Current and Emerging Role of Chemotherapy in Oral Cancer
The role of chemotherapy in oral cancer has been evolving [1]. In addition to palliation, it also has an established role in curative management [2]. It can be offered as a single modality treatment for palliation, in combination with concomitant radiatio
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Current and Emerging Role of Chemotherapy in Oral Cancer Potjana Jitawatanarat, Yujie Zhao, Vijay Patil, Amit Joshi, Vanita Noronha, and Kumar Prabhash
5.1
Introduction
The role of chemotherapy in oral cancer has been evolving [1]. In addition to palliation, it also has an established role in curative management [2]. It can be offered as a single modality treatment for palliation, in combination with concomitant radiation therapy (chemoradiation) as either adjuvant therapy following surgical resection or primary definitive treatment for locally advanced disease, or as induction therapy prior to definitive treatment. Unlike surgery, chemotherapy usually exerts its cytotoxic activity systemically; therefore it is often associated with side effects caused by toxicities to the normal tissues. The toxicities and cellular resistance to chemotherapy are two major obstacles to the clinical efficacy of chemotherapy [3]. Recent advances in understanding molecular biology of HNSCC have opened many new research directions. In addition to traditional cytotoxic chemotherapy, novel targeted therapy has demonstrated its efficacy in palliation [4]. Although most of the studies of chemotherapy in HNSCC were not site specific, many of the findings may be applicable to oral cancers.
5.2
Chemotherapy Agents in HNSCC
The most commonly used cytotoxic chemotherapeutic agents in HNSCC are platinum derivatives (cisplatin, carboplatin), taxanes (paclitaxel, docetaxel), and antimetabolic agents (methotrexate, 5-fluorouracil (5-FU)) (Table 5.1). P. Jitawatanarat Department of Hematology and Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA V. Patil • A. Joshi • V. Noronha Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India Y. Zhao Roswell Park Cancer Institute, Buffalo, NY, USA K. Prabhash (*) Department of Medical Oncology, Tata Memorial Hospital, Mumbai (TBC), Mumbai, India e-mail: [email protected] © Springer International Publishing Switzerland 2017 M.A. Kuriakose (ed.), Contemporary Oral Oncology, DOI 10.1007/978-3-319-14917-2_5
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Phase II single-arm trial for first-line chemotherapy treatment Phase II single-arm trial for pretreated patient Phase II single-arm trial for first-line chemotherapy treatment
Phase II single-arm (two dose cohorts) trial for first-line chemotherapy treatment
Degardin et al. (1998) [6] Testolin et al. (1994) [7] Degardin. et al. (1996) [8]
Murphy et al. (2001) [9]
Oxaliplatin 130 mg/m2 every 3 weeks
Unknown/40
33/7 (21.2 %)
Vinorelbine 20 mg/m2 weekly
15/1 (6.6 %)
Unknown
32 weeks
OS No OS difference
Gemcitabine 800 mg/m2 (or 1250 mg/m2) weekly, 3 weeks on 1 week off
RR 13 %
Unknown
a
RR response rate, PFS progression-free survival, TTP time to disease progression, TTF time to treatment failure, DOR duration of response, OS overall survival No statistically significant difference among arms
Pivot et al. (2001) [10] MartinezTrufero et al. (2010) [11]
RR 6 %
RR 16 %a DOR: 6.4 monthsa RR 16 % DOR: 19 weeks
RR/PFS/TTP/TTF/DOR RR 21 %a DOR: 6.1 mon
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