Gemcitabine-Based Chemoradiation in the Treatment of Locally
Advanced Head and Neck Cancer: Systematic Review of Literature
and Meta-Analysis

J 2016

Gemcitabine-Based Chemoradiation in the Treatment of Locally Advanced Head and Neck Cancer: Systematic Review of Literature and Meta-Analysis

VANDERVEKEN, Olivier M.; Petr SZTURZ; Pol SPECENIER; Marco C. MERLANO; Marco BENASSO et al.

Základní údaje

Originální název

Gemcitabine-Based Chemoradiation in the Treatment of Locally Advanced Head and Neck Cancer: Systematic Review of Literature and Meta-Analysis

Autoři

VANDERVEKEN, Olivier M.; Petr SZTURZ; Pol SPECENIER; Marco C. MERLANO; Marco BENASSO; Dirk VAN GESTEL; Kristien WOUTERS; Carl VAN LAER; Danielle VAN DEN WEYNGAERT; Marc PEETERS a Jan VERMORKEN

Vydání

ONCOLOGIST, DURHAM, ALPHAMED PRESS, 2016, 1083-7159

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30200 3.2 Clinical medicine

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 4.962

Označené pro přenos do RIV

Ano

Kód RIV

RIV/00216224:14110/16:00090829

Organizační jednotka

Lékařská fakulta

Klíčová slova anglicky

Chemotherapy; Concomitant chemoradiotherapy; Gemcitabine; Head and neck cancer; Neoplasms; Oncology; Radiotherapy; Radiation; Toxicity

Štítky

EL OK

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 15. 9. 2016 15:36, Soňa Böhmová

Anotace

V originále

Background. Platinum-based concurrent chemoradiation (CCRT) improves locoregional control and overall survival of locoregionally advanced (LA) squamous cell carcinoma of the head and neck (SCCHN) when compared to radiotherapy alone, but this approach is hampered by significant toxicity. Therefore, alternative ways to enhance the radiation effects are worth investigating. Gemcitabine (2',2'-difluorodeoxycytidine), in addition to its activity against a variety of solid tumors, including SCCHN, is one of the most potent radiosensitizers, and it has an overall favorable safety profile. In this paper, the clinical experience with gemcita bine-based chemoradiation in the treatment of patients with LA-SCCHN is reviewed. Methods. We conducted a review of the literature on the clinical experience with radiotherapy combined with either single-agent gemcitabine or gemcitabine/cisplatin-based polychemotherapy for the treatment of patients with LA-SCCHN. We also searched abstracts in databases of major international oncology meetings from the last 20 years. A meta-analysis was performed to calculate pooled proportions with 95% confidence intervals (Os) for complete response rate and grade 3-4 acute mucositis rate. Results. A total of 13 papers were eligible for the literature review. For schedules using a gemcitabine dose intensity (DI) below 50 mg/m2 per week, the complete response rate was 86% (95% CI, 74%-93%) with grade 3-4 acute mucositis rate of 38% (95% CI, 27%-50%) and acceptable late toxicity. In one of the studies employing such low Dls, survival data were provided showing a 3-year overall survival of 50%. Compared with DI 50 mg/m2 per week, there was no difference in the complete response rate (71%; 95% Cl, 55%-83%; p =.087) but a significantly higher (p <.001) grade 3-4 acute mucositis rate of 74% (95% Cl, 62V0-83%), often leading to treatment interruptions (survival data provided in 8 studies; 3-year overall survival, 27%-63%). Late toxicity comprising mainly dysphagia was generally underreported, whereas information about xerostomia and skin fibrosis was scarce. Conclusion. This review highlights the radiosensitizing potential of gemcitabine and suggests that even very low dosages (less than 50 mg/m2 per week) provide a sufficient therapeutic ratio and therefore should befurther investigated. Refinements in radiation schemes, including intensity-modulated radiation therapy, in combination with low-dose gemcitabine and targeted agents, such as cetuximab, are currently being investigated.

Citovat

VANDERVEKEN, Olivier M.; Petr SZTURZ; Pol SPECENIER; Marco C. MERLANO; Marco BENASSO; Dirk VAN GESTEL; Kristien WOUTERS; Carl VAN LAER; Danielle VAN DEN WEYNGAERT; Marc PEETERS a Jan VERMORKEN. Gemcitabine-Based Chemoradiation in the Treatment of Locally Advanced Head and Neck Cancer: Systematic Review of Literature and Meta-Analysis. ONCOLOGIST. DURHAM: ALPHAMED PRESS, 2016, roč. 21, č. 1, s. 59-71. ISSN 1083-7159. Dostupné z: https://doi.org/10.1634/theoncologist.2015-0246.

