PURPOSE: We assessed the safety and efficacy of synchronous VEGF and epidermal growth factor receptor (EGFR) blockade with concurrent chemoradiation (CRT) in locally advanced head and neck cancer (HNC). EXPERIMENTAL DESIGN: Newly diagnosed patients with stage III/IV HNC received a 2-week lead-in of bevacizumab and/or erlotinib, followed by both agents with concurrent cisplatin and twice daily radiotherapy. Safety was assessed using Common Toxicity Criteria version 3.0. The primary efficacy endpoint was clinical complete response (CR) rate after CRT. RESULTS: Twenty-nine patients enrolled on study, with 27 completing therapy. Common grade III toxicities were mucositis (n = 14), dysphagia (n = 8), dehydration (n = 7), osteoradionecrosis (n = 3), and soft tissue necrosis (n = 2). Feeding tube placement was required in 79% but no patient remained dependent at 12-month posttreatment. Clinical CR after CRT was 96% [95% confidence interval (CI), 82%-100%]. Median follow-up was 46 months in survivors, with 3-year locoregional control and distant metastasis-free survival rates of 85% and 93%. Three-year estimated progression-free survival, disease-specific survival, and overall survival rates were 82%, 89%, and 86%, respectively. Dynamic contrast enhanced MRI (DCE-MRI) analysis showed that patients who had failed had lower baseline pretreatment median K(trans) values, with subsequent increases after lead-in therapy and 1 week of CRT. Patients who did not fail had higher median K(trans) values that decreased during therapy. CONCLUSIONS: Dual VEGF/EGFR inhibition can be integrated with CRT in locally advanced HNC, with efficacy that compares favorably with historical controls albeit with an increased risk of osteoradionecrosis. Pretreatment and early DCE-MRI may prospectively identify patients at high risk of failure.
PURPOSE: We assessed the safety and efficacy of synchronous VEGF and epidermal growth factor receptor (EGFR) blockade with concurrent chemoradiation (CRT) in locally advanced head and neck cancer (HNC). EXPERIMENTAL DESIGN: Newly diagnosed patients with stage III/IV HNC received a 2-week lead-in of bevacizumab and/or erlotinib, followed by both agents with concurrent cisplatin and twice daily radiotherapy. Safety was assessed using Common Toxicity Criteria version 3.0. The primary efficacy endpoint was clinical complete response (CR) rate after CRT. RESULTS: Twenty-nine patients enrolled on study, with 27 completing therapy. Common grade III toxicities were mucositis (n = 14), dysphagia (n = 8), dehydration (n = 7), osteoradionecrosis (n = 3), and soft tissue necrosis (n = 2). Feeding tube placement was required in 79% but no patient remained dependent at 12-month posttreatment. Clinical CR after CRT was 96% [95% confidence interval (CI), 82%-100%]. Median follow-up was 46 months in survivors, with 3-year locoregional control and distant metastasis-free survival rates of 85% and 93%. Three-year estimated progression-free survival, disease-specific survival, and overall survival rates were 82%, 89%, and 86%, respectively. Dynamic contrast enhanced MRI (DCE-MRI) analysis showed that patients who had failed had lower baseline pretreatment median K(trans) values, with subsequent increases after lead-in therapy and 1 week of CRT. Patients who did not fail had higher median K(trans) values that decreased during therapy. CONCLUSIONS: Dual VEGF/EGFR inhibition can be integrated with CRT in locally advanced HNC, with efficacy that compares favorably with historical controls albeit with an increased risk of osteoradionecrosis. Pretreatment and early DCE-MRI may prospectively identify patients at high risk of failure.
Authors: Min Yao; Charles Woods; Pierre Lavertu; Pingfu Fu; Michael Gibson; Rod Rezaee; Chad Zender; Jay Wasman; Neelesh Sharma; Mitchell Machtay; Panayiotis Savvides Journal: Head Neck Date: 2016-02-26 Impact factor: 3.147
Authors: Min Yao; Nicholas Galanopoulos; Pierre Lavertu; Pingfu Fu; Michael Gibson; Athanassios Argiris; Rod Rezaee; Chad Zender; Jay Wasman; Mitchell Machtay; Panos Savvides Journal: Head Neck Date: 2014-10-29 Impact factor: 3.147
Authors: Matthew G Fury; Han Xiao; Eric J Sherman; Shrujal Baxi; Stephanie Smith-Marrone; Karen Schupak; Richard Gewanter; Daphna Gelblum; Sofia Haque; Heiko Schoder; Jatin P Shah; Nora Katabi; Rachel Kurtzman; Brynna Lipson; Lisa Cox; Nancy Y Lee; David G Pfister Journal: Head Neck Date: 2015-07-06 Impact factor: 3.147
Authors: L S Blaszkowsky; D P Ryan; J Szymonifka; D R Borger; A X Zhu; J W Clark; E L Kwak; H J Mamon; J N Allen; E Vasudev; P C Shellito; J C Cusack; D L Berger; T S Hong Journal: Ann Oncol Date: 2014-01 Impact factor: 32.976
Authors: Matthew J Nyflot; Tim J Kruser; Anne M Traynor; Deepak Khuntia; David T Yang; Gregory K Hartig; Timothy M McCulloch; Peggy A Wiederholt; Lindell R Gentry; Tien Hoang; Robert Jeraj; Paul M Harari Journal: Int J Radiat Oncol Biol Phys Date: 2015-02-03 Impact factor: 7.038