Docetaxel and cisplatin: An active regimen in patients with locally advanced, recurrent or metastatic squamous cell carcinoma of the head and neck - Results of a phase II study of the EORTC Early Clinical Studies Group

Background. Docetaxel and cisplatin are among the most active antitumor age nts in head and neck cancer, and phase I studies found the combination of t he two drugs to be feasible. The EORTC ECSG performed a multicenter phase I I study in patients with locally advanced, recurrent or metastatic squamous cell carcinoma of the head and neck to evaluate the antitumor efficacy and toxicity of this combination. Patients and methods. Eligibility criteria included written informed consen t, a WHO performance status <2, life expectancy of >12 weeks, and adequate bone marrow liver and renal function. Neoadjuvant pretreatment with cisplat in-based chemotherapy or prior radiotherapy were allowed. Patients were ine ligible if pretreated with taxoids, had CNS involvement, concurrent maligna ncy, peripheral neuropathy, or no measurable disease. Treatment consisted o f docetaxel 100 mg/m(2) (one-hour i.v. infusion), followed by cisplatin 75 mg/m(2) (three hour i.v. infusion), repeated every three weeks. Supportive care included hydration, 5HT3-antagonists, and corticosteroids. Results. Forty-four patients (median age 55 years, range 35-76) entered the trial; 41 patients were eligible, 164 cycles of treatment were evaluable f or toxicity, and 31 patients for response. Fourteen patients had undergone prior surgery, 15 had received radiotherapy, and five had had chemotherapy. A median number of four treatment cycles (range 1-6) was given. Hematologi c and non-hematologic toxicities were common, but hypersensitivity reaction s and fluid retention were very infrequent due to corticosteroid prophylaxi s. Four patients were taken off the study due to toxicity, and one toxic de ath occurred due to pneumonia. Among 41 eligible patients, objective respon ses as confirmed by independent review included six complete remissions and 16 partial remissions, resulting in an overall response rate of 53.7% (95% confidence interval: 37.4%-69.3%). Responses occurred in locally advanced, recurrent and metastatic disease, both in pre- and non-pretreated patients . Of 22 evaluable, non-pretreated patients with locally advanced or metasta tic disease, five achieved complete responses, and 14 partial responses. Ob served among nine evaluable pretreated patients with locally advanced or me tastatic head and neck cancer were one complete response and two partial re sponses. Conclusion. The combination of docetaxel and cisplatin is feasible and acti ve in locally advanced, recurrent, and metastatic squamous cell carcinoma o f the head and neck.