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Muniz IDAF, Araujo M, Bouassaly J, Farshadi F, Atique M, Esfahani K, Bonan PRF, Hier M, Mascarella M, Mlynarek A, Alaoui-Jamali M, da Silva SD. Therapeutic Advances and Challenges for the Management of HPV-Associated Oropharyngeal Cancer. Int J Mol Sci 2024; 25:4009. [PMID: 38612819 PMCID: PMC11012756 DOI: 10.3390/ijms25074009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
The use of conventional chemotherapy in conjunction with targeted and immunotherapy drugs has emerged as an option to limit the severity of side effects in patients diagnosed with head and neck cancer (HNC), particularly oropharyngeal cancer (OPC). OPC prevalence has increased exponentially in the past 30 years due to the prevalence of human papillomavirus (HPV) infection. This study reports a comprehensive review of clinical trials registered in public databases and reported in the literature (PubMed/Medline, Scopus, and ISI web of science databases). Of the 55 clinical trials identified, the majority (83.3%) were conducted after 2015, of which 77.7% were performed in the United States alone. Eight drugs have been approved by the FDA for HNC, including both generic and commercial forms: bleomycin sulfate, cetuximab (Erbitux), docetaxel (Taxotere), hydroxyurea (Hydrea), pembrolizumab (Keytruda), loqtorzi (Toripalimab-tpzi), methotrexate sodium (Trexall), and nivolumab (Opdivo). The most common drugs to treat HPV-associated OPC under these clinical trials and implemented as well for HPV-negative HNC include cisplatin, nivolumab, cetuximab, paclitaxel, pembrolizumab, 5-fluorouracil, and docetaxel. Few studies have highlighted the necessity for new drugs specifically tailored to patients with HPV-associated OPC, where molecular mechanisms and clinical prognosis are distinct from HPV-negative tumors. In this context, we identified most mutated genes found in HPV-associated OPC that can represent potential targets for drug development. These include TP53, PIK3CA, PTEN, NOTCH1, RB1, FAT1, FBXW7, HRAS, KRAS, and CDKN2A.
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Affiliation(s)
- Isis de Araújo Ferreira Muniz
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
- Graduate Program in Dentistry, Federal University of Paraíba, João Pessoa 58051-900, PB, Brazil
| | - Megan Araujo
- Division of Experimental Medicine and Oncology, Department of Medicine and Health Sciences, McGill University, Montreal, QC HC3 1E2, Canada; (M.A.); (J.B.)
| | - Jenna Bouassaly
- Division of Experimental Medicine and Oncology, Department of Medicine and Health Sciences, McGill University, Montreal, QC HC3 1E2, Canada; (M.A.); (J.B.)
| | - Fatemeh Farshadi
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
- Division of Experimental Medicine and Oncology, Department of Medicine and Health Sciences, McGill University, Montreal, QC HC3 1E2, Canada; (M.A.); (J.B.)
| | - Mai Atique
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
| | - Khashayar Esfahani
- Department of Oncology, McGill University, Montreal, QC HC3 1E2, Canada;
| | - Paulo Rogerio Ferreti Bonan
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
- Graduate Program in Dentistry, Federal University of Paraíba, João Pessoa 58051-900, PB, Brazil
| | - Michael Hier
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
| | - Marco Mascarella
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
| | - Alex Mlynarek
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
| | - Moulay Alaoui-Jamali
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
| | - Sabrina Daniela da Silva
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
- Division of Experimental Medicine and Oncology, Department of Medicine and Health Sciences, McGill University, Montreal, QC HC3 1E2, Canada; (M.A.); (J.B.)
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de Souza Viana L, de Aguiar Silva FC, Andrade Dos Anjos Jacome A, Calheiros Campelo Maia D, Duarte de Mattos M, Arthur Jacinto A, Elias Mamere A, Boldrini Junior D, de Castro Capuzzo R, Roberto Santos C, Lopes Carvalho A. Efficacy and safety of a cisplatin and paclitaxel induction regimen followed by chemoradiotherapy for patients with locally advanced head and neck squamous cell carcinoma. Head Neck 2015; 38 Suppl 1:E970-80. [PMID: 26031625 DOI: 10.1002/hed.24137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 03/14/2015] [Accepted: 05/21/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The purpose of this phase II trial was to evaluate the tolerability, safety, and efficacy of a non-5-fluorouracil (5-FU)-based induction chemotherapy followed by chemoradiotherapy (CRT) for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). METHODS Sixty patients with stage III to IV HNSCC were treated with induction paclitaxel and cisplatin (TP; paclitaxel 175 mg/m(2) and cisplatin 80 mg/m(2) , 3 cycles) followed by CRT (cisplatin 100 mg/m(2) ; D1, 22, and 43 of radiotherapy). RESULTS Fifty-six patients (93.3%) completed 3 cycles of induction TP (no treatment-related deaths), 52 (86.7%) completed definitive CRT per protocol (adverse event [AE] grade ≥2 in 53.3%). The overall response rate after induction TP was 82.5% for patients with resectable disease and 55.5% for unresectable disease (p = .023), and complete response (CR) rate after CRT was 70.0% for patients with resectable disease and 30.0% for unresectable disease (p = .005). CONCLUSION Induction TP followed by cisplatin based-CRT was well-tolerated, safe, and had high overall response rate in selected patients with locally advanced HNSCC. © 2015 Wiley Periodicals, Inc. Head Neck 38: E970-E980, 2016.
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Affiliation(s)
| | | | | | | | | | | | - Augusto Elias Mamere
- Department of Radiotherapy, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | | | - Carlos Roberto Santos
- Department of Head and Neck Surgery, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Andre Lopes Carvalho
- Department of Head and Neck Surgery, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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de Mello RA, Gerós S, Alves MP, Moreira F, Avezedo I, Dinis J. Cetuximab plus platinum-based chemotherapy in head and neck squamous cell carcinoma: a retrospective study in a single comprehensive European cancer institution. PLoS One 2014; 9:e86697. [PMID: 24516537 PMCID: PMC3916324 DOI: 10.1371/journal.pone.0086697] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/11/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The use of cetuximab in combination with platinum (P) plus 5-fluorouracil (F) has previously been demonstrated to be effective in the treatment of metastatic squamous cell cancer of head and neck (SCCHN). We investigated the efficacy and outcome of this protocol as a first-line treatment for patients with recurrent or metastatic disease. We evaluated overall-survival (OS), progression-free-survival (PFS), overall response rate (ORR) and the treatment toxicity profile in a retrospective cohort. PATIENTS AND METHODS This study enrolled 121 patients with untreated recurrent or metastatic SCCHN. The patients received PF+ cetuximab every 3 weeks for a maximum of 6 cycles. Patients with stable disease who received PF+ cetuximab continued to receive cetuximab until disease progressed or unacceptable toxic effects were experienced, whichever occurred first. RESULTS The median patient age was 53 (37-78) years. The patient cohort was 86.8% male. The addition of cetuximab to PF in the recurrent or metastatic setting provided an OS of 11 months (Confidential Interval, CI, 95%, 8.684-13.316) and PFS of 8 months (CI 95%, 6.051-9.949). The disease control rate was 48.9%, and the ORR was 23.91%. The most common grade 3 or 4 adverse events in the PF+ cetuximab regimen were febrile neutropenia (5.7%), skin rash (3.8%) and mucosistis (3.8%). CONCLUSIONS The results of this study suggest that cetuximab plus platinum-fluorouracil chemotherapy is a good option for systemic treatment in advanced SSCHN patients. This regimen has a well-tolerated toxicity profile.
