Single hit chemo guides therapy for larynx cancer

Among individuals with advanced cancer of the larynx or voice box, a single cycle of chemotherapy can identify those whose cancer is very likely to be successfully treated nonsurgically with chemotherapy and radiation alone, a study shows.

"The important observation from this trial," Dr. Susan Urba said, "is that only one cycle of chemotherapy is able to identify which patients with laryngeal cancer would be better treated with chemoradiation, and which would be better treated with surgery."

"This decision is made only 3 weeks after the cycle of chemotherapy," she added, "and so there is no delay before the patient gets the most appropriate definitive therapy."

Urba and colleagues from the University of Michigan Comprehensive Cancer Center in Ann Arbor conducted a trial to see if they could select appropriate patients for "organ preserving" therapy based on their response to an initial single cycle of chemotherapy.

Ninety-seven patients with stage III and IV larynx cancer were given a single cycle of chemotherapy consisting of cisplatin on day 1 and fluorouracil for 5 days.

Following "induction" chemotherapy, two patients discontinued before they could be evaluated, while 73 (75 percent) achieved a partial tumor response of more than 50 percent and proceeded to "definitive" chemotherapy and radiation therapy.

The remaining 22 patients achieved less than a 50 percent response to induction chemotherapy; 19 of them underwent immediate surgery, while 3 could not be treated further.

Using this integrated approach, larynx preservation was achieved in 70 percent of patients at 3 years, according to the team.

Moreover, "our survival data is very promising," Urba told Reuters Health. The overall survival rate at 3 years is 85 percent. "We believe that the excellent survival is due to early salvage surgery for patients whose tumor is not very sensitive to chemotherapy and radiation," Urba said.

Her team's results are published in the Journal of Clinical Oncology.

In a commentary in the journal, Drs. David G. Pfister of Memorial Sloan-Kettering Cancer Center in New York and John A. Ridge of Fox-Chase Cancer Center in Philadelphia, call the study "noteworthy," concluding "additional trials evaluating this therapeutic approach seem warranted."

SOURCE: Journal of Clinical Oncology February 1, 2006.