Journal
ONCOTARGET
Volume 6, Issue 21, Pages 18707-18714Publisher
IMPACT JOURNALS LLC
DOI: 10.18632/oncotarget.4531
Keywords
induction chemotherapy; oral squamous cell carcinoma; cisplatin; docetaxel; 5-fluorouracil
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Funding
- National Key Technology R&D Program of China [2007BAI18B03]
- National Natural Science Foundation of China [81272979, 81472519]
- Science and Technology Commission of Shanghai Municipality [13QH1401700]
- Shanghai Municipal Human Resources and Social Security Bureau [201447]
- Intramural Research Program of the National Institute of Neuroogical Disorders and Stroke at the National Institutes of Health
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Previously, we conducted a randomized phase III trial of TPF (docetaxel, cisplatin, and 5-fluorouracil) induction chemotherapy in surgically managed locally advanced oral squamous cell carcinoma (OSCC) and found no improvement in overall survival. This study reports long-term follow-up results from our initial trial. All patients had clinical stage III or IVA locally advanced OSCC. In the experimental group, patients received two cycles of TPF induction chemotherapy (75mg/m(2) docetaxel d1, 75mg/m(2) cisplatin d1, and 750mg/m(2)/day 5-fluorouracil d1-5) followed by radical surgery and post-operative radiotherapy; in the control group, patients received upfront radical surgery and post-operative radiotherapy. The primary endpoint was overall survival. Among 256 enrolled patients with a median follow-up of 70 months, estimated 5-year overall survival, disease-free survival, locoregional recurrence-free survival, and distant metastasis-free survival rates were 61.1%, 52.7%, 55.2%, and 60.4%, respectively. There were no significant differences in survival rates between experimental and control groups. However, patients with favorable pathologic responses had improved outcomes compared to those with unfavorable pathologic responses and to those in the control group. Although TPF induction chemotherapy did not improve long-term survival compared to surgery upfront in patients with stage III and IVA OSCC, a favorable pathologic response after induction chemotherapy may be used as a major endpoint and prognosticator in future studies. Furthermore, the negative results observed in this trial may be represent type II error from an underpowered study. Future larger scale phase III trials are warranted to investigate whether a significant benefit exists for TPF induction chemotherapy in surgically managed OSCC.
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