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Kongwattanakul S, Petchann N, Petroch P, Thanthong S, Tungfung S, Chamchod S, Pitiporn S, Nantajit D. Prophylactic management of radiation-induced mucositis using herbal mouthwash in patients with head and neck cancer: an assessor-blinded randomized controlled trial. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2022; 19:771-780. [PMID: 35218685 DOI: 10.1515/jcim-2021-0457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Radiation-induced mucositis (RIOM) is one of the most common side effects from head and neck radiotherapy. Several reagents have been introduced to manage the symptom; however, there is still a limited number of effective reagents. Herbal mouthwashes with payayor (Clinacanthus nutans Lindau) and fingerroot (Boesenbergia rotunda) were tested their efficacies in preventing and reducing severity of RIOM in comparison with normal saline with sodium bicarbonate. METHODS One hundred twenty patients with head and neck cancer undergoing radiotherapy participated in the study and were randomly assigned into three treatment groups using block randomization method. The participants were assigned one of the three mouthwashes for use throughout their radiotherapy course and were assessed for their mucositis scores from week one to six into their radiotherapy course as well as at one-month follow-up. Body mass index was also measured for comparison of nutritional status. RESULTS The two mouthwashes were similarly effective in prophylaxis of RIOM in term of severity. The averaged mucositis scores were less than two for all groups. For the onset of RIOM, both herbal mouthwashes could slightly delay the symptom but not statistically significant. Patients' body mass index across the three treatment groups was also comparable. The patients were largely satisfied with all the mouthwashes with no clear preference on any of them. CONCLUSIONS Prophylactic treatment of RIOM using herbal mouthwashes could substitute the current standard of normal saline with bicarbonate. A different formulation of the two herbs could potentially improve the prophylactic outcome. TRIAL REGISTRATION NO NCT03359187.
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Affiliation(s)
- Sirikorn Kongwattanakul
- Department of Radiation Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Nutjaree Petchann
- Department of Radiation Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Petcharat Petroch
- Department of Radiation Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Saengrawee Thanthong
- Faculty of Nursing, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Sunanta Tungfung
- Department of Radiation Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Sasikarn Chamchod
- Department of Radiation Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Supaporn Pitiporn
- Chaopraya Abhaiphubejhr Hospital, Prachinburi, Thailand
- Chaopraya Abhaiphubejhr Hospital Foundation, Prachinburi, Thailand
| | - Danupon Nantajit
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
- Centre for Host Microbiome Interactions, Faculty of Dentistry and Craniofacial Sciences, King's College London, London, UK
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Lozano A, Marruecos J, Rubió J, Farré N, Gómez-Millán J, Morera R, Planas I, Lanzuela M, Vázquez-Masedo MG, Cascallar L, Giralt J, Escames G, Valentí V, Grima P, Bosser R, Tarragó C, Mesía R. Randomized placebo-controlled phase II trial of high-dose melatonin mucoadhesive oral gel for the prevention and treatment of oral mucositis in patients with head and neck cancer undergoing radiation therapy concurrent with systemic treatment. Clin Transl Oncol 2021; 23:1801-1810. [PMID: 33738704 DOI: 10.1007/s12094-021-02586-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/06/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE The objective of this trial was to evaluate the safety and efficacy of melatonin oral gel mouthwashes in the prevention and treatment of oral mucositis (OM) in patients treated with concurrent radiation and systemic treatment for head and neck cancer. METHODS Randomized, phase II, double-blind, placebo-controlled trial (1:1 ratio) of 3% melatonin oral gel mouthwashes vs. placebo, during IMRT (total dose ≥ 66 Gy) plus concurrent Q3W cisplatin or cetuximab. Primary endpoint: grade 3-4 OM or Severe Oral Mucositis (SOM) incidence by RTOG, NCI, and a composite RTOG-NCI scales. Secondary endpoints: SOM duration and grade 2-4 OM or Ulcerative Oral Mucositis (UOM) incidence and duration. RESULTS Eighty-four patients were included in the study. Concurrent systemic treatments were cisplatin (n = 54; 64%) or cetuximab (n = 30; 36%). Compared with the placebo arm, RTOG-defined SOM incidence was numerically lower in the 3% melatonin oral gel arm (53 vs. 64%, P = 0.36). In patients treated with cisplatin, assessed by the RTOG-NCI composite scale, both SOM incidence (44 vs. 78%; P = 0.02) and median SOM duration (0 vs. 22 days; P = 0.022) were significantly reduced in the melatonin arm. Median UOM duration assessed by the RTOG-NCI scale was also significantly shorter in the melatonin arm (49 vs. 73 days; P = 0.014). Rate of adverse events and overall response rate were similar between the two arms. CONCLUSIONS Treatment with melatonin oral gel showed a consistent trend to lower incidence and shorter SOM duration and shorter duration of UOM. These results warrant further investigation in phase III clinical trial.
