Response to a single dose of neoadjuvant chemotherapy indicates the optimal treatment course for patients with laryngeal cancer, according to a study published in JAMA Otolaryngology (published online February 2, 2017; doi:10.1001/jamaoto.2016.3669).
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The advancement of chemoradiation for treating laryngeal cancer led to a major shift in treatment as an alternative to laryngectomy. However, even as treatment options for laryngeal cancer seem to improve, survival rates have not.
Gregory T Wolf, MD, department of otolaryngology, University of Michigan Health System, and colleagues conducted an investigation to determine whether improved survival could be achieved by incorporating a single cycle of neoadjuvant chemotherapy for patients with advanced laryngeal cancer, followed by either immediate surgery or a combination of chemotherapy and radiation. Researchers sampled 153 patients with stage III or IV laryngeal cancer in an academic institution between 2002 and 2012. About half of these patients received neoadjuvant chemotherapy; the other half received surgery or chemoradiotherapy. Those patients who responded to the neoadjuvant chemotherapy continued treatment with concurrent chemoradiotherapy, while those who did not respond were referred immediately for laryngectomy.
Results showed that 5-year overall survival (OS) and disease-specific survival (DSS) rates were 75% and 83% for the entire cohort of patients. For patients with advanced disease, those who received neoadjuvant chemotherapy to guide treatment selection had OS and DSS rates of 76% and 79%, respectively. Those who received concurrent chemoradiotherapy had OS and DSS rates of 61% and 66%, respectively. Patients who received surgery had OS and DSS rates of 78% and 91%, respectively.
Statistical analysis showed that DSS was significantly improved with the neoadjuvant chemotherapy response-guided treatment compared with chemoradiotherapy (hazard ratio, 0.48; 95% CI, 0.29-0.80).
Researchers concluded that primary surgery and neoadjuvant chemotherapy approaches were superior to concurrent chemoradiotherapy. They acknowledge the importance of individual patient characteristics and tumor biology for selecting the best therapy options.
