Phase II study of etoposide (VP-16) in the treatment of advanced head and neck cancer

Salvage Therapy with Oral Etoposide in Recurrent and/or Metastatic Squamous Cell Carcinoma of the Head and Neck

BACKGROUND

The purpose of this retrospective evaluation was to assess the palliative effect of oral etoposide in heavily pretreated patients with squamous cell carcinoma of the head and neck.

PATIENTS AND METHODS

Between October 1995 and February 2003, a total of 26 patients with metastatic and/or recurrent squamous cell carcinoma of the head and neck (SCCHN) were treated with oral etoposide. Therapy consisted of etoposide at a total dose of 100 mg daily for 7 days and was repeated every 4 weeks until progression of disease or for a maximum of 8 courses. Eighteen patients underwent primary surgery of the tumour followed by adjuvant irradiation or surgery after neoadjuvant radiochemotherapy. Eight patients had primary irradiation with or without concomitant chemotherapy. All patients previously received at least one palliative chemotherapy with cisplatin/5-floururacil (5-FU) or cisplatin/taxotere. Patients did not routinely receive anti-emetic medication.

RESULTS

All patients were eligible for toxicity and survival assessment, and 24 of 26 patients for response evaluation according to an intention-to-treat principle. Two patients had a partial response (8 percent); disease was stable in 9 patients (35 percent) and progressed in 13 patients (50 percent). The median time to progression for all patients was 3 months (range, 2-54), and median overall survival was 10 months (range, 2-52). Toxicity was in general mild and moderate (Grade 1 and 2), except three patients, who experienced Grade 3 anaemia, and one patient who had Grade 3 thrombocytopenia without bleeding complications. Severe nonhematologic adverse reactions were not seen, except for alopecia.

CONCLUSION

Our data suggest that oral etoposid is markedly effective, in regard to stabilization of disease and survival, and an excellent tolerated therapy for pretreated patients with recurrent and/or metastatic head and neck carcinomas. Its advantage over other commonly used and more intensive regimens such as 5-fluorouracil (5-FU) + cisplatin or taxane-containing combinations is its superior tolerance, in particular the incidence of nausea and vomiting, complete alopecia, and/or hematologic complications.

A phase II study of prolonged oral etoposide in advanced or recurrent carcinoma of the cervix

OBJECTIVE

To evaluate the efficacy and toxicity of prolonged oral etoposide as single agent chemotherapy in patients with advanced or recurrent carcinoma of the cervix.

METHODS

Between May 1991 and February 1993, 44 patients with advanced or recurrent carcinoma of the cervix were entered onto this study. Patients were eligible if they had received no more than two prior cytotoxic regimens. The initial dose of etoposide was 37.5 mg/m2 administered orally on a daily basis on days 1-21 of a 28-day cycle. Subsequent doses were unchanged, reduced, escalated, or omitted according to toxicity. Patients were evaluated for response and toxicity using standard Gynecologic Oncology Group criteria.

RESULTS

Forty-four patients were evaluable for response and toxicity. The overall response rate was 9.1% (2 CR, 2 PR). In patients with no prior chemotherapy the response rate was 4/25 compared to 0/19 for those who had prior therapy. The mean response duration was 2.7 months and the median survival from treatment for all patients was 7.7 months. The major toxicity was granulocytopenia, with 11% of patients having grade 3 or 4 toxicity. Gastrointestinal toxicity of some degree occurred in 11% of patients, and alopecia was universal.

CONCLUSION

Prolonged oral etoposide has limited activity in advanced or recurrent carcinoma of the cervix. Its use as palliative therapy for this disease is not indicated.

Effects of mitomycin-C and etoposide in cell culture and in nude mice: the role of G-CSF mutein

The combination of mitomycin-C and etoposide showed synergistic cell kill effects in vitro against HEp-2 laryngeal squamous carcinoma cells both in monolayer and in multicellular tumor spheroid systems. This combination was also synergistic in inhibiting HEp-2 tumors growing in nude mice. One course of this combination produced no complete regression of this tumor. When these two agents were combined with recombinant human granulocyte colony-stimulating factor (G-CSF) mutein, the doses of the drugs could be escalated approximately 1.5-fold higher than the doses that were tolerated without G-CSF support. With this modest dose intensification, apparent cure was observed. High-dose mitomycin-C plus etoposide with G-CSF support may be useful for the treatment of patients with inoperable squamous cell carcinoma of the head and neck.