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Affiliation(s)
- A Lozano
- Institut Català d'Oncologia (ICO), Hospital Durán I Reynals, Avda de la Granvia de l'Hospitalet, 199, L'Hospitalet, 08907, Barcelona, Spain.
| | - J Marruecos
- Institut Català d'Oncologia (ICO), Hospital Universitari Dr. Josep Trueta, Avda França s/n, 17007, Girona, Spain
| | - J Rubió
- Institut Català d'Oncologia (ICO), Hospital Universitari Dr. Josep Trueta, Avda França s/n, 17007, Girona, Spain
| | - N Farré
- Hospital de la Santa Creu i Sant Pau, C/Sant Quintí, 89, 08041, Barcelona, Spain
| | - J Gómez-Millán
- Hospital Universitario Virgen de la Victoria, Campus de Teatinos, s/n, 29010, Málaga, Spain
| | - R Morera
- Hospital Universitario la Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - I Planas
- Institut Català d'Oncologia (ICO), Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, Badalona, 08916, Barcelona, Spain
| | - M Lanzuela
- Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009, Zaragoza, Spain
| | - M G Vázquez-Masedo
- Hospital Clínico San Carlos, C/Profesor Martín Lagos, s/n, 28040, Madrid, Spain
| | - L Cascallar
- Hospital Clínico Universitario de Santiago, CHUS, Rúa da Choupana, s/n, Santiago de Compostela, 15706, A Coruña, Spain
| | - J Giralt
- Hospital Universitari de la Vall d'Hebron, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - G Escames
- Biomedical Research Center, Health Sciences Technology Park, University of Granada, Granada Hospital Complex, 18016, Granada, Spain.,Department of Physiology, University of Granada, CIBERFES, IBS, Granada Hospital Complex, 18016, Granada, Spain
| | - V Valentí
- Hospital de Sant Pau i Santa Tecla, C/ Rambla Vella, 14, 43003, Tarragona, Spain
| | - P Grima
- Ferrer Internacional SA, Avenida Diagonal, 549, 08029, Barcelona, Spain
| | - R Bosser
- Spherium Biomed, S.L.U., C/ Joan XXIII, 10, 08950, Esplugues de Llobregat, Spain
| | - C Tarragó
- Ferrer Internacional SA, Avenida Diagonal, 549, 08029, Barcelona, Spain.,Spherium Biomed, S.L.U., C/ Joan XXIII, 10, 08950, Esplugues de Llobregat, Spain
| | - R Mesía
- Institut Català d'Oncologia (ICO), Hospital Durán I Reynals, Avda de la Granvia de l'Hospitalet, 199, L'Hospitalet, 08907, Barcelona, Spain.,Institut Català d'Oncologia (ICO), Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, Badalona, 08916, Barcelona, Spain
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How Should We Approach Locally Advanced Squamous Cell Carcinoma of Head and Neck Cancer Patients Ineligible for Standard Non-surgical Treatment? Curr Oncol Rep 2020; 22:118. [PMID: 32945988 DOI: 10.1007/s11912-020-00984-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Cisplatin has been established as one of the most important agents in multidisciplinary treatment for head and neck cancer (HNC). However, since HNC patients are often elderly and typically have several comorbidities, a limited number of patients can tolerate high-dose cisplatin in real-world HNC populations. We will provide a review of therapeutic alternatives to high-dose cisplatin-based treatment in the setting of definitive and postoperative chemoradiotherapy (CRT) or induction chemotherapy. RECENT FINDINGS Clinical criteria for CDDP ineligibility have been discussed in HNC. When considering cisplatin-based chemotherapy as part of a non-surgical approach, precise evaluation of the patient's physical condition, nutritional status, and comorbidities is needed. Upfront surgery is an important option with high curability, if a de-intensified non-surgical