Chemoradiation Combination Could Preserve Larynx in Patients With Laryngeal and Hypolaryngeal Cancer

Chemoradiation Combination Could Preserve Larynx in Patients With Laryngeal and Hypolaryngeal Cancer
Chemoradiation Combination Could Preserve Larynx in Patients With Laryngeal and Hypolaryngeal Cancer

Researchers assessed the rates of laryngeal preservation and laryngectomy-free survival in patients with laryngeal or hypopharyngeal cancer who received the monoclonal antibody cetuximab and radiation therapy (CRT) or radiation therapy alone.1

Typically, patients with locoregionally advanced squamous cell carcinomas of the larynx or hypopharynx undergo surgical resection, usually with laryngectomy with or without postoperative radiotherapy.

Laryngectomy is an effective treatment, but loss of voice is a major adverse effect of the procedure. With the realization that many patients could avoid total laryngectomy with primary radiotherapy, clinicians introduced combination chemotherapy strategies for patients with laryngeal or hypopharyngeal cancer.

This study examined data from a secondary subgroup of patients enrolled in a phase 3 study. The phase 3 study involved 424 patients enrolled at 73 centers in 15 countries.

Of the enrolled patients, 168 treated patients with larynx or hypopharynx cancer were included in the subgroup analysis. Ninety of these patients were in the CRT group, and 78 were in the radiotherapy alone group.

Laryngeal preservation at 2 years was 88% in the CRT group and 86% in the radiotherapy alone group. This study lacked enough statistical power to assess organ preservation. Median overall survival was 27 months for CRT and 21 months for radiotherapy alone.

At 2 years, the CRT group experienced a 4% absolute improvement in laryngectomy-free survival over the radiotherapy alone group. By 3 years, the absolute improvement was 8.9%. No differences between treatments regarding need for a feeding tube, speech, or quality of life were reported.

"The higher rate of laryngeal preservation that was achieved with the use of CRT compared with radiotherapy alone was encouraging. These results need to be interpreted in the context of a retrospective subset analysis with limited sample size," the authors wrote.

"This treatment approach warrants further evaluation in larger populations to fully assess the potential value of cetuximab or other molecular targeting agents to augment laryngeal preservation rates."

Reference

1. Saba NF, Shin DM. The challenges of laryngeal preservation – is it the systemic agent or the proper sequence of therapy? JAMA Otolaryngol Head Neck Surg. 2016 Jul 7. doi:10.1001/jamaoto.2016.1228. [Epub ahead of print]

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