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Affiliation(s)
- Ramon Andrade de Mello
- Department of Medical Oncology, Head and Neck Unit, Portuguese Oncology Institute, Porto, Portugal
- Department of Medicine and Biomedical Sciences, School of Medicine, University of Algarve, Faro, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sandra Gerós
- Service of Otorhinolaryngology, Head and Neck Unit, Portuguese Oncology Institute, Porto, Portugal
- Department of Otorhinolaryngology and Cervical Facial Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Marcos Pantarotto Alves
- Department of Medical Oncology, Head and Neck Unit, Portuguese Oncology Institute, Porto, Portugal
| | - Filipa Moreira
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Isabel Avezedo
- Department of Medical Oncology, Head and Neck Unit, Portuguese Oncology Institute, Porto, Portugal
| | - José Dinis
- Department of Medical Oncology, Head and Neck Unit, Portuguese Oncology Institute, Porto, Portugal
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Zhang H, Graham CM, Elci O, Griswold ME, Zhang X, Khan MA, Pitman K, Caudell JJ, Hamilton RD, Ganeshan B, Smith AD. Locally advanced squamous cell carcinoma of the head and neck: CT texture and histogram analysis allow independent prediction of overall survival in patients treated with induction chemotherapy. Radiology 2013; 269:801-9. [PMID: 23912620 DOI: 10.1148/radiol.13130110] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To determine if computed tomographic (CT) texture and histogram analysis measurements of the primary mass are independently associated with overall survival in patients with locally advanced squamous cell carcinoma of the head and neck who were previously treated with cisplatin, 5-fluorouracil, and docetaxel (TPF) induction chemotherapy. MATERIALS AND METHODS This institutional review board-approved retrospective study included 72 patients with locally advanced squamous cell carcinoma of the head and neck who were treated with induction TPF chemotherapy in 2004-2010. CT texture and histogram analysis of the primary mass on the pretherapy CT images were performed by using TexRAD software before and after application of spatial filters at different anatomic scales ranging from fine detail to coarse features. Cox proportional hazards models were used to examine the association between overall survival and the baseline CT imaging measurements and clinical variables. RESULTS Primary mass entropy and skewness measurements with multiple spatial filters were associated with overall survival. Multivariate Cox regression analysis incorporating clinical and imaging variables indicated that primary mass size (hazard ratio [HR], 1.58 for each 1-cm increase; P = .018), N stage (HR, 8.77 for N3 vs N0 or N1; P = .002; HR, 4.99 for N3 vs N2; P = .001), and primary mass entropy (HR, 2.10 for each 0.5-unit increase; P = .036) and skewness (HR, 3.67 for each 1.0-unit increase; P = .009) measurements with the 1.0 spatial filter were independently associated with overall survival. CONCLUSION Independent of tumor size, N stage, and other clinical variables, primary mass CT texture and histogram analysis parameters are associated with overall survival in patients with locally advanced squamous cell carcinoma of the head and neck who were treated with induction TPF. Online supplemental material is available for this article.
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Affiliation(s)
- Haowei Zhang
- From the Department of Radiology (H.Z., C.M.G., M.K., A.D.S.), Center for Biostatistics and Bioinformatics (O.E., M.E.G., X.Z.), Department of Otolaryngology (K.P.), Department of Radiation Oncology (J.J.C.), and Department of Medicine (R.D.H.), University of Mississippi Medical Center 2500 N State St, Jackson, MS 39216; Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Fla (J.J.C.); and Institute of Nuclear Medicine, University College London, London, England (B.G.)
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Abstract
Five hundred and fifty thousand new head and neck cancer cases are diagnosed each year worldwide. They are mostly locally advanced squamous cell carcinoma with a poor prognosis in terms of locoregional and distant failure. A major challenge for patients with locally advanced squamous cell carcinoma is to achieve a high cure rate while preserving functions. Treatment strategies are designed according to the disease stage, primary site, operable status, patient age, and performance status. Surgery, radiation therapy, chemotherapy, and more recently molecular-targeted therapies are part of these strategies, but their sequence remains to be defined. Over the last 30 years, induction chemotherapy has attained an important position in the management of patients with locally advanced squamous cell carcinoma, particularly since the introduction of taxanes. The decision to deliver induction chemotherapy (and its intensification) must be considered in the light of other treatments aiming at better locoregional control (normofractioned radiotherapy, accelerated or hyperfractionated radiotherapy, addition of concurrent chemotherapy, or of targeted therapy) with or without adjuvant treatment. This review summarizes the rationale, these data, and perspectives on induction chemotherapy-based strategies.
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Yu L, Li HZ, Lu SM, Liu WW, Li JF, Wang HB, Xu W. Alteration in TWIST expression: possible role in paclitaxel-induced apoptosis in human laryngeal carcinoma Hep-2 cell line. Croat Med J 2010; 50:536-42. [PMID: 20017221 DOI: 10.3325/cmj.2009.50.536] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
AIM To explore the relationship between alteration in the expression of TWIST, highly conserved transcription factor from the basic helix-loop-helix family, and apoptosis of Hep-2 cells induced by chemotherapeutic agent paclitaxel. METHODS Morphological changes of Hep-2 cells were observed by acridine orange cytochemistry staining. Viability of Hep-2 cells treated with various concentrations of paclitaxel was examined by cell proliferation assay. Apoptosis was examined by flow cytometry. The mRNA and protein expression of TWIST in response to paclitaxel at 24 hours, 48 hours, and 72 hours was examined by reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting, respectively. RESULTS Typical morphological changes of apoptotic cells at 24 hours, 48 hours, or 72 hours after treatment wiyth paclitaxel (10x10(-9) mol/L) were observed. The cell survival rates significantly decreased in a concentration- and time-dependent manner (P=0.001). Paclitaxel-induced apoptosis increased with culture time (22.6+/-5.3% after 24 hours, 38.7+/-7.9% after 48 hours, and 52.4+/-14.3% after 72 hours; P=0.002). Both mRNA and protein expression of TWIST was markedly decreased at both mRNA levels and protein levels, at 24 hours, 48 hours, and 72 hours in the paclitaxel-induced apoptosis of Hep-2 cells (P<0.001). CONCLUSION TWIST, which has a significantly decreased expression in response to paclitaxel in Hep-2 cells, may play a pivotal role in paclitaxel-induced apoptosis of Hep-2 cells.
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Affiliation(s)
- Liang Yu
- Department of Otolaryngology and Head and Neck Surgery, Provincial Hospital affiliated to Shandong University, Jinan, 250021, Peoples' Republic of China
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Parthan A, Posner MR, Brammer C, Beltran P, Jansen JP. Cost utility of docetaxel as induction chemotherapy followed by chemoradiation in locally advanced squamous cell carcinoma of the head and neck. Head Neck 2009; 31:1255-62. [DOI: 10.1002/hed.21096] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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8
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Oikawa H, Nakamura R, Nakasato T, Nishimura K, Sato H, Ehara S. Radiotherapy and concomitant intra-arterial docetaxel combined with systemic 5-fluorouracil and cisplatin for oropharyngeal cancer: a preliminary report--improvement of locoregional control of oropharyngeal cancer. Int J Radiat Oncol Biol Phys 2009; 75:338-42. [PMID: 19735860 DOI: 10.1016/j.ijrobp.2009.02.084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 02/16/2009] [Accepted: 02/26/2009] [Indexed: 11/25/2022]
Abstract
PURPOSE To confirm the advantage of chemoradiotherapy using intra-arterial docetaxel with intravenous cisplatin and 5-fluorouracil. PATIENTS AND METHODS A total of 26 oropharyngeal cancer patients (1, 2, 2, and 21 patients had Stage I, II, III, and IVa-IVc, respectively) were treated with two sessions of this chemoradiotherapy regimen. External beam radiotherapy was delivered using large portals that included the primary site and the regional lymph nodes initially (range, 40-41.4 Gy) and the metastatic lymph nodes later (60 or 72 Gy). All tumor-supplying branches of the carotid arteries were cannulated, and 40 mg/m(2) docetaxel was individually infused on Day 1. The other systemic chemotherapy agents included 60 mg/m(2) cisplatin on Day 2 and 500 mg/m(2) 5-fluorouracil on Days 2-6. RESULTS The primary response of the tumor was complete in 21 (81%), partial in 4 (15%), and progressive in 1 patient. Grade 4 mucositis, leukopenia, and dermatitis was observed in 3, 2, and 1 patients, respectively. During a median follow-up of 10 months, the disease recurred at the primary site and at a distant organ in 2 (8%) and 3 (12%) patients, respectively. Three patients died because of cancer progression. Two patients (8%) with a partial response were compromised by lethal bleeding from the tumor bed or chemotherapeutic toxicity. The 3-year locoregional control rate and the 3-year overall survival rate was 73% and 77%, respectively. CONCLUSION This method resulted in an excellent primary tumor response rate (96%) and moderate acute toxicity. Additional follow-up is required to ascertain the usefulness of this modality.