approach is estimated to be unavoidable. Although no prospective data are available regarding alternatives to definitive cisplatin-based combination therapy for patients undergoing a non-surgical approach, cetuximab, carboplatin, or split-dose cisplatin-based regimens may be employed for cisplatin-ineligible patients in clinical practice. The combination of immune checkpoint inhibitors with radiotherapy may be a promising novel approach, and some trials are currently targeting the specific cohort of patients ineligible for high-dose cisplatin. There are no standard treatments for patients ineligible for high-dose cisplatin. A personalized treatment strategy should be proposed based on the individual benefit-to-risk ratio of each treatment option in patients ineligible for the standard of care. Prospective clinical trials for cisplatin-ineligible patients with locally advanced HNC still need to be performed.
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Safety and efficacy of concurrent carboplatin or cetuximab plus radiotherapy for locally advanced head and neck cancer patients ineligible for treatment with cisplatin. Int J Clin Oncol 2019; 24:468-475. [DOI: 10.1007/s10147-018-01392-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 12/29/2018] [Indexed: 11/26/2022]
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Mortezaee K, Shabeeb D, Musa AE, Najafi M, Farhood B. Metformin as a Radiation Modifier; Implications to Normal Tissue Protection and Tumor Sensitization. CURRENT CLINICAL PHARMACOLOGY 2019; 14:41-53. [PMID: 30360725 DOI: 10.2174/1574884713666181025141559] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Nowadays, ionizing radiation is used for several applications in medicine, industry, agriculture, and nuclear power generation. Besides the beneficial roles of ionizing radiation, there are some concerns about accidental exposure to radioactive sources. The threat posed by its use in terrorism is of global concern. Furthermore, there are several side effects to normal organs for patients who had undergone radiation treatment for cancer. Hence, the modulation of radiation response in normal tissues was one of the most important aims of radiobiology. Although, so far, several agents have been investigated for protection and mitigation of radiation injury. Agents such as amifostine may lead to severe toxicity, while others may interfere with radiation therapy outcomes as a result of tumor protection. Metformin is a natural agent that is well known as an antidiabetic drug. It has shown some antioxidant effects and enhances DNA repair capacity, thereby ameliorating cell death following exposure to radiation. Moreover, through targeting endogenous ROS production within cells, it can mitigate radiation injury. This could potentially make it an effective radiation countermeasure. In contrast to other radioprotectors, metformin has shown modulatory effects through induction of several genes such as AMPK, which suppresses reduction/ oxidation (redox) reactions, protects cells from accumulation of unrepaired DNA, and attenuates initiation of inflammation as well as fibrotic pathways. Interestingly, these properties of metformin can sensitize cancer cells to radiotherapy. CONCLUSION In this article, we aimed to review the interesting properties of metformin such as radioprotection, radiomitigation and radiosensitization, which could make it an interesting adjuvant for clinical radiotherapy, as well as an interesting candidate for mitigation of radiation injury after a radiation disaster.
