SPECIAL DEPARTMENTS
Authors: Jim Janinis, Gerassimos Panagos, A. Dimitrios Colevas
Journal: Journal of Clinical Oncology (2000)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2000.18.6.1393 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 10715312 Jim JaninisxJim JaninisSearch for articles by this author , Gerassimos PanagosxGerassimos PanagosSearch for articles by this author A. Dimitrios ColevasxA. Dimitrios ColevasSearch for articles by this author Show More Saint Anargiri Cancer Center AthensGreeceDana-Farber/Partners Cancercare BostonMA https://doi.org/10.1200/JCO.2000.18.6.1393 First Page Full Text PDF Figures and Tables © 2000 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse13032000In Reply:We agree with Drs Janinis and Panagos that the 4-day docetaxel, cisplatin, fluorouracil, and leucovorin (TPFL4) regimen is only one of a myriad of docetaxel, cisplatin, and fluorouracil–containing regimens of potential benefit to patients with locoregionally advanced squamous cell carcinoma (SCCA) of the head and neck.1-3 Despite the dramatic reduction in toxicity and hospitalization rates in the TPFL4 trial versus the TPFL5 trial, we agree that further refinement of the regimen in early-phase clinical trials is warranted before embarking on a large comparative trial with standard regimens. We are concerned with the low complete response rates associated with the Saint Anargiri Cancer Center’s regimen and look forward to follow-up survival data both from our trials and theirs.3Trials at Dana-Farber/Partners Cancercare, which further dose-escalate docetaxel and reduce hospitalizations associated with chemotherapy delivery, are accruing participants. We are now delivering these regimens on a 21-day cycle rather than a 28-day cycle to reduce overall treatment time and using induction and concurrent chemoradiotherapy in these trials.We are not wedded to the concept of exclusive sequential chemoradiotherapy and laud the attempts by others to explore concomitant taxane and PF and radiotherapy (AA Abitbol, personal communication). We are concerned, however, about the feasibility of delivering adequate systemic therapy when drugs are given exclusively simultaneously with radiation therapy. Furthermore, it is our impression that the short- and long-term locoregional morbidity of concomitant aggressive chemotherapy and radiation therapy may be considerably worse than that of sequential therapy.4,5We eagerly await the results of the Radiation Therapy Oncology Group’s 91-11 study, a large randomized trial of sequential chemoradiotherapy versus concomitant chemoradiotherapy versus radiotherapy alone in patients with advanced larynx SCCA that uses conventionally dosed cisplatin and fluorouracil. It is hoped that the results of this trial will provide direction for further trials.Given the tools we presently have to treat patients with SCCA of the head and neck, we believe a combined sequential and concomitant approach will ultimately prove most beneficial. Investigating such regimens that incorporate new, highly active drugs is our present approach to the treatment of these patients.4. Colevas AD, Busse PM, Norris CM, et al: Induction chemotherapy with docetaxel, cisplatin, fluorouracil, and leucovorin for squamous cell carcinoma of the head and neck: A phase I/II trial. J Clin Oncol 16::1331,1998-1339, Link, Google Scholar4. Colevas AD, Norris CM, Tishler RB, et al: Phase II trial of docetaxel, cisplatin, fluorouracil, and leucovorin as induction for squamous cell carcinoma of the head and neck. J Clin Oncol 17::3503,1999-3511, Link, Google Scholar4. Janinis J, Papadakou M, Panagos G, et al: A phase II study of combined chemotherapy with docetaxel, cisplatin, and 5-fluorouracil in patients with advanced squamous cell carcinoma of the head and neck and nasopharyngeal carcinoma. Proc Am Soc Clin Oncol 16::402a,,1997 (abstr) Google Scholar4. Abitol A, Sridhar K, Lewin A, et al: Hyperfractionated radiation therapy and 5-fluorouracil, cisplatin, and mitomycin-C (+/− granulocyte colony-stimulating factor) in the treatment of patients with locally advanced head and neck carcinoma. Cancer 80::266,1997-276, Crossref, Medline, Google Scholar4. Brizel D, Albers M, Fisher S, et al: Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 338::1798,1998-1804, Crossref, Medline, Google Scholar