Treatment response lowers tumor symptom burden in recurrent and/or metastatic head and neck cancer
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RESEARCH ARTICLE
Open Access
Treatment response lowers tumor symptom burden in recurrent and/or metastatic head and neck cancer Markus Hecht1* , Dennis Hahn2, Philipp Wolber3, Matthias G. Hautmann4, Dietmar Reichert5, Steffi Weniger6, Claus Belka7, Tobias Bergmann8, Thomas Göhler9, Manfred Welslau10, Christina Große-Thie11, Orlando Guntinas-Lichius12, Jens von der Grün13, Panagiotis Balermpas13, Katrin Orlowski14, Diethelm Messinger15, Karsten G. Stenzel14 and Rainer Fietkau1
Abstract Background: Head and neck squamous cell cancer (HNSCC) frequently causes severe symptoms that may be reduced, when the tumor is successfully treated. The SOCCER trial studied the association of treatment response with patient reported tumor symptom burden in first line treatment of recurrent and/or metastatic HNSCC. Methods: In this prospective, multi-center, non-interventional trial patients were treated either with platinum-based chemotherapy and cetuximab or radiotherapy and cetuximab. Tumor symptom burden was assessed every four weeks with a questionnaire containing ten visual analogue scales (VAS, range 0–100), which were summarized to the overall VAS score. Results: Fourhundred seventy patients were registered in 97 German centers. A total of 315 patients with at least the baseline and one subsequent questionnaire were available for analysis. Changes in the VAS score were rated as absolute differences from baseline. Negative values indicate improvement of symptoms. The overall VAS score improved significantly at the first post-baseline assessment in responders (− 2.13 vs. non-responders + 1.15, p = 0.048), and even more for the best post-baseline assessment (− 7.82 vs. non-responders − 1.97, p = 0.0005). The VAS for pain (− 16.37 vs. non-responders − 8.89, p = 0.001) and swallowing of solid food (− 16.67 vs. non-responders − 5.06, p = 0.002) improved significantly more in responders (best post-baseline assessment). In the multivariable Cox regression analysis, worse overall VAS scores were associated with worse overall survival (hazard ratio for death 1.12 per 10 points increment on the overall VAS scale, 95% CI 1.05–1.20, p = 0.0009). Conclusion: In unselected patients beyond randomized controlled trials, treatment response lowers tumor symptom burden in recurrent and/or metastatic HNSCC. Trial registration: ClinicalTrials.gov, NCT00122460. Registered 22 Juli 2005, Keywords: Symptom, Response, HNSCC, Cetuximab, Chemotherapy * Correspondence: [email protected] Preliminary analyses were presented at ESMO2016 (994P) and ESMO2018 (1064P).The trial was funded by Merck Serono GmbH an affiliate of Merck KGaA, Darmstadt, Germany. 1 Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054 Erlangen, Germany Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, di
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