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Affiliation(s)
- Keywan Mortezaee
- Department of Anatomy, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Dheyauldeen Shabeeb
- Department of Medical Physics & Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences (International Campus), Tehran, Iran
- Department of Physiology, College of Medicine, University of Misan, Misan, Iraq
| | - Ahmed E Musa
- Department of Medical Physics & Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences (International Campus), Tehran, Iran
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Najafi
- Radiology and Nuclear Medicine Department, School of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Bagher Farhood
- Department of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran
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Karsten R, Stuiver M, van der Molen L, Navran A, de Boer J, Hilgers F, Klop W, Smeele L. From reactive to proactive tube feeding during chemoradiotherapy for head and neck cancer: A clinical prediction model-based approach. Oral Oncol 2019; 88:172-179. [DOI: 10.1016/j.oraloncology.2018.11.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/21/2018] [Accepted: 11/28/2018] [Indexed: 12/18/2022]
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Saba NF, Mody MD, Tan ES, Gill HS, Rinaldo A, Takes RP, Strojan P, Hartl DM, Vermorken JB, Haigentz M, Ferlito A. Toxicities of systemic agents in squamous cell carcinoma of the head and neck (SCCHN); A new perspective in the era of immunotherapy. Crit Rev Oncol Hematol 2017; 115:50-58. [PMID: 28602169 DOI: 10.1016/j.critrevonc.2017.04.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/16/2017] [Accepted: 04/26/2017] [Indexed: 02/08/2023] Open
Abstract
Squamous cell carcinoma of the head and neck (SCCHN) is a difficult to treat malignancy and represents the seventh most common cancer worldwide. Systemic therapy has a critical role in the treatment of locally advanced and recurrent/metastatic disease. Cytotoxic chemotherapy has been primarily used along with radiation and surgery, with cisplatin being the standard of care choice of therapy. When contraindications to cisplatin exist, other agents such as carboplatin, taxanes, 5-fluorouracil, and cetuximab are used. Similarly, in the advanced or metastatic setting, platinum agents, taxanes and cetuximab have been predominantly utilized. With the recent approval of novel agents such as pembrolizumab and nivolumab, and their distinct toxicity profiles, an understanding of the potential sequelae of the different systemic agents is essential to the careful selection of agents in the advanced disease setting. Going forward, choosing novel agents will be weighed against traditional chemotherapy, and understanding the toxicities at stake is critical in this process. In addition to providing an overview of the toxicity profile of the different systemic agents, we also provide a perspective into the future of SCCHN treatment.
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Affiliation(s)
- Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA.
| | - Mayur D Mody
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Elaine S Tan
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Harpaul S Gill
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France; Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France
| | - Jan B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Missak Haigentz
- Department of Medicine, Division of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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Brown TE, Wittholz K, Way M, Banks MD, Hughes BGM, Lin CY, Kenny LM, Bauer JD. Investigation of p16 status, chemotherapy regimen, and other nutrition markers for predicting gastrostomy in patients with head and neck cancer. Head Neck 2017; 39:868-875. [DOI: 10.1002/hed.24630] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/05/2016] [Accepted: 10/07/2016] [Indexed: 12/23/2022] Open
Affiliation(s)
- Teresa E. Brown
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Queensland Australia
- Centre for Dietetic Research (C-DIET-R), School of Human Movement and Nutrition Sciences; University of Queensland; Brisbane Australia
| | - Kym Wittholz
- Centre for Dietetic Research (C-DIET-R), School of Human Movement and Nutrition Sciences; University of Queensland; Brisbane Australia
| | - Mandy Way
- QIMR; Berghofer Medical Research Institute; Herston Queensland Australia
| | - Merrilyn D. Banks
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Queensland Australia
| | - Brett G. M. Hughes
- Cancer Care Services; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Queensland Australia
