No Survival Advantage Seen With Induction Chemotherapy vs Chemoradiation in Head and Neck Cancer
Survival rates are not increased and the likelihood of receiving a full course of radiation is decreased for patients with locally advanced head and neck cancer who receive induction chemotherapy (IC) rather than the standard treatment of chemoradiation (CRT). This study examined more than 8000 patient records from the National Cancer Data Base and represents the largest comparative analysis of IC and CRT in head and neck cancer to date.1
Induction chemotherapy is an area of active controversy in the treatment of locally advanced head and neck squamous cell carcinoma (HNSCC).
“Most randomized trials designed to address whether induction chemotherapy improves outcomes by enhancing local control and minimizing distant metastases have failed to demonstrate an increased overall survival benefit,” explained study co-author Daniel W. Bowles, MD, an assistant professor in the department of medical oncology at the University of Colorado School of Medicine and director of cancer research and staff physician at the Denver VA Medical Center. “Those findings, however, typically were based on study designs that enrolled too few patients or too few patients with advanced cancers, thereby diluting the possible benefit of IC.”
This study examined 8003 records from the National Cancer Data Base (NCDB) of patients with T(any) N2b-3 M0 oropharyngeal, laryngeal, or hypopharyngeal cancer diagnosed between 2003 and 2011. Among these, 1917 patients received IC and 6086 received CRT.
The analysis showed that patients who were treated with IC were less likely to receive a full dose of radiation therapy afterward (odds ratio, 1.42; P < .01).
Median overall survival after IC was 52 months vs 65 months for CRT (P < .01); however, this difference did not persist with multivariate analysis or propensity score-matched analysis.
Subgroup analyses identified no groups of patients that benefit from IC.
“While we suspected that induction chemotherapy would not have an impact on our entire study population, we thought it might prolong survival for the most advanced cancers,” said Bowles. “Our finding from this large database that IC is not associated with improved overall survival over CRT, even for these patients, will continue to dampen enthusiasm for routine use of induction therapy. In cancer care, sometimes more is less. If adding induction chemotherapy fails to improve survival over the current standard of care, then we should reconsider its use.”
1. Stokes W, Amini A, McDermott J, et al. Induction chemotherapy predicts cumulative radiation dose and fails to improve survival in advanced head and neck cancer, National Cancer Database analysis. Presented at: 2016 Multidisciplinary Head and Neck Cancer Symposium; Scottsdale, AZ; February 18, 2016. Abstract 109.