复发性头颈部鳞状细胞癌（SCCHN）患者接受培美曲赛联合吉西他滨诱导化疗（IC）有效_头颈部鳞癌

复发性头颈部鳞状细胞癌（SCCHN）患者接受培美曲赛联合吉西他滨诱导化疗（IC）有效

2011-03-22 来源：医脉通

关键词：头颈部鳞癌

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文献标题：Phase II trial of pemetrexed-based induction chemotherapy followed by concomitant chemoradiotherapy in previously irradiated patients with squamous cell carcinoma of the head and neck
文献出处：Ann Oncol. 2011 Mar 8
PMID：21385883

《肿瘤学年鉴》（Ann Oncol）3月8日在线发表的一项结果显示，复发性头颈部鳞状细胞癌（SCCHN）患者接受培美曲赛联合吉西他滨诱导化疗（IC）有效且耐受性良好。　　

该研究受试者为对标准治疗不能依从的复发性SCCHN患者。IC包括2个为期28天的治疗周期：第1天和第14天给予吉西他滨和培美曲塞，继以手术切除，如果符合条件，继以 CRRT（包括卡铂、培美曲塞和每日1次分割放疗）。　　

结果表明，研究共纳入35例受试者， 31例可进行反应评估，其中11例反应[反应率为35%，95%可信区间（CI）为19.2～54.6]。在24例开始CRRT的受试者中，研究评估了11例患者影像学反应，其中4例完全缓解，2例部分缓解，5例疾病进展。中位无进展生存期和总生存期分别为5.5个月（95% CI为3.6～8.3）和9.5个月（95% CI为7.2～15.4）。1年总生存率为43% （95% CI为26%～58%）。对IC反应的受试者生存改善（P=0.02）。毒性反应包括黏膜炎、皮炎、中性粒细胞减少、感染、出血、脱水和疼痛。

医脉通推荐原文摘要：
Ann Oncol. 2011 Mar 8

Phase II trial of pemetrexed-based induction chemotherapy followed by concomitant chemoradiotherapy in previously irradiated patients with squamous cell carcinoma of the head and neck
Villaflor VM, Haraf D, Salama JK, Kocherginsky M, Langerman A, Gomez-Abuin G, Beniwal P, Blair EA, Stenson KM, Portugal L, Seiwert T, Williams RD, Dekker AJ, Witt ME, Vokes EE, Cohen EE.

BACKGROUND: Concurrent chemoreirradiation therapy (CRRT) offers a therapeutic option for patients with locoregionally recurrent squamous cell carcinoma of the head and neck (SCCHN). We hypothesized that response to induction chemotherapy (IC) would improve outcome and predict increased survival.

PATIENTS AND METHODS: Subjects with recurrent SCCHN not amenable to standard therapy were eligible. IC consisted of two 28-day cycles of gemcitabine and pemetrexed on days 1 and 14, followed by surgical resection, if appropriate, and/or CRRT consisting of carboplatin, pemetrexed, and single daily fractionated radiotherapy.

RESULTS: Thirty-five subjects were enrolled, 31 were assessable for response, with 11 responders [response rate = 35%; 95% confidence interval (CI) 19.2-54.6]. Among 24 subjects who started CRRT, 11 were assessable for radiographic response, 4 complete response, 2 partial response, and 5 progressive disease. Median progression-free survival and overall survival (OS) were 5.5 months (95% CI 3.6-8.3) and 9.5 months (95% CI 7.2-15.4), respectively. One-year OS was 43% (95% CI 26% to 58%). Subjects who responded to IC had improved survival (P = 0.02). Toxic effects included mucositis, dermatitis, neutropenia, infection, hemorrhage, dehydration, and pain.

CONCLUSIONS: The combination of pemetrexed plus gemcitabine was active and well tolerated in recurrent SCCHN. Response to IC may help stratify prognosis and offer an objective and dynamic metric in recurrent SCCHN patients being considered for CRRT.

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