Chemosensitivity testing of human mouth carcinoma cell line

The chemosensitivity of KB cells derived from oral epidermal carcinoma to various antitumor agents was analyzed using the MTT[3-(4,5-dimethyl-2-thiazoyl)-2,5-diphenyl-2H tetrazolium bromide] assay. Optical density (OD) for MTT assay was measured with dual wavelengths. The chemosensitivity of the drugs was evaluated by the 50% OD (OD50) of each drug concentration in the control group. Five platinum (Pt) drugs and 3 anthracycline (AC) drugs were used in this study. The chemosensitivity differed among the 5 Pt drugs. No significant difference was observed among the 3 AC drugs. A linear increase in OD corresponding to an increase in number of cells was observed. When 0.1 M sodium succinate (S.S.) was added to 0.4% MTT, the sensitivity increased five-fold compared to the control group without S.S. The MTT assay is a precise, rapid, easy and inexpensive experimental system useful for evaluation of antitumor drug sensitivity on tumor cell lines.

Induction intra-arterial cisplatin and bleomycin in head and neck cancer

Fifty-two consecutive patients, affected by large T2 (greater than 3 cm), T3, T4, N0, or N1 previously untreated squamous cell carcinoma of the head and neck, entered this phase I-II study. Treatment consisted of a continuous 8-day infusion on the following daily schedule: cisplatin 25 mg and bleomycin 15 mg administered for 4 and 20 hours, respectively. Technical-related toxicities were 1 case each of coagulation and displacement of the catheter and 1 case of reversible monoparesis of the contralateral arm. Drug-related relevant toxicities accounted for 4 cass of grade 3 or 4 leukopenia and 2 cases of peripheral palsy of the 7th and 12th cranial nerve, respectively. Forty-five of 50 evaluable patients obtained an objective response. In particular, 13 patients obtained a complete response, 22 a partial response greater than or equal to 75%, and 10 a partial response greater than or equal to 50%. Furthermore, 5 of 31 patients showed a complete pathologic disappearance of the tumor, whereas in 12 of 31 only a microscopic residue was found.

Phase II trial of etoposide and doxorubicin in advanced head and neck cancer

In an effort to improve the response rate of patients with advanced head and neck cancer, a clinical trial combining two infrequently studied drugs was conducted. Twelve patients with squamous cell carcinoma of the head and neck were treated with 3-day continuous infusions of etoposide (90 mg/m2/day) and doxorubicin (15 mg/m2/day). All patients had been heavily pre-treated with surgery, radiation therapy, and/or chemotherapy. No objective responses were observed in 9 evaluable patients. One patient maintained stable disease state for 4 months. The major toxicity was Grade 3 or 4 myelosuppression which occurred in 42% of administered cycles. Although single-agent etoposide and doxorubicin have shown response rates of 10%-40% in patients with squamous cell carcinoma of the head and neck, we were disappointed to find that the combination of etoposide and doxorubicin has little or no activity in patients with advanced head and neck cancer. The toxicity encountered with this combination was significant.

Phase II clinical trial of the combination VP-16, bleomycin, and cis-diamminedichloroplatinum in patients with advanced upper aerodigestive squamous cell carcinoma

Fifteen patients with advanced upper aerodigestive carcinomas of squamous cell histology received the three-agent cytotoxic regimen of VP-16, bleomycin, and cis-diamminedichloroplatinum (CDDP) administered as a continuous 120-h infusion. The objective response rate was 40%. Median times to progression and survival were 3.2 months and 4.3 months, respectively. Hematologic and gastrointestinal toxicities were relatively transient and manageable. Our experience indicates that this three-drug program does not offer a substantial therapeutic advantage compared with more conventional single agent cytotoxic approaches for advanced head and neck cancer.