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La chemioterapia neoadiuvante nei tumori della testa e del collo: novità e attuali indicazioni

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(1)

La chemioterapia neoadiuvante nei tumori della testa e del collo: novità e attuali indicazioni

Isacco Desideri

Università di Firenze

SODc Radioterapia – AOU Careggi

(2)

Induction Chemotherapy Rationale for LA-H&N tumours

Organ preservation

Decrease tumor Volume

Response is predictive of subsequent response to RT

Eliminate clinically occult micrometastatic disease

Response is transient and should be followed by definitive

treatment

(3)

An easy question: which is the best IC regimen?

Haddad R et al. Ann Oncol 2018

(4)

Impact of Taxane on Platinum doublet as IC

OS

PFS

Blanchard P et al. JCO 2013

(5)

LOCALLY ADVANCED SCCHN

(6)

Adding IC to CRT: a clear benefit?

No significant improvement of OS (Hazard Ratio: 1.010, 95% CL 0.84–1.21, p = 0.92)

..nor in a statistically significant benefit of PFS (Hazard Ratio: 0.91, 95% CL 0.75–1.1, p = 0.32).

NB: Results from Ghi study were still preliminary!

Budach W. Et al. Radiother Oncol 2016

(7)

Current standard-of-care paradigm in LA SCCHN

IC is only an accepted standard approach for larynx preservation in locoregionally advanced larynx and hypopharynx cancer

(8)

IC for laryngeal preservation

Study N Treatment Primary End

point (Larynx Preservation)

OS

VA Study Group

332 • Surgery  RT

• Cis + 5FU X 3  RT + Surgery 64% at 2 yrs

68%

68%

P= NS EORTC

24891

202 • Surgery  RT

• Cisplatin + 5-FU x 2-3 cycles  RT or Surgery  RT

35% at 5 yrs

35%

30%

P=NS RTOG 91-11 525 • RT alone (70 Gy)

• Cis + 5-FU 1000/m2 X 2

CR/PR  Cis/5FU X 1 RT NR  Surgery  RT

• Cis X 3 + RT

70% (65.7%) 75% (70.5%)

88% (83.6%)

56% (53.5%) 55% (59.2%)

54% (54.6%) VA laryngeal Ca Study. NEJM 1991;324:1685-1690

Lefebvre JL et al. JNCI 1996;88:890-899; Lefebvre. Ann of Oncology 2012;23:2708 Forastiere AA et al. JCO 2013;31: 845

(9)

SALTORL TRIAL: the definitive answer regarding laryngeal preservation

Estimated primary completion date: 2019

First results: 2021…

(10)

RTOG 91-11: 10 years update

Forastiere AA et al. JCO 2013

(11)

INTERCEPTOR: Italian study

Recruitement terminated (December 2016)

Toxicity data presented at last ICHNO Meeting

Final results expected very soon to be published

(12)

LOCALLY ADVANCED

NASOPHARYNGEAL CARCINOMA

(13)

Main Rationale for IC in LA-NPC

The disease shrinkage and the

subsequently RT volumes reduction can allow more effective and less toxic RT

Multiple-agents up-front chemotherapy can influence distant metastases and

overall survival.

(14)

Impact of IC in LA-NPC (1)

Blanchard P et al. Lancet Oncol 2015

(15)

Tan et al. Radiother Oncol 2018

Impact of IC in LA-NPC (2)

(16)

Modern trial assessing IC in LA-NPC

• Phase 3 RCT

• 480 patients

• LA-NPC

• TPF-> CCRT vs CCRT

• IMRT mandatory

Sun et al. Lancet Oncol 2016

(17)

Outcomes of IC in LA-NPC receiving IMRT

Sun et al. Lancet Oncol 2016

(18)

Conclusions

TPF is the IC regimen of choice

Larynx preservation is currently the only widely accepted setting for patients with resectable LA SCCHN in which IC has consensus value.

In LA-NPC CCRT is the treatment of choice; IC

may be considered in selected cases (T4? N3

bulky?) after multidisciplinary discussion

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