Combination therapy of advanced head and neck cancer: induction of remissions with diamminedichloroplatinum (II), bleomycin and radiation therapy.

Patients with unresectable, previously untreated head and neck cancer were given cis-diamminedichloroplatinum (II) (DDP), 3 mg/kg, with mannitol diuresis (day 1), followed by a continuous infusion of bleomycin, 0.25 mg/kg/day, days 3 through 10, after an initial loading dose of 0.25 mg/kg by rapid IV injection on day 3. The DDP was repeated on day 22, following which radiotherapy was delivered using standard doses, fractionations and portals. Patients were evaluated for response on day 22 and again at the conclusion of radiotherapy. Of 21 patients evaluable at day 22, there were four CR and 11 PR (greater than 50% reduction of all measureable disease), for a major response rate of 71%. Of five MR, four showed 30-60% reduction at the primary site. Of 16 who have finished the radiation phase of treatment, there are six CR, five PR and one MR with durations four to eight months. Toxicity in 33 patients included vomiting (33), alopecia (33), WBC less than 3000 (five), platelets less than 100,000 (one), dose-limiting mucositis during bleomycin (six) and peak serum creatinine greater than 2 (five), with one fatality. The regimen thus appears promising as initial therapy for the previously untreated patient. The same chemotherapy has produced much less encouraging results in prviously treated patients.