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Affiliation(s)
- Hirobumi Oikawa
- Department of Radiology, Iwate Medical University, Morioka, Japan.
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Evolution of clinical trials in head and neck cancer. Crit Rev Oncol Hematol 2009; 71:29-42. [DOI: 10.1016/j.critrevonc.2008.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 08/18/2008] [Accepted: 09/17/2008] [Indexed: 12/14/2022] Open
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Ashimori N, Zeitlin BD, Zhang Z, Warner K, Turkienicz IM, Spalding AC, Teknos TN, Wang S, Nör JE. TW-37, a small-molecule inhibitor of Bcl-2, mediates S-phase cell cycle arrest and suppresses head and neck tumor angiogenesis. Mol Cancer Ther 2009; 8:893-903. [PMID: 19372562 DOI: 10.1158/1535-7163.mct-08-1078] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Members of the Bcl-2 family play a major role in the pathobiology of head and neck cancer. We have shown that Bcl-2 orchestrates a cross talk between tumor cells and endothelial cells that have a direct effect on the progression of head and neck squamous cell carcinoma (HNSCC). Notably, Bcl-2 is significantly up-regulated in the tumor-associated endothelial cells compared with the endothelial cells of normal oral mucosa in patients with HNSCC. Here, we evaluated the effect of TW-37, a small-molecule inhibitor of Bcl-2, on the cell cycle and survival of endothelial cells and HNSCC and on the progression of xenografted tumors. TW-37 has an IC50 of 1.1 micromol/L for primary human endothelial cells and averaged 0.3 micromol/L for head and neck cancer cells (OSCC3, UM-SCC-1, and UM-SCC-74A). The combination of TW-37 and cisplatin showed enhanced cytotoxic effects for endothelial cells and HNSCC in vitro, compared with single drug treatment. Notably, whereas cisplatin led to an expected G2-M cell cycle arrest, TW-37 mediated an S-phase cell cycle arrest in endothelial cells and in HNSCC. In vivo, TW-37 inhibited tumor angiogenesis and induced tumor apoptosis without significant systemic toxicities. Combination of TW-37 and cisplatin enhanced the time to tumor failure (i.e., 4-fold increase in tumor volume), compared with either drug given separately. Collectively, these data reveal that therapeutic inhibition of Bcl-2 function with TW-37 is sufficient to arrest endothelial cells and HNSCC in the S phase of the cell cycle and to inhibit head and neck tumor angiogenesis.
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Affiliation(s)
- Naoki Ashimori
- Angiogenesis Research Laboratory, Department of Restorative Sciences, University of Michigan School of Dentistry, 1011 North University Room 2309, Ann Arbor, MI 48109-1078, USA
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Hsiao JR, Leu SF, Huang BM. Apoptotic mechanism of paclitaxel-induced cell death in human head and neck tumor cell lines. J Oral Pathol Med 2009; 38:188-97. [PMID: 19200178 DOI: 10.1111/j.1600-0714.2008.00732.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Paclitaxel (taxol) is clinically used to treat various human tumors. However, the cellular and molecular mechanism regarding apoptotic effect of paclitaxel on head and neck squamous cell carcinoma (HNSCC) remains elusive. METHODS The apoptotic effect and the mechanism of paclitaxel on FaDu hypopharyngeal cancer cell line, OEC-M1 gingival cancer cell line, and OC3 betel quid chewing-related buccal cancer cell lines were investigated by morphological observations, cell viability assay, flow cytometry assay and Western blotting methods. RESULTS Rounded-up cell number increased with membrane blebbing as the treatment of paclitaxel (50-500 nM) increased from 24 to 48 h among these cell lines. In cell viability assay, cell surviving rate significantly decreased from 87 to 27% as the dosage and duration of paclitaxel treatment increased (P < 0.05). Flow-cytometry analysis further demonstrated that 50 nM paclitaxel induced G2/M phase cell arrest among these cell lines within 8 h treatment, and then G2/M phase cell fraction significantly decreased as subG1 phase cell fraction significantly increased after 24 h treatment (P < 0.05), suggesting that cells underwent apoptosis. Furthermore, the activated caspases-8, -9, -3, -6 and poly ADP-ribose polymerase cleavage could all be significantly detected in FaDu, OEC-M1 and OC3 cells (P < 0.05). CONCLUSION Paclitaxel activated cell cycle arrest and caspase protein expressions to induce apoptosis in HNSCC cell lines.
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Affiliation(s)
- J-R Hsiao
- Department of Otolaryngology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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12
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Abstract
The intensification of radiation, induction chemotherapy, and concomitant chemoradiotherapy has been extensively investigated over the past 2 decades for the nonsurgical management of locally advanced, nonmetastatic squamous cell head and neck cancer (HNC). Concurrent chemoradiation has emerged as the standard of care, with the majority of its benefit resulting from improvements in locoregional disease control. Distant failure has become a more prominent problem in conjunction with these improvements. Concurrent chemotherapy provides suboptimal adjuvant treatment for distant disease. Multiagent induction chemotherapy holds more promise especially with the use of taxane-based regimens. Induction chemotherapy followed by concurrent chemoradiation (sequential chemoradiation) is now under investigation. The rationale and evidence supporting the choice to use or not to use a sequential program are discussed.
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Affiliation(s)
- David M Brizel
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
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Moore MG, Bhattacharyya N. Effectiveness of Chemotherapy and Radiotherapy in Sterilizing Cervical Nodal Disease in Squamous Cell Carcinoma of the Head and Neck. Laryngoscope 2009; 115:570-3. [PMID: 15805860 DOI: 10.1097/01.mlg.0000161359.58567.0e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Determine effects of chemoradiotherapy on nodal disease in head and neck squamous cell carcinoma (SCCA). STUDY DESIGN Matched case-control study. METHODS A series of neck dissections (ND) performed for SCCA of the head and neck was retrospectively reviewed. Three groups were identified: 1) planned ND after chemoradiotherapy, 2) ND after radiotherapy alone, and 3) ND before adjuvant therapy (control group). Demographic data, tumor-node-metastasis stage, and pathology were reviewed. Total number of nodes recovered, number of positive nodes, and extracapsular spread (ECS) were recorded. To each patient in the chemoradiotherapy group, a randomly matched dissection in the control group was identified, matching for preoperative N stage and ND type (comprehensive, supraomohyoid, or selective). Comparisons were conducted for total nodes, presence of positive nodes, and ECS. Similar matched comparisons were conducted for ND after radiotherapy alone versus the control group. RESULTS Ninety-seven NDs (N0 = 10 cases, N1 = 9, N2 = 69, and N3 = 9) were matched to control NDs without previous therapy. Total nodal yield was not statistically different between chemoradiotherapy and control groups (23.5 vs. 23.0 nodes, respectively, P = .77). Positive nodal yield was significantly lower for chemoradiotherapy versus control dissections (0.76 vs. 3.0, P < .001). The percent of chemoradiotherapy dissections recovered as positive nodes was 24.7% versus 68.0% of the control group (P < .001). ECS was identified in 13.4% of the chemoradiotherapy group versus 32.0% of the control group (P = .002). Radiotherapy alone produced less pronounced nodal reductions. CONCLUSIONS Chemoradiotherapy substantially decreases nodal disease and ECS in SCCA. However, a significant percentage of necks contain positive nodes after therapy, meriting consideration for ND.
