Cáncer de cabeza y cuello experiencia en Guatemala con cetuximab


Induction chemotherapy   followed by radiotherapy plus cetuximab for patients with laryngeal cancer (LC), Guatemala Experience

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Phase II trial: induction chemotherapy followed by  radiotherapy conventional plus  cetuximab weekly for patients with squamous-cell carcinoma locally advanced of laryngeal cancer, treated at the Instituto  Guatemalteco de Seguridad Social (IGSS), Guatemala, Guatemala.
Castro H, Hernandez C, García L, Castro N, Salazar L

Patients with unresectable, locally advanced stage III and IVA tumors of laryngeal cancer have satisfactory 5-years OS rate with induction chemotherapy (TAX 323, TAX 324), and cetuximab in combination with radiotherapy improved locoregional control and overall survival in patients with locally advanced tumors of the head and neck.  The interpretation of the results of the cetuximab-radiotherapy trial is quite difficult, since chemotherapy was not part of the study, we conducting a small phase II study treated at a single institution with chemoradiotherapy plus cetuximab, with the following schema: induction therapy with cisplatin (75 mg/m2) and docetaxel (75 mg/m2) every 3 weeks for four cycles followed cetuximab day 1 of radiotherapy with a loading dose of 400 mg per square meter, followed by 250 mg per square meter weekly throughout radiotherapy.

Results: from march-2009 to jun-2011 13 patients previously untreated, locally advanced squamous- cell carcinoma of laryngeal, have been included in order to identify patterns of recurrence, toxic effects, and SLD.  Median age was 59 (23 – 84).  62% patients present with stage III and 38% stage IVA.  Whit a median follow-up of 22 months, the actuarial 2-years DFS is 62%.  Local disease relapse occurred in 5 patients (38%).  The most common grade 3 or 4 adverse events were neutropenia (32% and 18%), 23% had grade 3 skin reactions.  There were no related deaths, all but one of the patients with recurrence died of cancer.  Significant prognostic factors for recurrence by univariate analysis were age (<60 vs >60) (p=0.03). The 2-year overall survival for laryngeal cancer was 80%.


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Conclusions: induction chemotherapy followed by radiotherapy with cetuximab for patients with advanced laryngeal cancer is feasible and safely, these preliminary results indicate that requires confirmation from randomized trials.

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