Interest to consider re-challenging by cetuximab and platinum containing regimen in recurrent Head and Neck Cancer
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Christian Borel1,7, Olivier Regnier-Gavier2, Hélène Carinato1, Sébastien Guihard3,7, Delphine Antoni3,9, Martin Demarchi1, Florian Sirlin4, Delphine Exinger2, Emilie Petit-Jean2, Alicia Thiery5, Guy Bronner6, Philippe Schultz6,8, Henri Flesch6, Véronique Frasie4, Danielle Prébay2, Thierry Petit1, Alain C. Jung7,10, Mickael Burgy1 and Pierre Coliat2,7,10
1Medical Oncology Department, Centre Paul Strauss, Strasbourg, France
2Pharmacy Department, Centre Paul Strauss, Strasbourg, France
3Radiotherapy Department, Centre Paul Strauss, Strasbourg, France
4Supportive Care Department, Centre Paul Strauss, Strasbourg, France
5Biostatistics Department, Centre Paul Strauss, Strasbourg, France
6ENT Specialist, Strasbourg, France
7Université de Strasbourg, Inserm IRFAC UMR_S1113, group « STREINTH », Strasbourg, France
8Department of Otolaryngology Head and Neck Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
9Radiobiology Laboratory, Centre Paul Strauss, Université de Strasbourg, Strasbourg, France
10Tumor biology Laboratory, Centre Paul Strauss, Université de Strasbourg, Strasbourg, France
Pierre Coliat, email: firstname.lastname@example.org
Keywords: HNSCC; EXTREME; re-challenge; platinum free Interval
Received: November 27, 2018 Accepted: December 13, 2018 Published: December 25, 2018
Background: The EXTREME protocol is the standard of care for recurrent or metastatic head and neck squamous-cell carcinoma (R/M HNSCC) in first line. Beyond the first-line except immunotherapy, poor efficacy was reported by second-line chemotherapy. Re-challenge strategies based on a repetition of the first line with platinum and cetuximab regimens might have been an option to consider.
Methods: We performed a retrospective study in order to assess the efficacy of the cetuximab plus platinum doublet-based chemotherapy regimen in patients with R/M HNSCC progressing after at least 3 months of cetuximab maintenance (EXTREME protocol). We complete a retrospective review of all medical records from R/M HNSCC patients treated after 16 weeks with the EXTREME regimen and treated with a re-challenge strategy between January 2010 and December 2014 in our institution (Centre Paul Strauss, Strasbourg, France).
Results: 33 patients were identified. The re-challenged strategy provided an ORR in 33.3% of cases and a DCR of 69.6% of cases. The median OS and PFS observed from the second line were 11.2 months and 6.5 months for the subset re-challenged by EXTREME or PCC regimens respectively. The response rate between patients with a platin free interval within 3 and 6 months and greater than 6 months were equal. Drugs dose intensity were better with the PCC protocol than the EXTREME regimen used as a rechallenge.
Conclusions: This study suggest re-challenging strategy by these regimens could be considered beyond the first line as an option when the platin free interval is greater than 3 months.
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