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Affiliation(s)
- Michael G Moore
- Division of Otolaryngology, Brigham and Women's Hospital, Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts 02115, USA
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Cho YH, Lee SH, Kim DW, Wu HG, Hah JH, Rhee CS, Sung MW, Kim KH, Heo DS. Long-term survival of resectable subset after induction chemotherapy in patients with locally advanced head and neck cancer. Head Neck 2008; 30:346-50. [DOI: 10.1002/hed.20713] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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15
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Induction Chemotherapy for Head and Neck Squamous Cell Carcinomas (SCCHN). Curr Treat Options Oncol 2007; 8:252-60. [DOI: 10.1007/s11864-007-0035-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Neoadjuvant docetaxel and cisplatin chemotherapy followed by local irradiation is highly active on locoregionally advanced squamous cell carcinoma of the head and neck. The Journal of Laryngology & Otology 2007; 122:722-7. [PMID: 17925058 DOI: 10.1017/s0022215107007323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to determine the treatment outcome of neoadjuvant docetaxel and cisplatin chemotherapy followed by local radiotherapy for chemotherapy-naïve patients with locoregionally advanced squamous cell carcinoma of the head and neck. Thirty-seven patients with stage III or IV squamous cell carcinoma of the head and neck who received docetaxel and cisplatin regimen for a maximum of three cycles followed by radiation therapy were enrolled in this study. The overall response rate to the regimen was 91.9 per cent (34 of 37) (the complete remission rate was 48.6 per cent). The median time to treatment failure was 38 months (95 per cent confidence interval, 15-61 months). The four year estimated overall survival rates were 85.1 per cent. The most frequent moderate-to-severe toxicity was grade 3-4 neutropenia. The most common acute non-haematologic toxicities included anorexia, nausea and asthenia. Neoadjuvant docetaxel and cisplatin chemotherapy followed by radiotherapy is a feasible treatment strategy for patients with locoregionally advanced squamous cell carcinoma of the head and neck.
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Rivera F, Vega-Villegas ME, López-Brea M, Isla D, Mayorga M, Galdós P, Rubio A, Del Valle A, García-Reija F, García-Montesinos B, Rodríguez-Iglesias J, Mayordomo J, Rama J, Saiz-Bustillo R, Sanz-Ortiz J. Randomized phase II study of cisplatin and 5-FU continuous infusion (PF) versus cisplatin, UFT and vinorelbine (UFTVP) as induction chemotherapy in locally advanced squamous cell head and neck cancer (LA-SCHNC). Cancer Chemother Pharmacol 2007; 62:253-61. [PMID: 17901953 DOI: 10.1007/s00280-007-0599-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 09/10/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We conducted a multicentric randomized phase II trial comparing 5-FU continuous infusion (PF) and cisplatin, UFT and vinorelbine (UFTVP) as induction chemotherapy (IC) in locally advanced squamous cell head and neck cancer (LA-SCHNC). Primary objective was complete response (CR) to IC and overall survival (OS) was a secondary objective. MATERIALS AND METHODS PF: cisplatin 100 mg/m(2) i.v. Day 1 (D1) and 5-FU 1,000 mg/m(2) per day i.v. continous infusion D1-D5, every 21 days. UFTVP: cisplatin 100 mg/m(2) i.v. D1; UFT 200 mg/m(2) per day p.o. D1-D21 and vinorelbine 25 mg/m(2) i.v. D1 and D8, every 21 days. Four IC courses were planned in both arms. RESULTS A total of 206 patients (pts) were included (PF/UFTVP: 99/107): oral cavity: 8%/10%, oropharynx: 20%/25%, hypopharynx: 17%/14%, larynx: 54%/50%. Stage (TNM, 2002): III: 41%/35%, IVA: 23%/27%, IVB: 35%/38%. Complete response to IC: PF:36%/UFTVP:31% (P: no significative (NS)). G 3-4 toxicity (PF/UFTVP): neutropenia: 52%/72%; febrile neutropenia: 3%/20% (P < 0.001); anaemia:1%/14% (P < 0.001); trombocytopenia: 5%/0% (P = 0.02); mucositis: 15%/7% (P < 0.001). Deaths during IC: 2(2%)/3(3%). IC with UFTVP was associated with a favourable OS in the Cox analysis (actuarial 5 year OS: 49% vs. 34%; HR: 0.67, 95% CI: 0.47-0.95, P: 0.03). CONCLUSIONS Although clinical response is equal in both arms, overall survival (Cox) is better in the UFTVP arm. Febrile neutropenia and anaemia were more frequent with UFTVP while mucositis and trombocytopenia were more severe with PF.
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Affiliation(s)
- Fernando Rivera
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, 39008, Santander, Spain.
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Hambek M, Werner C, Baghi M, Gstöttner W, Knecht R. Enhancement of docetaxel efficacy in head and neck cancer treatment by G0 cell stimulation. Eur J Cancer 2007; 43:1502-7. [PMID: 17524637 DOI: 10.1016/j.ejca.2005.09.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Accepted: 09/02/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Docetaxel has recently taken part in new chemotherapy regimens with promising activity especially in the first line therapy (induction chemotherapy) of head and neck cancer (SCCHN). Nevertheless a major problem concerning the response of SCCHN to chemotherapy is the high percentage of resting cells (G0-phase cells) being resistant to chemotherapy. To overcome this phenomenon we have investigated the capacity of several cytokines to switch on cells into division cycle and progress to the chemosensitive phases (S, M-phase). METHODS Il-6, Serotonin, G-CSF and EGF were used to stimulate G0-phase squamous cell cancer cells (Detroit 562, A431, UM-SCC 10B) for reentry in the cell cycle to enhance the response to docetaxel. The proportion of G0-phase cells was detected through multicolor FACS analysis and Ki67 staining. RESULTS Cell cycle reentering was most effective after combination treatment with Serotonin+EGF. The proportion of G0 phase cells was significantly reduced after stimulation with Serotonin+EGF (p<0.05). Corresponding to cell cycle reentry the cytotoxic effect of docetaxel was significantly (p<0.04) enhanced in the prestimulated cells compared to the control (docetaxel monotreatment). CONCLUSIONS Our investigations demonstrate for the first time that sensitizing G0 phase squamous cell carcinoma cells for docetaxel treatment is possible by prestimulation with target cytokines. Considering that up to 95% of tumor cells are in the resting (G0) phase of the cell cycle at the initiation of chemotherapy, prestimulation with EGF and serotonin could contribute to a synchronization of cancer cells. This would clearly enhance the cytotoxic effect.
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Affiliation(s)
- Markus Hambek
- ENT-Center, University Clinic Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt / Main, Germany.
