Cisplatin of benefit in head and neck cancer
Cisplatin, given with postoperative radiotherapy, improves disease-free survival in cancer of the head and neck. Two phase III trials with this finding were published last week — one carried out by a US group and the other by European researchers.
The interim report by the US group is based on results in 416 patients
who had a high risk of local recurrence. Their median follow up was 46
months. The European trial of 334 patients with locally advanced disease
had a median follow up of 60 months.
Ablative surgery was carried out four to six weeks before the administration
of radiotherapy, with or without three cycles of 100mg cisplatin per
square metre of body surface area (on days 1, 22 and 43 of radiotherapy).
Interim analyses show that the concomitant treatment enhanced the two-year
rate of local and regional control by 10 per cent in the US trial and
the five-year rate of disease-free survival by 11 per cent in the European
trial. Only the European trial demonstrated an increase in survival and
neither trial showed a reduction in metastases.
UK commentators say that the studies are “excellent examples of
evidence-based research and provide a strong basis for the inclusion
of concurrent chemotherapy in postoperative regimens of radiotherapy
for high risk patients.” However, as the disease recurs locally
in around 30 per cent of patients, further improvement is necessary.
In the US trial combined treatment was associated with a substantial
increase in adverse events. However, the European group found that the
combination did not cause an undue number of late complications (New
England Journal of Medicine 2004;350:1937, 1945 and 1997). |
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Pharmaceutical Journal
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