| | - Charles Y. Lin
- Cancer Care Services; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Lizbeth M. Kenny
- Cancer Care Services; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Judith D. Bauer
- Centre for Dietetic Research (C-DIET-R), School of Human Movement and Nutrition Sciences; University of Queensland; Brisbane Australia
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Ishimaru M, Ono S, Suzuki S, Matsui H, Fushimi K, Yasunaga H. Artificial nutrition dependence after cetuximab versus cisplatin combined with radiotherapy for advanced head and neck cancer: A propensity score-matched analysis. Head Neck 2016; 39:320-325. [PMID: 27635865 DOI: 10.1002/hed.24583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 07/13/2016] [Accepted: 08/05/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the effect of cetuximab-based radiotherapy (RT) with cisplatin-based concomitant chemoradiotherapy (CCRT) on artificial nutrition dependence in locoregional advanced head and neck cancer. METHODS We identified patients treated with cetuximab-based RT or CCRT between 2012 and 2014 in a Japanese national database, and used propensity score-matched analyses to evaluate artificial nutrition dependence for 30 days after starting chemotherapy and at hospital discharge. RESULTS Of 3935 eligible patients, propensity score matching generated 250 pairs. Thirty-day artificial nutrition dependence was significantly lower in the cetuximab-based RT group than in the CCRT group (25.6% vs 35.2%; odds ratio [OR] = 0.67; 95% confidence interval [CI] = 0.46-0.97; p = .036). No significant difference in artificial nutrition dependence at hospital discharge was shown (6.2% vs 7.2%; OR = 1.07; 95% CI = 0.52-2.17; p = .861). Difference in duration of hospitalization was insignificant. CONCLUSION Cetuximab-based RT may reduce short-term artificial nutrition dependence compared to CCRT. © 2016 Wiley Periodicals, Inc. Head Neck 39: 320-325, 2017.
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Affiliation(s)
- Miho Ishimaru
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Sachiko Ono
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Sayaka Suzuki
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Bonner JA, Giralt J, Harari PM, Baselga J, Spencer S, Bell D, Raben D, Liu J, Schulten J, Ang KK, Rosenthal DI. Association of human papillomavirus and p16 status with mucositis and dysphagia for head and neck cancer patients treated with radiotherapy with or without cetuximab: Assessment from a phase 3 registration trial. Eur J Cancer 2016; 64:1-11. [PMID: 27323346 PMCID: PMC5027878 DOI: 10.1016/j.ejca.2016.05.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/28/2016] [Accepted: 05/06/2016] [Indexed: 11/19/2022]
Abstract
Background Mucositis and dysphagia are common adverse effects of radiotherapy (RT) treatment of locally advanced squamous cell cancer of the head and neck (LA-SCCHN). Chemotherapy added to RT increases survival rates but causes worse mucositis and dysphagia. The aim of this analysis was to assess the impact of p16 status on mucositis, dysphagia, and feeding tube use in LA-SCCHN among patients treated with RT ± cetuximab in the phase 3 IMCL-9815 trial. Methods Patients received RT plus weekly cetuximab or RT alone. Subgroup analyses were conducted on patients with p16-positive (n = 75) or p16-negative (n = 106) oropharyngeal cancer (OPC), as determined by immunohistochemical analysis. The onset and duration of mucositis and dysphagia by treatment arm and p16 status were displayed using Kaplan–Meier curves and the log-rank test. P values for the incidence of mucositis and dysphagia were calculated using the Fisher exact test. Feeding tube use was assessed as the percent of patients reporting use. Results The baseline characteristics of patients treated with RT ± cetuximab were similar in both the p16-positive and p16-negative OPC subgroups. Patients within the p16-positive OPC subgroup had higher Karnofsky scores and were more likely to have stage T1–T3 cancer and be from the United States. Regardless of p16 status, there was no difference in the onset or duration of grade 3/4 mucositis or dysphagia in patient receiving RT plus cetuximab compared with those receiving RT alone. In the overall population, and the p16-positive and p16-negative OPC subpopulations, feeding tube use was not different for patients receiving RT plus cetuximab compared with RT alone. Conclusion Regardless of p16 status, the addition of cetuximab to RT did not alter the incidence, time to onset, severity, or duration of mucositis and dysphagia and did not impact the frequency of feeding tube use.