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Abstract
This paper reviews the efficacy and hazard of sequential combined treatment programs for squamous cell carcinoma of the head and neck. These regimens consist of initial systemic chemotherapy, known as neoadjuvant or induction chemotherapy, followed by radiation with or without concomitant chemotherapy.
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Affiliation(s)
- Merrill S Kies
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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20
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Willey CD, Murphy BA, Netterville JL, Burkey BB, Shyr Y, Shakhtour B, Kish B, Raben D, Chen C, Song JI, Kane MA, Cmelak AJ. A Phase II multi-institutional trial of chemoradiation using weekly docetaxel and erythropoietin for high-risk postoperative head and neck cancer patients. Int J Radiat Oncol Biol Phys 2007; 67:1323-31. [PMID: 17289289 DOI: 10.1016/j.ijrobp.2006.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Revised: 11/14/2006] [Accepted: 11/17/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine efficacy and toxicities of postoperative concurrent chemoradiation using docetaxel in high-risk head and neck cancer. METHODS AND MATERIALS High-risk patients were enrolled 2-8 weeks after surgery. Treatment included 60 Gy for 6 weeks with weekly docetaxel 25 mg/m(2) and erythropoietin alpha 40,000 U for hemoglobin < or =12 g/dL. Primary endpoints included locoregional control (LC), disease-free survival (DFS), and patterns of failure (POF). Secondary endpoints were toxicity and quality of life. RESULTS Eighteen patients were enrolled (14 male, 4 female), aged 24-70 years (median, 55 years). Primary site included oropharynx = 7, oral cavity = 8, hypopharynx = 1, and larynx = 2. Pathologic American Joint Committee on Cancer Stage was III = 3 patients, IV = 15 patients. High-risk eligibility included > or =2 positive lymph nodes = 13, extracapsular extension = 10, positive margins = 8 (11 patients with two or more risk factors). Docetaxel was reduced to 20 mg/m(2)/week after 5 patients had prolonged Grade 3 or higher mucositis. Overall, number of doses delivered was 2 of 6 = 1, 3 of 6 = 2, 4 of 6 = 2, 5 of 6 = 4, 6 of 6 = 9 patients. With median follow-up of 30 months (range, 5-66), 10 (56%) patients are alive and have no evidence of disease (NED); POF: three local recurrences (two with distant) and 1 distant only. One-year survival was 76%, median PFS and DFS had not been reached. Three-year LC was 82%. No Grade 3 or higher late toxicities were observed, although a few cases of prolonged mucositis and taste loss (>3 months) were seen, particularly at 25 mg/m(2)/week. CONCLUSION Postoperative radiation therapy with weekly docetaxel 20 or 25 mg/m(2)/week for high-risk postoperative head and neck cancer caused intolerable mucosal toxicity, prompting early study termination. Further studies should consider 15 mg/m(2). Actuarial 3-year LC is 82%, similar to cisplatin-based chemoradiation regimens. Distant metastasis remains an important issue requiring additional systemic interventions.
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Affiliation(s)
- Christopher D Willey
- Department of Radiation Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee 37232, USA
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Lehoczký P, McHugh PJ, Chovanec M. DNA interstrand cross-link repair in Saccharomyces cerevisiae. FEMS Microbiol Rev 2006; 31:109-33. [PMID: 17096663 DOI: 10.1111/j.1574-6976.2006.00046.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
DNA interstrand cross-links (ICL) present a formidable challenge to the cellular DNA repair apparatus. For Escherichia coli, a pathway which combines nucleotide excision repair (NER) and homologous recombination repair (HRR) to eliminate ICL has been characterized in detail, both genetically and biochemically. Mechanisms of ICL repair in eukaryotes have proved more difficult to define, primarily as a result of the fact that several pathways appear compete for ICL repair intermediates, and also because these competing activities are regulated in the cell cycle. The budding yeast Saccharomyces cerevisiae has proven a powerful tool for dissecting ICL repair. Important roles for NER, HRR and postreplication/translesion synthesis pathways have all been identified. Here we review, with reference to similarities and differences in higher eukaryotes, what has been discovered to date concerning ICL repair in this simple eukaryote.
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Affiliation(s)
- Peter Lehoczký
- Department of Molecular Genetics, Cancer Research Institute, Bratislava, Slovak Republic
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Roman E, Raez LE, Santos ES. Induction chemotherapy in the management of squamous cell carcinoma of the head and neck. Expert Rev Anticancer Ther 2006; 6:1205-15. [PMID: 17020455 DOI: 10.1586/14737140.6.9.1205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Platinum-based chemotherapy administered concurrently with radiation has been adopted as the standard treatment for locally advanced head and neck squamous cell carcinoma. Historically, randomized trials using induction chemotherapy prior to radiation therapy alone have failed to demonstrate a clear survival advantage, and concurrent chemoradiation has delivered better results than previously obtained with radiation therapy alone, establishing the benefit of adding chemotherapy. This method of treatment, together with new modalities of therapy and novel agents, has reintroduced the question of induction chemotherapy before definitive chemoradiation. Systemic chemotherapy offers a better possibility of reducing systemic metastasis and improving cosmetic appearance. This article reviews developing trends using induction chemotherapy followed by chemoradiation in patients with head and neck squamous cell carcinoma.
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Affiliation(s)
- Eloy Roman
- University of Miami, School of Medicine, Division of Hematology - Medical Oncology, Sylvester Comprehensive Cancer Center, 1475 NW 12 Avenue, Miami, FL 33136, USA.
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Fujisawa Y, Umebayashi Y, Ichikawa E, Kawachi Y, Otsuka F. Chemoradiation using low-dose cisplatin and 5-fluorouracil in locally advanced squamous cell carcinoma of the skin: a report of two cases. J Am Acad Dermatol 2006; 55:S81-5. [PMID: 17052540 DOI: 10.1016/j.jaad.2005.12.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Revised: 11/28/2005] [Accepted: 12/14/2005] [Indexed: 11/22/2022]
Abstract
Recently, low-dose 5-fluorouracil/cisplatin induction concurrent with radiation (chemoradiation) has been reported to be effective for locally advanced squamous cell carcinoma of the otorhinolaryngologic and gynecologic regions. However, to date, this therapeutic option has not been evaluated for squamous cell carcinoma of the skin. We evaluated chemoradiation therapy using cisplatin and 5-fluorouracil in two patients with locally advanced squamous cell carcinoma of the skin. Administration of cisplatin and 5-fluorouracil was conducted concurrently with conventionally fractionated radiation therapy. Cisplatin (patient 1: 4 mg/m(2)/d on days 1 to 5; patient 2: 15 mg/m(2)/d on days 1 to 5) and 5-fluorouracil (patient 1: 400 mg/m(2)/d for 7 days; patient 2: 850 mg/m(2)/d for 5 days) were administered intravenously for 1 hour and for 24 hours, respectively. Patient 1 underwent two courses of chemotherapy with a 3-week interval, and patient 2 underwent a single course of chemotherapy. The primary tumor of both patients showed complete regression, leaving ulceration. In patient 1, the ulceration completely resolved after 3 months. Patient 2 underwent surgical resection and full-thickness skin grafting. A histopathologic examination confirmed complete tumor regression. Neither patient suffered any serious side effects during this treatment. We conclude that chemoradiation using cisplatin and 5-fluorouracil was effective in these two patients with locally advanced squamous cell carcinoma of the skin. Several randomized studies have shown concurrent chemoradiation to be superior to radiation alone. This regimen is an option in managing patients who have unresectable primary tumors or who require preservation of local function.
