Download Comment : This study confirms the effectiveness of a technique

Head and neck cancer : Key messages from ASCO 2011
Targeted therapy :
Ang KK et al.J Clin Oncol 29: 2011 (suppl; abstr 5500)
http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=10
2&abstractID=79086
Conclusion : The addition of cetuximab (CET) to concurrent accelerated radiation plus
cisplatin failed to improve progression-free survival and overall survival in stage III-IV
head and neck squamous cell carcinomas (HNC)
Comment : The results of this study, with the failure of cetuximab addition to improve
outcome, were surprising. They show that "more" is not necessarily more active even
when the trial has an excellent rationale. This reminds us also about the necessity of
getting evidence-based data before introducing a new drug or a new combination into
clinical practice.
The RTOG launched a phase III trial in patients with stage III-IV carcinoma of the
oropharynx, larynx, and hypopharynx and good performance status. The experimental
regimen (Arm A) consisted of a loading dose and 6-7 weekly doses of CET given in
conjunction with the control arm (B) of 70-72 Gy (6 weeks) + 2 cycles of CDDP (q3 weeks).
From 11/’05 to 3/’09, 447 evaluable patients were randomized to Arm A and 448 to Arm B.
The median follow-up was 2.4 years for surviving patients There were no significant
differences in progression-free survival (HR [A/B]: 1.05, 0.84-1.29; P=0.66, the primary
endpoint, or in overall survival (HR: 0.87, 0.66-1.15; P=0.17).
Prevention of toxicity :
Anthunes HS et al. J Clin Oncol 29: 2011 (suppl; abstr LBA5524)
http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=10
2&abstractID=83204
Conclusion : Upfront low-level laser therapy (LLLT) in patients submitted to
concurrent chemoradiation (CRT) is an effective tool in reducing grades 3/4 oral
mucositis (OM), oral pain, use of narcotic and gastrostomia and improves quality of life.
Comment : This study confirms the effectiveness of a technique experimented since
several years at Institut Bordet. We believe that such preventive treatment should be
put in place at a large scale as avoiding to patients with head and neck cancer treated by
chemoradiation a highly painful side effects.
Oral mucositis (OM) remains a limiting factor in in head and neck squamous cell carcinomas
(HNSCC) patients (pts) treated with chemoradiation (CRT). From Jun 2007 to Dec 2010, 47
LLLT and 47 placebo pts were randomized between LLLT used daily (660nm-100mW4J/cm²) and placebo. CRT consisted of conventional RT 70.2 Gy (1.8Gy/d, 5 times/wk) +
concurrent cisplatin 100 mg/m2 every 3 wks. In the LLLT arm the incidence of OM G 3/4
was only 6.4% versus 48% in the placebo arm; HR of 0.13 (95% CI, p<0.001). LLLT patients
had less severe pain (p=0.012), used less narcotic analgesic, HR 0.33 (IC 95%, p<0.001) and
required less gastrostomia, HR 0.037 (IC 95%, p= 0.005). No LLLT pts had RT interrupted
due to OM. Results of EORTC QLQ-C30 also clearly favored the LLLT arm.