tolerabil ity of the combination of vinorelbine, cisplatin, and fi-fluorouracil given on an outpatient schedule in a series of 80 patients with recurr ent SCHNC. Patients and methods: Eighty patients with recurrent and/or metastatic SCHNC were treated with a combination of CDDP 80 mg/m(2) o n day 1, 5-FU 600 mg/m(2) as a 4-hour infusion on days 2-5, and vinore lbine 25 mg/m(2) on days 2+8. This cycle was repeated every 28 days. M ost patients had oral cavity, larynx, or oropharynx carcinoma (88%). F orty-seven had previously received surgery alone, two radiotherapy alo ne, and 31 surgery plus radiotherapy. Seventy-two patients had locoreg ional recurrency, and eight had distant metastases. Results: According to an intent-to-treat analysis, complete response (CR) of a mean dura tion of 12.7+ months was achieved in 13% of cases (95% CI 5%-21%), and partial response of 8.3+ months in 45% of patients (95% CI 33%-56%), for an overall response rate of 55% (95% CI 43%-65%). Nine patients (1 1%) showed no change, and 22 (28%) progressed. Five patients were not evaluable for response and toxicity. CR were seen more frequently in p atients pre treated with only surgery than in those who had also recei ved radiotherapy (15% vs. 9%; p = 0.7). No statistically significant d ifferences in response rate according to site of primary tumor were fo und (p = 0.8, NS). The received dose intensities of 5-FU, CDDP, and VN R were 90%, 99%, and 82%, respectively. The overall survival of the se ries as a whole was 9.7+ months (range 4-27). Toxicity was generally a cceptable. Grades 3 and 4 leukopenia were recorded in 11% and 5% of pa tients, respectively. Noteworthy was the occurrence of pain at the tum or site after vinorelbine administration in 5 patients. Conclusion: Th e combination regimen of CDDP, 5-FU and vinorelbine is quite active in the treatment of metastatic and/or recurrent SCHNC. This regimen shou ld be tested as initial treatment in previously untreated patients and compared to a standard regimen in recurrent SCHNC.