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Abstract
The combination of chemotherapy and radiation has led to clinical breakthroughs in several disease sites, and current work continues to define optimum combinations of proven chemotherapy as well as more recently available, noncytotoxic agents. Administration of systemic therapies allows modulation of radiation response to improve tumor control (radiosensitization) or to prevent normal tissue toxicity (radioprotection). Substantial progress has been made in identifying the targets of standard chemotherapeutic radiation sensitizers and protectors as well as in the introduction of a new generation of molecularly targeted therapies in combination with radiation. We have reviewed the most recent, predominantly early phase clinical trials combining systemic agents with radiation. Although the proof of an improved schedule ultimately needs to come from well-run Phase III trials, the search among schedules could be shortened by the use of surrogate endpoints such as presence of active drug metabolites in the tumor. This has been accomplished only in a few cases and needs to become a more standard part of radiation sensitizer and protector trials.
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Affiliation(s)
- Aaron C Spalding
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan 48109-0010, USA
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25
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Rapidis AD, Trichas M, Stavrinidis E, Roupakia A, Ioannidou G, Kritselis G, Liossi P, Giannakouras G, Douzinas EE, Katsilieris I. Induction chemotherapy followed by concurrent chemoradiation in advanced squamous cell carcinoma of the head and neck: Final results from a phase II study with docetaxel, cisplatin and 5-fluorouracil with a four-year follow-up. Oral Oncol 2006; 42:675-84. [PMID: 16731029 DOI: 10.1016/j.oraloncology.2005.12.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Revised: 12/03/2005] [Accepted: 12/06/2005] [Indexed: 11/22/2022]
Abstract
Encouraging results have recently been reported in patients (pts) with locally advanced unresectable squamous cell carcinoma of the head and neck (SCCHN) when induction chemotherapy (IC) is used and followed by radiotherapy (RT). The present study assessed the therapeutic response of an aggressive regimen consisting of docetaxel (TXT), cisplatin (CDDP) and 5-fluorouracil (5-Fu) as IC and concurrent with RT in pts with locally advanced (stages III and IV) SCCHN. 42 pts (35 male and 7 female) with a mean age of 58 years suffering from stages III and IV (Mo) SCCHN were included to this organ preservation phase II clinical trial. The site of the primary tumors was the anterior mouth in 9 pts, base of tongue and oropharynx in 12, middle third of the face in 8 and larynx in 13. The performance status of the pts was 0-1 according to WHO and above 80% according to Karnofsky classification. IC consisted of TXT (40 mg/m2), CDDP (40 mg/m2) and 5-Fu (350 mg/m2) every two weeks (wks) for a total of four courses and repeated, coupled with RT (66-68 cGys total dose fractionated at 200 Gy per day, 5 days a week), for up to seven wks. In total, pts received eight courses of chemotherapy (CT) at the end of RT treatment. Pts were evaluated at the end of IC, after RT and every six wks thereafter. 41 pts were eligible for evaluation after IC (one died from myocardial infarction) and 39 after completion of treatment (two died during RT). Statistical multivariate analysis was performed using SPSS (11) package. Complications from IC and RT were evaluated according to WHO criteria and included mucositis Grade (Gr) IV in 10% of the pts, Gr III in 50%, Gr II in 20%. Anemia presented in 40% of the pts with Gr II, 40% with Gr I, neutropenia 17% with Gr IV, 20% with Gr III, 30% with Gr II, thrombocytopenia 3% with Gr III, 10% with Gr I and xerostomia up to Gr II in 70% of the pts. The response rate (RR) after IC was complete response (CR) for 10 pts (24.4%), partial response (PR) for 22 (53.7%) and no response (NR) for 9 (21.9%). At the end of the treatment the RR in the intention-to-treat population were CR for 25 pts (64.1%), and PR for 14 (35.9%). Follow up ranges from 18 to 56 months (mts). 14 pts died during follow-up time. The mean survival time is 41 mts and the median 40. 2 pts with CR developed local recurrence and two distant metastases, whereas all pts with PR developed progressive disease (PD) and all but two are dead from disease. It is evident from this phase II study that TXT-CDDP-5Fu based IC followed by the same regimen coupled with RT improves local control. Pts that showed CR after IC continued to maintain disease status during RT (P-value=0.0181). In pts with SD concurrent RT did not alter dramatically disease outcome. Patients who showed complete response after both IC and RT presented a four-year survival rate of 74% compared to a 30% to partial responders (P-value=0.0001). Results are encouraging and further study of the toxicity and follow-up is needed to validate treatment effectiveness.
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Affiliation(s)
- Alexander D Rapidis
- Department of Maxillofacial Surgery, Greek Anticancer Institute, Saint Savvas Hospital, 171 Alexandras Avenue, and Department of Critical Care Medicine, University of Athens Medical School, 115 22, Greece.
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Psyrri A, Fountzilas G. Advances in the treatment of locally advanced non-nasopharyngeal squamous cell carcinoma of the head and neck region. Med Oncol 2006; 23:1-15. [PMID: 16645225 DOI: 10.1385/mo:23:1:1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Revised: 11/30/1999] [Accepted: 05/12/2005] [Indexed: 01/08/2023]
Abstract
Over the past decade important advances have been made in the treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN). Traditionally, chemotherapy has been incorporated in the treatment of SCCHN either before local treatment as induction, concomitantly with radiation, or following local treatment as adjuvant therapy. A number of randomized trials and meta-analyses have demonstrated that induction chemotherapy (usually based on the combination of cisplatin and 5-d continuous infusion of fluorouracil) followed by local treatment or concomitant chemoradiotherapy (CCRT) each prolongs survival and results in organ preservation in a significant number of patients. Survival rates appear to be higher when CCRT with cisplatin is used. Furthermore, accelerated fractionation radiation regimens have shown improved local control rates in randomized trials. Recently, new therapeutic strategies such as induction chemotherapy followed by CCRT or the incorporation of newer agents such as taxanes are under intense investigation and preliminary results are promising. Advances in molecular biology have led to the elucidation of molecular mechanisms that initiate and maintain the malignant phenotype in SCCHN. The identification of molecular targets has revolutionized our approach to cancer therapy and resulted in the introduction of novel targeted therapies. Cyclin-dependent kinases, the tumor suppressor p53 gene, and epidermal growth factor receptor are some of the molecular targets of such therapies in patients with SCCHN.
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Affiliation(s)
- Amanda Psyrri
- Department of Medical Oncology, Papageorgiou Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
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Felici A, Loos WJ, Verweij J, Cirillo I, de Bruijn P, Nooter K, Mathijssen RHJ, de Jonge MJA. A pharmacokinetic interaction study of docetaxel and cisplatin plus or minus 5-fluorouracil in the treatment of patients with recurrent or metastatic solid tumors. Cancer Chemother Pharmacol 2006; 58:673-80. [PMID: 16544143 DOI: 10.1007/s00280-006-0221-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Accepted: 02/20/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The purpose of this study was to look at the pharmacokinetics of docetaxel, cisplatin-derived platinum and 5-fluorouracil (5-FU), when used in combination, to exclude potential clinically relevant pharmacokinetic interactions. METHODS Fifteen patients with recurrent or metastatic solid tumors were randomized to receive docetaxel 75 mg/m2 and cisplatin 75 mg/m2 in the first treatment course on day 1 and the same combination plus 5-FU 750 mg/m2/day on days 1-5 in the second course, or the two treatment courses in reversed order. Cycles were repeated every 3 weeks. A pharmacokinetic analysis was performed during the first two cycles. RESULTS Full pharmacokinetic data was available for 12 of the 15 patients. Treatment was tolerated well, with frequency of toxicity consistent with the safety profile known for docetaxel, cisplatin and 5-FU. Mean clearance values for docetaxel and cisplatin showed no statistically significant difference across the "triple" and the "double" combination treatments, and the mean pharmacokinetic parameters of all agents were within the ranges for previously reported single agent treatment. CONCLUSION No clinically relevant pharmacokinetic interactions between docetaxel, cisplatin and 5-FU used in combination were noticed in this study.
