The chemotherapeutic treatment of recurrent and/or metastatic squamous cell carcinoma (SCC) of the head and neck (H & N) has a very dismal prognosis, with survival usually not exceeding 1 year. Reported objective response rates vary between 3% and 70%. This difference appears largely attributable to the heterogeneity of the patient populations included in most published Phase I1 studies in H & N cancer. They usually include together initially metastatic, recurrent, and post primary treatment metastatic disease patients. These patients respond differently to chemotherapy. Because of this situation, we decided to study a more homogeneous patient population consisting of metastatic patients only. Cisplatin (CDDP) and vindesine (VDS) are active agents in H & N SCC. As VDS has a cyclespecific activity, the therapeutic index may be increased if it is administered in a continuous infusion (CI) schedule. Thirty-three patients with metastatic H & N (69% biopsy proven) were treated with a combination regimen including CDDP (100 mg/mz) day 1 and VDS 0.6 to 1 mg/mz for 96 hours of CI. Thirty-one patients were evaluable for response: five had a complete response (CR; 16%) and 11 had a partial response (PR; 36%) with an overall rate response of 52% (95% confidence limit: 33% to 70%). Median duration of CR was 6.4 months (3 to 19 months) and 4.4 months for PR (3 to 6 months). A decrease in the leukocytes was the main toxicity encountered with this regimen. This combination regimen containing CDDP and CI VDS was well tolerated and active in H & N SCC. The incorporation of an active vincaalkaloid in neoadjuvant regimens should be considered. Cancer 66:640-644,1990.
ATIENTS WITH RECURRENT and/or metastatic head P and neck squamous cell carcinoma (H & N SCC) have a bad prognosis with a median survival between 3 and 9 months'.2 despite systemic chemotherapy.
Cisplatin (CDDP) is one of the most active drugs in H & N SCC with a overall response rate (RR) of 28%.3 However, RRs vary from 3%4 to 73%.5 When CDDP is combined with other active drugs the reported RRs range from