DOCETAXEL AND CISPLATIN (TP) IN COMPARISON TO DOCETAXEL, CISPLATIN AND FLUOROURACIL (TPF) FOR THE INDUCTION THERAPY OF LOCALLY ADVANCED HEAD AND NECK SQUAMOUS CELL CARCINOMA

Introduction: Locally advanced head and neck squamous cell carcinoma (LAHNSCC) treatment involves disease control with maximum anatomical preservation, for which multimodal therapy with induction chemotherapy may be indicated. The combination of docetaxel, cisplatin and infusional fluorouracil (TPF) is the standard approach. However, some prospective single arm trials have shown activity with the use of docetaxel and cisplatin (TP) in this setting. Objective: To compare efficacy and safety of TPF versus (vs) TP in LAHNSCC. Methods: In this retrospective study, LAHNSCC patients submitted to induction therapy in the University of Campinas (UNICAMP) from 2015 to 2019 were analyzed. Demographic and clinical data, overall response rate (RR), toxicity, disease-free survival (DFS) and overall survival (OS) were obtained. Differences in response rate were assessed by multiple logistic regression, while for survival analyses, Cox regression was performed. Results: In a median follow-up of 16 months (m), 55 patients were included, with a median age of 57 years. Most patients were active smokers and alcohol consumers with oropharynx and larynx tumors. There was an excess of ECOG 1 in patients treated with TPF compared to TP (75,9% vs 45%, p 0.13) and higher interval (>28 days) between cycles in TPF compared to TP (78% vs 52%). TPF regimen had a RR of 75% in comparison to 91% for TP (p 0.13). There were few differences in grades 3 or 4 toxicities between TPF and TP arms (32% vs 23%, p 0.595). At 13.8 m of follow-up, there were no differences for TPF vs TP regarding DFS (median 10.12 vs 28.08 m, HR 0.48; 95% CI 0.20-1.10, p 0.08) or OS (median 14.5 m vs not reached; HR 0.51 95% CI 0.19-1.3, p 0.175), when correcting for ECOG status and interval between cycles. Higher interval of cycles in TPF and TP was related with worse DFS (8.47m vs not reached, HR 2.92 95% CI 1.077.94, p 0.035; OS 14.95 m vs not reached, HR 2.07 95% CI 0.72-5.99, p 0.176). Conclusions: In this analysis, TP was not associated with worse efficacy outcomes. There may be a potential role for TP as a more practical and costless therapy alternative, since treatment delays are related with worse DFS. Prospective, randomized trials are required to support these findings in patients with LAHNSCC.