Larynx preservation according to EORTC strategy is state of the art treatment
The EORTC Head and Neck Cancer Group (HNCG) was a pioneer in the field of organ preservation starting with the initiation of the first larynx preservation trial in 1989. EORTC trial 24891 compared PF (cisplatin and 5-FU) induction chemotherapy followed by radiation therapy (RT) versus total laryngectomy, radical neck dissection, and postoperative RT in patients with hypopharyngeal cancer (J Natl Cancer Institute 1996;88:890-899). A recently published ten year follow up study confirmed that the larynx preservation strategy provides similar overall survival rates as compared with conventional treatment with total laryngectomy and allowed two third of the survivors to retain their larynx (Ann Oncol 2012;23(10):2708-2714).
Locally advanced setting
EORTC neoadjuvant triple drug (Docetaxel, cisplatin and 5-FU) is standard treatment in locally advanced unresectable tumors and for larynx preservation. The role of chemotherapy was radically changed in head and neck cancers following publication of the EORTC 24971 trial (N Engl J Med 2007;357(17):1695-1704). In this study, the role of neoadjuvant chemotherapy (NACT) was evaluated in patients with non-resectable locally advanced head and neck cancer. Patients were randomly assigned to receive PF based NACT or TPF (Docetaxel, cisplatin and 5-FU) based NACT followed by RT alone. TPF-NACT showed superior outcome with regard to locoregional tumor control and survival in comparison with the PF NACT regimen and was shown to have a better tolerance and quality of life. The long term follow up with a median of eight years was presented at ASCO 2011 (J Clin Oncol 2011;29(15):367s, abs. 5530).
High risk patients
EORTC trial 22931: Postoperative combined chemoradiation approach (N Engl J Med 2004;350(19):1945-1952). In this study postoperative concurrent administration of high dose cisplatin with postoperative radiotherapy was proven to be more efficacious than radiotherapy alone in patients with locally advanced head and neck cancer without an undue number of late complications. This strategy is now adopted as state of the art treatment.
Building upon previous results. EORTC trial 24061
In this phase II study, the feasibility and efficacy of four cycles of TPF regimen combined with the EGFR inhibitor cetuximab followed by the concomitant use of radiotherapy and one platinum compound, cisplatin or carboplatin (for radio sensitization), plus cetuximab was being studied. This trial was closed in 2010 after recruitment of 47 patients due to an unexpectedly high rate of toxicities, and the results will be published soon. Phase I/II EORTC trial 24051: induction chemotherapy followed by chemoradiation with or without lapatinib, a dual EGFR/ErbB2 kinase inhibitor, in patients with locally advanced larynx and hypopharynx squamous cell carcinoma. This trial was opened in 2007 and enrolled seven patients, however the trial was stopped due to toxicity.
Innovative drug development in head and neck cancer: a new highly integrated multidisciplinary platform
EORTC trial 90111-24111: Neoadjuvant afatinib based treatment strategies followed by surgery in squamous cell carcinoma of the head and neck: an EORTC NOCI-HNCG window study. This concept study evaluates the strategy of discovering the activity of targeted agents using biology and molecular imaging techniques like FDGPET.
The platform will serve the development of other targeted agents.