Prolonged Overall Treatment Time and Lack of Skin Rash Negatively Impact Overall Survival in Locally Advanced Head and Neck Cancer ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2017-06-03

AUTHORS

Julien Roman, Gurvan Dissaux, Maelenn Gouillou, Yves Gobel, Gael Potard, Jean-Christophe Leclere, Virginie Conan-Charlet, Dorothy Gujral, Ronan Abgral, Briac Guibourg, Olivier Pradier, Ulrike Schick

ABSTRACT

BackgroundCetuximab, a chimeric monoclonal antibody against EGFR sensitizes tumors to radiotherapy (RT), but is associated with skin and mucosal toxicity.ObjectiveWe report outcomes and tolerance of definitive RT in association with cetuximab in patients with locally advanced squamous cell carcinoma (LASCC) of the head and neck.Patients and MethodsBetween 2006 and 2011, 92 consecutive patients with LASCC of the head and neck were treated with RT and concomitant weekly cetuximab. Median age was 61.7 years. Most patients presented with oropharyngeal tumors (52.2%) and stage IV disease (77.2%).ResultsSixty-nine patients received at least 7 cycles of cetuximab. Cetuximab was stopped at the first infusion following allergic reactions in four patients. During RT, 37% of patients developed grade ≥ 3 dermatitis; grade ≥ 2 cetuximab-induced rash occurred in 43 patients (46.7%). Severe mucositis (grade ≥ 3) affected 57.6% of patients. Ten percent of patients did not receive the full course of RT, and temporary discontinuation due to acute toxicity was frequent and affected 37 patients (53%). The median RT overall treatment time (OTT) in patients with interrupted RT was 56 days (47–75) compared to 51 days (47–65) in patients who did not require toxicity-related radiation interruptions (p < 0.05). After a median follow-up of 17.5 months (1.3–107.6) for all patients, median overall survival was 17.9 months (95% CI: 12.7–23.2), and loco-regional control (LRC) was 9.2 months (95% CI: 3.9–14.4). On multivariate analysis, hemoglobin concentration and occurrence of rash grade ≥ 2 were independent prognostic factors for LRC (p = 0.023 and p = 0.006, respectively). Lack of rash and extended OTT negatively impacted overall survival (p = 0.048 and 0.052, respectively).ConclusionsSkin and mucosal toxicity remains an issue in patients with LASCC of the head and neck treated with concomitant cetuximab and RT. Severe toxicity leads to treatment interruptions and prolonged overall treatment time, with consequent decreased overall survival in these patients. More... »

PAGES

505-512

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s11523-017-0499-0

DOI

http://dx.doi.org/10.1007/s11523-017-0499-0

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1085758548

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28580506


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30 schema:keywords BackgroundCetuximab
31 EGFR
32 Impact Overall Survival
33 LASCC
34 MethodsBetween 2006
35 ResultsSixty-nine patients
36 acute toxicity
37 advanced head
38 advanced squamous cell carcinoma
39 age
40 allergic reactions
41 analysis
42 antibodies
43 association
44 cancer patients
45 carcinoma
46 cell carcinoma
47 cetuximab
48 cetuximab-induced rash
49 chimeric monoclonal antibody
50 concentration
51 concomitant cetuximab
52 consecutive patients
53 consequent
54 control
55 course
56 cycle
57 cycles of cetuximab
58 days
59 definitive radiotherapy
60 dermatitis
61 discontinuation
62 disease
63 factors
64 first infusion
65 full course
66 grade
67 head
68 hemoglobin concentration
69 independent prognostic factor
70 infusion
71 interruption
72 issues
73 lack
74 loco-regional control
75 median age
76 median overall survival
77 monoclonal antibodies
78 months
79 most patients
80 mucosal toxicity
81 mucositis
82 multivariate analysis
83 neck
84 neck cancer patients
85 occurrence
86 oropharyngeal tumors
87 outcomes
88 overall survival
89 overall treatment time
90 patients
91 percent
92 percent of patients
93 prognostic factors
94 radiation interruptions
95 radiotherapy
96 rash
97 rash grade
98 reaction
99 report outcomes
100 severe mucositis
101 severe toxicity
102 skin
103 skin rash
104 squamous cell carcinoma
105 stage IV disease
106 survival
107 temporary discontinuation
108 time
109 tolerance
110 toxicity
111 treatment interruption
112 treatment time
113 tumors
114 weekly cetuximab
115 years
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