Cancer Consult by Syed A. Abutalib & Maurie Markman

Author:Syed A. Abutalib & Maurie Markman [Abutalib, A., Syed & Markman, Maurie]
Language: eng
Format: epub
ISBN: 9781118589212
Publisher: Wiley
Published: 2014-06-12T10:48:35+00:00

Will increase laryngeal preservation when compared to radiation therapy alone

Will improve survival when compared to radiation therapy alone

Will improve loco-regional control when compared to radiation and concurrent single-agent cisplatin

Has become the standard of care for patients with unresectable, loco-regionally advanced disease

Has been of optimal benefit when also given with concurrent single-agent cisplatin

Cetuximab, a monoclonal antibody directed against the epidermal growth factor receptor (EGFR), is the only monoclonal antibody that has been approved by the US Food and Drug Administration for the treatment of HNSCC. This is based on a phase III randomized multicentered study that compared RT plus cetuximab with RT alone in the treatment of stage III or IV nonmetastatic HNSCC. There was an improvement in loco-regional control, progression-free survival, and overall survival (median duration: 49 vs. 29.3 months; P = 0.03) from the addition of cetuximab to RT. With the exception of the characteristic cutaneous toxicity of cetuximab (acneiform rash), the incidence of grade 3 toxicities, particularly mucositis, was not significantly higher in the group treated with cetuximab.

Cetuximab has not, however, been demonstrated to be superior or even equivalent to concurrent radiation and cisplatin. The RTOG 1016 trial is an ongoing phase III randomized trial that will attempt to answer this question by comparing cetuximab with concurrent RT, to cisplatin with concurrent RT in HPV-positive patients. Cetuximab has not been well tested in an organ preservation protocol. It also cannot be considered a treatment standard for patients with unresectable disease in the absence of a direct comparative trial with radiation and cisplatin. When added to radiation and concurrent cisplatin, no apparent benefit was identified in the RTOG 0522 trial.

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