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Affiliation(s)
- A Felici
- Department of Medical Oncology, Erasmus University Medical Center/Daniel den Hoed, Groene Hilledijk 301, 3075, Rotterdam, The Netherlands.
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Posner MR. Paradigm shift in the treatment of head and neck cancer: the role of neoadjuvant chemotherapy. Oncologist 2006; 10 Suppl 3:11-9. [PMID: 16368867 DOI: 10.1634/theoncologist.10-90003-11] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chemotherapy is an integral component of the management of patients with locally advanced head and neck cancer, though the optimal use of chemotherapy remains to be defined. The combination of a platinum agent and 5-fluorouracil has been used as the standard neoadjuvant treatment and has been shown to permit organ preservation in operable patients and improve long-term survival outcomes in operable and inoperable patients. Recently, the addition of a taxane, docetaxel or paclitaxel, to standard platinum plus 5-fluorouracil induction chemotherapy has been shown to further improve response rates and survival outcomes. Phase III data are emerging to support combinations of docetaxel or paclitaxel with a platinum plus 5-fluorouracil as a new, more effective and less toxic standard for neoadjuvant chemotherapy. Sequential treatment regimens, incorporating a combination of induction chemotherapy and chemoradiation, are also under study in efforts to further improve long-term survival outcomes. Induction regimens incorporating docetaxel or paclitaxel with a platinum plus 5-fluorouracil are under evaluation in this setting. Randomized trials comparing a sequential treatment approach with standard therapies are also being undertaken and will likely define a new treatment paradigm for patients with locally advanced head and neck cancer.
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Affiliation(s)
- Marshall R Posner
- Head and Neck Oncology Program, Dana Farber Cancer Institute, 44 Binney Street SW, Suite 430, Boston, Massachusetts 02115-6013, USA.
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Guadagnolo BA, Haddad RI, Posner MR, Weeks L, Wirth LJ, Norris CM, Sullivan CA, Goguen L, Busse PM, Tishler R. Organ Preservation and Treatment Toxicity With Induction Chemotherapy Followed by Radiation Therapy or Chemoradiation for Advanced Laryngeal Cancer. Am J Clin Oncol 2005; 28:371-8. [PMID: 16062079 DOI: 10.1097/01.coc.0000162423.13431.8d] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The authors reviewed records of patients with advanced laryngeal cancer treated with induction chemotherapy (IC) and hyperfractionated radiation therapy (RT) or chemoradiation (CRT) to determine the rates of organ preservation and function. METHODS A total of 29 patients with stage III (45%) and stage IV (55%) squamous cell carcinoma of the larynx (SCCL), were treated with IC and RT or CRT in 1 of 7 consecutive trials. Fifty-five percent had clinically node-positive disease. Fifty-five percent and 45% had T3 or T4 tumors, respectively. All received 3 cycles of platinum-based IC. Daily RT was given to 48%, twice-daily RT to 45%, and concomitant boost RT to 7%. CRT was carboplatin (28%) or docetaxel (28%). Those treated with twice-daily RT did not receive CRT. RESULTS The median follow-up is 52 months. Overall survival is 66%. Relapse occurred in 12 patients (41%), and 6 underwent salvage laryngectomy (5 stage III, 1 stage IV). Fifty-nine percent of patients (17 of 29) are alive at last follow-up with an anatomically intact larynx, and 48% (14 of 29) are alive with a functional larynx. Of the 23 patients for whom detailed information on gastrostomy tube (g-tube) placement/removal was available, median time with g-tube was 12 months, and 15 of 23 patients (65%) had a g-tube for 6 months or more. Twenty-three of all 29 patients (79%) retained an anatomically intact larynx, but 7 of 23 (30%) never resumed their pretreatment organ function. The overall rate of functional organ preservation, regardless of survival, was 55% (16/29). The 7 of 29 patients (26%) who retained a nonfunctional larynx required permanent g-tube or were unable to return to pretreatment oral intake capability. Nine of 13 with T4 SCCL (69%) compared with 7 of 16 (44%) T3 SCCL retained a functional larynx. CONCLUSION The rate of larynx preservation is high, but toxicity remains significant with IC followed by hyperfractionated RT or CRT in advanced laryngeal cancer. Half of all patients were alive, able to retain their larynx, and return to pretreatment function. Advanced stage was not an indicator of poor outcome.
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Fonseca E, Grau JJ, Sastre J, García-Gómez JM, Rueda A, Pastor M, Lara MA, Navalón M, Berrocal A, Tisaire JL, Cruz JJ. Induction chemotherapy with cisplatin/docetaxel versus cisplatin/5-fluorouracil for locally advanced squamous cell carcinoma of the head and neck: A randomised phase II study. Eur J Cancer 2005; 41:1254-60. [PMID: 15908196 DOI: 10.1016/j.ejca.2005.02.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Accepted: 02/28/2005] [Indexed: 11/22/2022]
Abstract
A combination of cisplatin and 5-fluorouracil (PF) is considered the standard induction chemotherapy regimen for squamous cell carcinoma of the head and neck (SCCHN). The present study compares the efficacy and safety of a new combination of cisplatin/docetaxel versus the PF regimen. A total of 83 chemotherapy-naive patients with locally advanced SCCHN were randomised to receive every 21 d (i) docetaxel 85 mg/m2 i.v. on day 1 and cisplatin 40 mg/m2 i.v. on days 1 and 2 (arm A) or (ii) cisplatin 100 mg/m2 i.v. on day 1 followed by 5-fluorouracil 1000 mg/m2 in 24 h continuous infusion for 5 d (arm B). A total of 287 cycles (range 1-3 per patient) were administered. Among 76 patients evaluable for response, the overall response rate in arm A was 70% (complete response (CR) 26%, partial response (PR) 44%) and in arm B 69% (CR 16%, PR 54%), respectively. Median survival in arm A was 7.6 months (95% CI: 5.8-11.1) and 9.9 months (95% CI: 7.4-14.6) for arm B. The most frequent grade 3/4 toxicity in arm A was neutropaenia (34.1%) and diarrhoea (9.8%) versus mucositis (29.3%) and neutropaenia (19.5%) in arm B. Both schedules present a similar efficacy, with different but acceptable toxicity patterns.
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Affiliation(s)
- Emilio Fonseca
- Servicio de Oncología Médica, Hospital Clínico Universitario, Paseo de San Vicente, 182, 37007-Salamanca, Spain
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Posner MR, Haddad RI, Wirth L, Norris CM, Goguen LA, Mahadevan A, Sullivan C, Tishler RB. Induction chemotherapy in locally advanced squamous cell cancer of the head and neck: evolution of the sequential treatment approach. Semin Oncol 2005; 31:778-85. [PMID: 15599855 DOI: 10.1053/j.seminoncol.2004.09.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cisplatin plus 5-fluorouracil (5-FU) (PF regimen) induction chemotherapy (IC) has been studied over the last two decades and has proven to be a durable and effective therapy for patients with locally advanced squamous cell cancer of the head and neck (SCCHN). Although randomized trials and meta-analyses have demonstrated that PF-based IC improves survival, reduces systemic metastases, and permits organ preservation, the effect on overall survival has been less robust than the results seen with cisplatin-based chemoradiotherapy (CRT) regimens. Differences in trial design, scheduling, and surgical interventions account for some of the variation in results. As studies have evolved, it has become evident that there are advantages to both approaches. This perception has led to the concept of sequential therapy (ST), the combination of IC, CRT, and surgery. ST programs are being studied intently in many centers. Phase II and III trials of ST regimens have reported unprecedented survival results in patients with locally advanced disease. In addition, the hypothesis that PF plus a taxane may result in an improved survival, compared to PF alone, for patients with locally advanced SCCHN on ST treatments is being tested in phase III trials. Although ST has not been compared head to head with CRT, early results support the use of this treatment paradigm in patients with poor prognosis SCCHN and should lead to definitive phase III trials in the near future. ST may represent the cutting edge of therapy for patients with curable, locally advanced SCCHN.