@article{1354117,
   author = {Vanderveken, Olivier M. and Szturz, Petr and Specenier, Pol and Merlano, Marco C. and Benasso, Marco and Van Gestel, Dirk and Wouters, Kristien and Van Laer, Carl and Van den Weyngaert, Danielle and Peeters, Marc and Vermorken, Jan},
   article_location = {DURHAM},
   article_number = {1},
   doi = {https://doi.org/10.1634/theoncologist.2015-0246},
   keywords = {Chemotherapy; Concomitant chemoradiotherapy; Gemcitabine; Head and neck cancer; Neoplasms; Oncology; Radiotherapy; Radiation; Toxicity},
   language = {eng},
   issn = {1083-7159},
   journal = {ONCOLOGIST},
   title = {Gemcitabine-Based Chemoradiation in the Treatment of Locally Advanced Head and Neck Cancer: Systematic Review of Literature and Meta-Analysis},
   url = {http://theoncologist.alphamedpress.org/content/21/1/59},
   volume = {21},
   year = {2016}
}

TY  - JOUR
ID  - 1354117
AU  - Vanderveken, Olivier M. - Szturz, Petr - Specenier, Pol - Merlano, Marco C. - Benasso, Marco - Van Gestel, Dirk - Wouters, Kristien - Van Laer, Carl - Van den Weyngaert, Danielle - Peeters, Marc - Vermorken, Jan
PY  - 2016
TI  - Gemcitabine-Based Chemoradiation in the Treatment of Locally Advanced Head and Neck Cancer: Systematic Review of Literature and Meta-Analysis
JF  - ONCOLOGIST
VL  - 21
IS  - 1
SP  - 59-71
EP  - 59-71
PB  - ALPHAMED PRESS
SN  - 10837159
KW  - Chemotherapy
KW  - Concomitant chemoradiotherapy
KW  - Gemcitabine
KW  - Head and neck cancer
KW  - Neoplasms
KW  - Oncology
KW  - Radiotherapy
KW  - Radiation
KW  - Toxicity
UR  - http://theoncologist.alphamedpress.org/content/21/1/59
N2  - Background. Platinum-based concurrent chemoradiation (CCRT) improves locoregional control and overall survival of locoregionally advanced (LA) squamous cell carcinoma of the head and neck (SCCHN) when compared to radiotherapy alone, but this approach is hampered by significant toxicity. Therefore, alternative ways to enhance the radiation effects are worth investigating. Gemcitabine (2',2'-difluorodeoxycytidine), in addition to its activity against a variety of solid tumors, including SCCHN, is one of the most potent radiosensitizers, and it has an overall favorable safety profile. In this paper, the clinical experience with gemcita bine-based chemoradiation in the treatment of patients with LA-SCCHN is reviewed. Methods. We conducted a review of the literature on the clinical experience with radiotherapy combined with either single-agent gemcitabine or gemcitabine/cisplatin-based polychemotherapy for the treatment of patients with LA-SCCHN. We also searched abstracts in databases of major international oncology meetings from the last 20 years. A meta-analysis was performed to calculate pooled proportions with 95% confidence intervals (Os) for complete response rate and grade 3-4 acute mucositis rate. Results. A total of 13 papers were eligible for the literature review. For schedules using a gemcitabine dose intensity (DI) below 50 mg/m2 per week, the complete response rate was 86% (95% CI, 74%-93%) with grade 3-4 acute mucositis rate of 38% (95% CI, 27%-50%) and acceptable late toxicity. In one of the studies employing such low Dls, survival data were provided showing a 3-year overall survival of 50%. Compared with DI 50 mg/m2 per week, there was no difference in the complete response rate (71%; 95% Cl, 55%-83%; p =.087) but a significantly higher (p <.001) grade 3-4 acute mucositis rate of 74% (95% Cl, 62V0-83%), often leading to treatment interruptions (survival data provided in 8 studies; 3-year overall survival, 27%-63%). Late toxicity comprising mainly dysphagia was generally underreported, whereas information about xerostomia and skin fibrosis was scarce. Conclusion. This review highlights the radiosensitizing potential of gemcitabine and suggests that even very low dosages (less than 50 mg/m2 per week) provide a sufficient therapeutic ratio and therefore should befurther investigated. Refinements in radiation schemes, including intensity-modulated radiation therapy, in combination with low-dose gemcitabine and targeted agents, such as cetuximab, are currently being investigated.
ER  -

VANDERVEKEN, Olivier M.; Petr SZTURZ; Pol SPECENIER; Marco C. MERLANO; Marco BENASSO; Dirk VAN GESTEL; Kristien WOUTERS; Carl VAN LAER; Danielle VAN DEN WEYNGAERT; Marc PEETERS a Jan VERMORKEN. Gemcitabine-Based Chemoradiation in the Treatment of Locally Advanced Head and Neck Cancer: Systematic Review of Literature and Meta-Analysis. \textit{ONCOLOGIST}. DURHAM: ALPHAMED PRESS, 2016, roč.~21, č.~1, s.~59-71. ISSN~1083-7159. Dostupné z: https://doi.org/10.1634/theoncologist.2015-0246.

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