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Affiliation(s)
- James A Bonner
- University of Alabama at Birmingham Comprehensive Cancer Center, Department of Radiation Oncology, 619 19th Street South, Birmingham, AL 35233, USA.
| | - Jordi Giralt
- Servei d'Oncologia Radioteràpica, Hospital Universitari Valld'Hebron, 08035 Barcelona, Spain
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue K4/336, Madison, WI 53792, USA
| | - Jose Baselga
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sharon Spencer
- University of Alabama, Hazelrig-Salter Radiation Oncology Center, 1700 6th Avenue South, Birmingham, AL 35233, USA
| | - Diana Bell
- MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - David Raben
- Department of Radiation Oncology at the Anschutz Medical Campus, 1665 Aurora Court, Suite 1032, Aurora, CO 80045, USA
| | | | - Jeltje Schulten
- Merck KGaA, Frankfurter Str 250, 135/001, 64293 Darmstadt, Germany
| | - Kian K Ang
- MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - David I Rosenthal
- MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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Zhu G, Lin JC, Kim SB, Bernier J, Agarwal JP, Vermorken JB, Thinh DHQ, Cheng HC, Yun HJ, Chitapanarux I, Lertsanguansinchai P, Reddy VA, He X. Asian expert recommendation on management of skin and mucosal effects of radiation, with or without the addition of cetuximab or chemotherapy, in treatment of head and neck squamous cell carcinoma. BMC Cancer 2016; 16:42. [PMID: 26817597 PMCID: PMC4730602 DOI: 10.1186/s12885-016-2073-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 01/19/2016] [Indexed: 11/16/2022] Open
Abstract
With increasing numbers of patients with unresectable locoregionally advanced (LA) head and neck squamous cell carcinoma (HNSCC) receiving cetuximab/radiotherapy (RT), several guidelines on the early detection and management of skin-related toxicities have been developed. Considering the existing management guidelines for these treatment-induced conditions, clinical applicability and standardization of grading methods has remained a cause of concern globally, particularly in Asian countries. In this study, we attempted to collate the literature and clinical experience across Asian countries to compile a practical and implementable set of recommendations for Asian oncologists to manage skin- and mucosa-related toxicities arising from different types of radiation, with or without the addition of cetuximab or chemotherapy. In December 2013, an international panel of experts in the field of head and neck cancer management assembled for an Asia-Pacific head and neck cancer expert panel meeting in China. The compilation of discussion outcomes of this meeting and literature data ultimately led to the development of a set of recommendations for physicians with regards to the approach and management of dermatological conditions arising from RT, chemotherapy/RT and cetuximab/RT, and similarly for the approach and management of mucositis resulting from RT, with or without the addition of chemotherapy or cetuximab. These recommendations helped to adapt guidelines published in the literature or text books into bedside practice, and may also serve as a starting point for developing individual institutional side-effect management protocols with adequate training and education.