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Affiliation(s)
- Marshall R Posner
- Department of Medical Oncology, Dana-Farber Cancer Institute, SW 430, 44 Binney Street, Boston, MA 02115, USA.
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Teymoortash A, Bien S, Dalchow C, Sesterhenn A, Lippert BM, Werner JA. Selective High-Dose Intra-Arterial Cisplatin as Palliative Treatment for Incurable Head and Neck Cancer. Oncol Res Treat 2004; 27:547-51. [PMID: 15591713 DOI: 10.1159/000081336] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of the present study was to evaluate the palliative effect of selective intra-arterial chemotherapy in progressive unresectable head and neck cancer previously treated with radiochemotherapy. PATIENTS AND METHODS 8 patients with advanced residual or recurrent squamous cell carcinoma of the head and neck were evaluated. These patients were included in the present study particularly because of progredient pain and recurrent bleedings due to tumor progression. In addition 6/8 patients suffered from unpleasant tumor-related smell. All patients received simultaneous infusions of cisplatin (150 mg/m2) intra-arterially to the tumor and sodium thiosulfate intravenously (9 g/m2) for systemic neutralization of cisplatin. The patients were treated by at most 4 cycles of selective intra-arterial chemotherapy via femoral approach. RESULTS Tumor-associated pain, occurrence of tumor bleeding and tumor-related smell were reduced after at least 2 cycles of intra-arterial chemotherapy in all patients. Clinical and radiological assessment of the primary tumor site revealed a partial response in 4 patients while 4 patients were classified as nonresponders. Intra-arterial cisplatin treatment was well tolerated. CONCLUSION Selective intra-arterial cisplatin therapy can be delivered safely for palliation of tumor-related symptoms of incurable head and neck cancer.
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Affiliation(s)
- A Teymoortash
- Department of Otolaryngology, Head and Neck Surgery, Philipps University of Marburg, Germany.
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Kurita H, Yamamoto E, Nozaki S, Wada S, Furuta I, Kurashina K. Multicenter phase I trial of induction chemotherapy with docetaxel and nedaplatin for oral squamous cell carcinoma. Oral Oncol 2004; 40:1000-6. [PMID: 15509491 DOI: 10.1016/j.oraloncology.2004.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2004] [Accepted: 05/06/2004] [Indexed: 11/15/2022]
Abstract
A phase I study of combination neoadjuvant chemotherapy with docetaxel (DOC) and nadaplatin (CDGP) was conducted in patients with untreated, advanced but operable oral squamous cell carcinoma. DOC was administered (one-hour i.v. infusion) on day 1 followed by CDGP (one-hour i.v. infusion). The dose levels of DOC and CDGP tested were 60/70, 60/80, 60/90, 60/100, and 70/100 (mg/m(2)). Fifteen patients enrolled in this study and median age was 60 years. Dose-limiting toxicity (DLT) occurred in one of six patients at DOC dose of 60 mg/m(2) and CDGP dose of 100 mg/m(2). The DLT was diarrhea. Because one additional patient at this dose-level developed grade 4 neutropenia lasting for 4 days that approached DLT and because fear of severe hematological problems was predicted, further dose escalation was not performed. This combination chemotherapy is active and well tolerated and warrants a phase II study. We recommended 60 mg/m(2) DOC and 100 mg/m(2) CDGP for phase II study.
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Affiliation(s)
- Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto 390-8621, Japan
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Giabbai B, Degano M. Crystal Structure to 1.7 Å of the Escherichia coli Pyrimidine Nucleoside Hydrolase YeiK, a Novel Candidate for Cancer Gene Therapy. Structure 2004; 12:739-49. [PMID: 15130467 DOI: 10.1016/j.str.2004.03.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Revised: 02/18/2004] [Accepted: 03/10/2004] [Indexed: 11/18/2022]
Abstract
Enzymes with nucleoside hydrolase (NH) activity are crucial for salvaging nucleic acid components in purine auxotrophic protozoan parasites, but are also present in prokaryotes and higher eukaryotes. Here we analyze the distribution of genes encoding for putative NH proteins and characterize the yeiK gene product from Escherichia coli as a pyrimidine-specific NH. The crystal structure of YeiK to 1.7 A defines the structural basis for its substrate specificity and identifies residues involved in the catalytic mechanism that differ from both nonspecific and purine-specific NHs. Large differences in the tetrameric quaternary structure compared to nonspecific protozoan NHs are brought forth by minor differences in the interacting surfaces. The first structural and functional characterization of a nonparasitic, pyrimidine nucleoside-specific NH suggests a possible role for these enzymes in the metabolism of tRNA nucleosides. The high catalytic efficiency of YeiK toward 5-fluorouridine could be exploited for suicide gene therapy in cancer treatment.
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Affiliation(s)
- Barbara Giabbai
- Biocrystallography Unit, DIBIT, San Raffaele Scientific Institute, via Olgettina 58, I-20132 Milan, Italy
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Abstract
Cancer of the head and neck is an important medical problem, with approximately 46,500 cases predicted in the United States alone in 2003. Worldwide, more than 600,000 cases are anticipated. While several different histologic subtypes of head and neck cancer are seen in different parts of the world, more than 90% of tumors diagnosed in the United States are squamous cell carcinomas. Major strides in the management of this disease have been made in the last decade. These include, but are not limited to, the evolution of organ preservation, the increasingly well recognized role of concurrent chemoradiation therapy as either definitive therapy for unresectable disease or adjuvant therapy for high-risk surgical disease, and significant improvements in cytotoxic chemotherapy. The role of chemotherapy in this disease has been a subject of debate. Chemotherapy is now routinely included in the multimodality treatment of unresectable disease of the oral pharynx, larynx, and oral cavity. There is now increasing evidence supporting the role of induction chemotherapy in head and neck cancer. As intensified chemotherapy and radiation therapy have improved local control, the increasing incidence of distant metastases has necessitated the need for enhanced systemic control. These approaches are the topics of extensive investigations.
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Affiliation(s)
- Fadlo R Khuri
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
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Haddad R, Wirth L, Costello R, Weeks L, Posner M. Phase II randomized study of concomitant chemoradiation using weekly carboplatin/paclitaxel with or without daily subcutaneous amifostine in patients with newly diagnosed locally advanced squamous cell carcinoma of the head and neck. Semin Oncol 2003; 30:84-8. [PMID: 14727246 DOI: 10.1053/j.seminoncol.2003.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The treatment of head and neck cancer continues to evolve. The recent use of aggressive chemoradiotherapy protocols has resulted in significant morbidity involving mucositis, dysphagia, and a higher rate of feeding tube dependency. We have initiated a randomized phase II study with concomitant chemoradiotherapy with or without subcutaneous amifostine (Ethyol, WR-2721; MedImmune, Inc, Gaithersburg, MD). This article presents a detailed background, rationale, and endpoints for this study and discusses future directions in the treatment of head and neck cancer.
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Affiliation(s)
- Robert Haddad
- Department of Medical Oncology, Head and Neck Division, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
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