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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 388-389

Neoadjuvant chemotherapy in oral cavity cancer: A new horizon?


Department of Radiation Oncology, National Cancer Institute, AIIMS, New Delhi, India

Date of Submission09-Mar-2020
Date of Decision09-Mar-2020
Date of Acceptance23-Mar-2020
Date of Web Publication19-Jun-2020

Correspondence Address:
Supriya Mallick
AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_76_20

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How to cite this article:
Mallick S, Giridhar P. Neoadjuvant chemotherapy in oral cavity cancer: A new horizon?. Cancer Res Stat Treat 2020;3:388-9

How to cite this URL:
Mallick S, Giridhar P. Neoadjuvant chemotherapy in oral cavity cancer: A new horizon?. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Jul 14];3:388-9. Available from: http://www.crstonline.com/text.asp?2020/3/2/388/287266



Oral cavity cancer poses a great challenge as it constitutes nearly 10% of all cancers in India [1] and nearly 80% cases present in the advanced stage. An R0 surgical resection is considered the cornerstone of therapy followed by adjuvant radiation. Achieving an R0 surgical resection may be difficult in many cases. The article by Goel et al. has nicely summarized the evidence of using neoadjuvant chemotherapy (NACT) in oral cavity cancer.[2] The authors have done an extensive narrative review on the existing evidence of NACT in oral cavity cancer and not attempted to do a systematic review which may be considered a limitation of the article. NACT was evaluated for early oral cancer in two trials by Licitra et al.[3] and Zhong et al.[4] Both the trials failed to show any survival advantage when added to standard surgery followed by adjuvant radiation. In a subset analysis, NACT was found to be associated with less mandible resections.[2] NACT in advanced head and neck cancer was used in TAX 323[5] and TAX 324[6] trials with a promising 10% survival advantage with the three drug docetaxel, cisplatin, 5-fluorouracil (TPF) regimen. But, these trials were criticized as both compared TPF to PF as NACT regimen and lacked the standard of care concurrent chemoradiation (CTRT) without NACT arm. Subsequently, few other trials including PARADIGM [7] and DeCIDE [8] trials failed to show an improvement in outcome with NACT in locally advanced head and neck cancer compared to standard CTRT. The subsequent hypothesis of survival improvement with NACT for high risk N2 or N3 locally advanced head and neck cancer also failed to show additional benefit. NACT in laryngeal cancer was initially tried with a promise of organ preservation [9] but was replaced by CTRT afterwards.[10] These findings significantly dent the hypothesis that NACT may control micro-metastases which can translate into survival. Interestingly, NACT in other solid tumors (breast cancer, lung cancer, carcinoma cervix, carcinoma esophagus, carcinoma stomach) has not dramatically changed the survival outcome. A couple of hypotheses may explain the situation. First, after exposure of chemotherapy, cancer cells develop higher potential to develop newer mutations and become more resistant to therapy. Second, after the use of NACT, the sensitive tumor cells are killed easily and then the resistant cells show accelerated repopulation which ultimately leads to poorer disease control. A point should also be made that the addition of one more modality adds to the toxicity and cost of care. It may also happen that many patients with borderline performance status become ineligible for the definitive treatment. So, NACT should not be used as a regular treatment option and should be evaluated in unresectable oral cavity cancer in a well-designed clinical trial.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Available from: https://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf. [Last accessed on 2020 March 20].  Back to cited text no. 1
    
2.
Goel A, Singla A, Prabhash K. Neoadjuvant chemotherapy in oral cancer: Current status and future possibilities. Cancer Res Stat Treat 2020;3:51-9.  Back to cited text no. 2
  [Full text]  
3.
Licitra L, Grandi C, Guzzo M, Mariani L, Lo Vullo S, Valvo F, et al. Primary chemotherapy in resectable oral cavity squamous cell cancer: A randomized controlled trial. J Clin Oncol 2003;21:327-33.  Back to cited text no. 3
    
4.
Zhong LP, Zhang CP, Ren GX, Guo W, William WN Jr, Sun J, et al. Randomized phase III trial of induction chemotherapy with docetaxel, cisplatin, and fluorouracil followed by surgery versus up-front surgery in locally advanced resectable oral squamous cell carcinoma. J Clin Oncol 2013;31:744-51.  Back to cited text no. 4
    
5.
Vermorken JB, Remenar E, van Herpen C, Gorlia T, Mesia R, Degardin M, et al. Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med 2007;357:1695-704.  Back to cited text no. 5
    
6.
Lorch JH, Goloubeva O, Haddad RI, Cullen K, Sarlis N, Tishler R, et al. Induction chemotherapy with cisplatin and fluorouracil alone or in combination with docetaxel in locally advanced squamous-cell cancer of the head and neck: Long-term results of the TAX324 randomised phase 3 trial. Lancet Oncol 2011;12:153-9.  Back to cited text no. 6
    
7.
Haddad R, O'Neill A, Rabinowits G, Tishler R, Khuri F, Adkins D, et al. Induction chemotherapy followed by concurrent chemoradiotherapy (sequential chemoradiotherapy) versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer (PARADIGM): A randomised phase 3 trial. Lancet Oncol 2013;14:257-64.  Back to cited text no. 7
    
8.
Cohen EE, Karrison TG, Kocherginsky M, Mueller J, Egan R, Huang CH, et al. Phase III randomized trial of induction chemotherapy in patients with N2 or N3 locally advanced head and neck cancer. J Clin Oncol 2014;32:2735-43.  Back to cited text no. 8
    
9.
Department of Veterans Affairs Laryngeal Cancer Study Group, Wolf GT, Fisher SG, Hong WK, Hillman R, Spaulding M, Laramore GE, et al. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 1991;324:1685-90.  Back to cited text no. 9
    
10.
Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003;349:2091-8.  Back to cited text no. 10
    




 

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