Phase III comparison of high-dose paclitaxel plus cisplatin plus granulocyte colony-stimulating factor versus low-dose paclitaxel plus cisplatin in advanced head and neck cancer: Eastern Cooperative Oncology Group Study E1393
Aa. Forastiere et al., Phase III comparison of high-dose paclitaxel plus cisplatin plus granulocyte colony-stimulating factor versus low-dose paclitaxel plus cisplatin in advanced head and neck cancer: Eastern Cooperative Oncology Group Study E1393, J CL ONCOL, 19(4), 2001, pp. 1088-1095
Purpose: To determine dose-response effects and the activity of paclitaxel
combined with cisplatin in patients with incurable squamous cell carcinoma
of the head and neck.
Patients and Methods: Two hundred ten patients with locally advanced, recur
rent, or metastatic disease were randomly placed in either Arm A, paclitaxe
l 200 mg/m(2) (24-hour infusion) + cisplatin 75mg/m(2) + granulocyte colony
-stimulating factor, or Arm B, paclitaxel 135 mg/m(2) (24-hour infusion) cisplatin 75 mg/m(2). Cycles were repeated every 3 weeks until progression
or a total of 12 cycles for complete responses. Primary outcomes were event
-free and overall survival.
Results: No significant differences in outcomes were observed between the h
igh- and low-dose paclitaxel regimens. The estimated median survival was 7.
3 months (95% confidence interval, 6.0 to 8.6). The 1-year survival rate wa
s 29%, and event-free survival was 4.0 months. The objective response rate
(complete response plus partial response) war 35% for the high-dose patient
s and 36% for the low-dose patients. Myelosuppression was the most frequent
toxicity: grade 3 or 4 granulocytopenia, 70% of patients in Arm A and 78%
in Arm a; febrile neutropenia, 27% of patients in Arm A and 39% in Arm a. G
rade 5 toxicities occurred in 22 patients (10.5%). Treatment was terminated
early in 31% because of excessive toxicity or patient refusal.
Conclusion: This phase III multicenter trial showed (1) no advantage for hi
gh-dose paclitaxel and (2) excessive hematologic toxicity associated with b
oth regimens. Therefore, neither of the paclitaxel regimens evaluated in th
is trial can be recommended.