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The Slippery Role of Induction Chemotherapy in Head and Neck Cancer: Myth and Reality

机译:感应化疗在头部和颈部癌症中的光滑作用:神话与现实

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Chemoradiotherapy as an alternative to surgery can be offered to patients affected by loco-regionally advanced head and neck cancer (HNC). Induction chemotherapy is a valid option, supported by few positive trials, but its real efficacy is still a matter of debate. The standard regimen for induction chemotherapy in Europe is a combination of docetaxel (75 mg/m ~(2)) and reduced dose doses of cisplatin (75 mg/m ~(2)) and 5-fluorouracil (750 mg/m ~(2) day, for five consecutive days) (TPF). It is less toxic and more effective than the historical therapy PF (cisplatin 100 mg/m ~(2) and fluorouracil 1,000 mg/m ~(2)/day for five consecutive days). However, in some studies treatment-related mortality has been reported to be as high as 6%. Therefore, some less toxic combinations, such as a modified TPF regimen and the combination of carboplatin plus paclitaxel have been studied. These regimens are showing promising results but deserve further validation in comparative trials. Furthermore, several trials are underway in order to enhance TPF with immune checkpoints inhibitors. Compared to chemoradiotherapy, induction chemotherapy followed by chemoradiation was shown to be non-inferior, and it could decrease the distant metastatic progression, especially in high-risk populations. For selected patients, induction chemotherapy could be a strong option. The chemoselective process that leads to immediate surgery for non-responders, the high response rate (complete responses are sometimes observed), and the survival data, are all arguments in favor of induction chemotherapy, if performed in experienced centers involving health professionals in the context of a skilled multidisciplinary team.
机译:将化学疗法作为替代手术的替代方案可以向受基地区域晚期头部和颈部癌症(HNC)影响的患者提供。诱导化疗是一种有效的选择,支持少数阳性试验,但其真正的功效仍然是辩论问题。欧洲的诱导化疗的标准方案是多西紫杉醇(75mg / m〜(2))的组合,并减少的顺铂(75mg / m〜(2))和5-氟尿嘧啶(750mg / m〜( 2)一天,连续五天)(TPF)。它比历史疗法PF(顺铂100mg / m〜(2)和氟尿嘧啶连续五天的氟尿嘧啶且氟尿嘧啶且氟尿嘧啶更低。然而,在一些研究中,据报告治疗相关死亡率高达6%。因此,已经研究了一些较小的毒性组合,例如改性的TPF方案和卡铂加紫杉醇的组合。这些方案显示出现有希望的结果,但在比较试验中应该得到进一步的验证。此外,正在进行几种试验,以增强具有免疫检查点抑制剂的TPF。与化学疗法相比,诱导化学疗法随后被视为非劣等,并且可以降低远处转移性进展,特别是在高危人群中。对于选定的患者,诱导化疗可能是强烈的选择。导致非响应者立即手术的化学选择性过程,高响应率(有时会观察到完全反应)和生存数据,是有利于诱导化疗的争论,如果在涉及卫生专业人员在上下文中的经验中心进行熟练的多学科团队。

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