Neoadjuvant modified TPF (docetaxel, cisplatin, fluorouracil) for patients unfit to standard TPF in locally advanced head and neck squamous cell carcinoma: a study of 48 patients

Jérôme Fayette, Clara Fontaine-Delaruelle, Alexis Ambrun, Clémentine Daveau, Marc Poupart, Antoine Ramade, Philippe Zrounba, Eve-Marie Neidhardt, Julien Péron, Alpha Diallo, Philippe Céruse, Jérôme Fayette, Clara Fontaine-Delaruelle, Alexis Ambrun, Clémentine Daveau, Marc Poupart, Antoine Ramade, Philippe Zrounba, Eve-Marie Neidhardt, Julien Péron, Alpha Diallo, Philippe Céruse

Abstract

TPF (docetaxel, cisplatin, fluorouracil) is the standard chemotherapy used for induction in locally advanced head and neck squamous cell carcinoma (LAHNSCC). Its toxicity limits it to younger patients with good functional status and without significant comorbidity. Since modified TPF (mTPF) demonstrated higher tolerability with similar efficacy in gastric cancer, we tested this scheme on frail patients.From July 2010 to July 2014, the files of the 48 patients treated for LAHNSCC with mTPF in three French institutions were retrospectively collected.mTPF was chosen because of age>70 years, or severe denutrition, or PS>1, or severe comorbidities or after severe toxicity of standard TPF. During the first 4 cycles, 2 patients died, 14 secondary hospitalizations were required and 10 patients stopped treatment due to no lethal toxicity. Two patients died during radiotherapy.The response rate was 83% (19% complete response). With a median follow-up of 15.2 months, 4 patients died during treatment, 8 died of non-head and neck cancer related disorders, 18 progressed (17 deaths) and 18 were free of disease. The median overall survival was 18.5 months (95% IC: 16.9-30.0).mTPF is effective in terms of response rate compared with the standard TPF and could become a new option in induction for frail patients with LAHNSCC.

Keywords: TPF; cisplatin; frail patients; head and neck cancer; induction.

Conflict of interest statement

Dr. Philippe Ceruse is a member of the board of Merck-Serono. Other authors have no conflict of interest.

Figures

Figure 1. Overall survival
Figure 1. Overall survival
Figure 2. Time to relapse
Figure 2. Time to relapse

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