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Affiliation(s)
- Guopei Zhu
- />Fudan University Cancer Hospital, Shanghai, China
| | - Jin-Ching Lin
- />Taichung Veterans General Hospital, Taichung, Taiwan
| | | | | | | | - Jan B. Vermorken
- />University of Antwerp (UA) and Antwerp University Hospital (UZA), Edegem, Belgium
| | | | | | - Hwan Jung Yun
- />Chungnam National University Hospital, Daejeon, Korea
| | | | | | | | - Xia He
- />Jiangsu Cancer Hospital, Nanjing, China
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Kurokawa M, Watanabe Nemoto M, Harada R, Kobayashi H, Horikoshi T, Kanazawa A, Togasaki G, Abe Y, Chazono H, Hanazawa T, Okamoto Y, Uno T. Initial experience of radiotherapy plus cetuximab for Japanese head and neck cancer patients. JOURNAL OF RADIATION RESEARCH 2015; 56:849-855. [PMID: 26160181 PMCID: PMC4577007 DOI: 10.1093/jrr/rrv038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/19/2015] [Accepted: 05/23/2015] [Indexed: 06/04/2023]
Abstract
In Japan, cetuximab with concurrent bioradiotherapy (BRT) for squamous cell carcinoma of head and neck (SCCHN) was approved in December 2012. We herein report our initial experience of BRT, with special emphasis on acute toxicities of this combination therapy. Thirty-one non-metastatic SCCHN patients who underwent BRT using cetuximab between July 2013 and June 2014 were retrospectively evaluated. All patients received cetuximab with a loading dose of 400 mg/m(2) one week before the start of radiotherapy, followed by 250 mg/m(2) per week during radiotherapy. The median cycle of cetuximab was seven cycles and the median dose of radiotherapy was 70 Gy. Twenty-five patients (80.6%) accomplished planned radiotherapy and six cycles or more cetuximab administration. Six patients (19.4%) discontinued cetuximab. Grade 3 dermatitis, mucositis and infusion reaction occurred in 19.4%, 48.3% and 3.2%, respectively. One patient experienced Grade 3 gastrointestinal bleeding caused by diverticular hemorrhage during BRT. Grade 3 drug-induced pneumonitis occurred in two patients. The response rate was 74%, including 55% with a complete response. BRT using cetuximab for Japanese patients with SCCHN was feasible as an alternative for cisplatin-based concurrent chemoradiation, although longer follow-up is necessary to evaluate late toxicities.
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Affiliation(s)
- Marie Kurokawa
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Miho Watanabe Nemoto
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Rintaro Harada
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Hiroki Kobayashi
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Takuro Horikoshi
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Aki Kanazawa
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Gentaro Togasaki
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Yukinao Abe
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Hideaki Chazono
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Toyoyuki Hanazawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Takashi Uno
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
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Sakashita T, Homma A, Hatakeyama H, Furusawa J, Kano S, Mizumachi T, Iizuka S, Onimaru R, Tsuchiya K, Yasuda K, Shirato H, Fukuda S. Comparison of acute toxicities associated with cetuximab-based bioradiotherapy and platinum-based chemoradiotherapy for head and neck squamous cell carcinomas: A single-institution retrospective study in Japan. Acta Otolaryngol 2015; 135:853-8. [PMID: 25814008 DOI: 10.3109/00016489.2015.1030772] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Grade ≥ 3 mucositis/stomatitis and inability to feed orally were problematic for patients undergoing cetuximab-based bioradiotherapy (BRT) as well as platinum-based chemoradiotherapy (CRT). Severe mucositis/stomatitis and radiation dermatitis should be addressed carefully in patients undergoing cetuximab-based BRT as well. OBJECTIVES The efficacy of cetuximab-based BRT in locally advanced head and neck squamous cell carcinomas has been established. However, the safety of cetuximab-based BRT in comparison with platinum-based CRT is currently under investigation. METHOD This study retrospectively analyzed 14 patients undergoing cetuximab-based BRT and 29 patients undergoing platinum-based CRT to compare the incidence of acute toxicities. In the BRT group, an initial cetuximab loading dose of 400 mg/m(2) was delivered 1 week before the start of radiotherapy. Seven weekly infusions of 250 mg/m(2) of cetuximab followed during the definitive radiotherapy. In the CRT group, cisplatin was administered at a dose of 40 mg/m(2) weekly during the definitive radiotherapy. RESULTS The BRT group had a higher incidence of Grade ≥ 3 radiation dermatitis than did the CRT group (43% vs 3%, respectively, p < 0.01). The incidence rate of Grade ≥ 3 mucositis/stomatitis was 64.3% and 41.4% in the BRT and CRT group, respectively (p = 0.1484), while the incidence rate of the inability to feed orally was 38.5% and 55.2%, respectively (p = 0.2053).
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