M. Machtay et al., A phase I trial of 96-hour paclitaxel infusion plus accelerated radiotherapy for unresectable head and neck cancer, INT J RAD O, 44(2), 1999, pp. 311-315
Citations number
18
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Onconogenesis & Cancer Research
Journal title
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
Purpose: To determine the maximum tolerated dose (MTD) of paclitaxel given
as a 96-hour continuous infusion during Weeks 1 and 5 of an accelerated rad
iotherapy schedule for the definitive treatment of advanced (nonmetastatic)
unresectable squamous cell carcinoma of the head and neck (SCCHN).
Methods and Materials: Thirteen patients with Stage IV SCCHN were enrolled.
Radiotherapy consisted of 70 -72 Gy over 6 weeks, with a fractionation sch
eme of 2 Gy q.d. for 4 weeks followed by 1.6 Gy b.i.d. for 2 weeks, with no
planned interruptions. Paclitaxel was administered over a 96-hour continuo
us infusion during Weeks 1 and 5 of radiotherapy at the following dose leve
ls: Dose Level 1: 40 mg/m(2)/96-honrs (3 patients); Dose Level 2: 80 mg/m(2
)/96-hrs (5 patients); Dose Level 3: 120 mg/m(2)/96-hours (2 patients); and
Dose Level 2A: 100 mg/m(2)/96hours (3 patients).
Results: The MTD of Paclitaxel was 100 mg/m2/96-hours, All but one patient
(who experienced progressive disease after receiving 61 Gy and both cycles
of paclitaxel) completed therapy as planned. Dose-limiting toxicity occurre
d in both patients enrolled at Dose Level 3, with one patient experiencing
Grade 3 diffuse moist desquamation and the other patient experiencing Grade
1 mucositis and febrile neutropenia. Thus, Dose Level 2A was opened and no
dose limiting toxicity was noted. Grade 3 non-dose limiting mucositis and
dermatitis occurred at all paclitaxel dose levels. There were no treatment-
related deaths. All Grade 3 and 4 toxicities were reversible. Complete resp
onses were seen in 8 of 13 patients, 4 patients achieved partial responses,
and 1 patient had no response/progressive disease.
Conclusions: Infusional paclitaxel over 96 hours during Weeks 1 and 5 of th
is accelerated radiotherapy schedule is feasible. The MTD of paclitaxel in
this protocol was 100 mg/m2/96-hours. Dose-limiting toxicities were primari
ly enhanced epithelial reactions, but febrile neutropenia also occurred. Al
l patients develop non-dose limiting Grade 3 skin and mucosal reactions, re
flecting the high treatment intensity. This regimen merits further investig
ation. (C) 1999 Elsevier Science Inc.