Comb in a tio n Ch em o therapy with Cis-Dia m m in e dic h lo ropla tin um , On c o vin , an d Bleo m ycin (COB) in Advanced Head and Neck Cancer Phase I1 MAGID H. AMER, MD, FRCS (ENG.), FRCP(C),* RONALD M. IZBICKI, DO,* V. K. VAITKEVICIUS, MD, FACP,t AND MUHYI AL-SARRAF, MD, FRCP(C), FACP* Twenty-eight consecutive patients with advanced head and neck epidermoid carcinoma were treated with a single course of kombination chemotherapy which included high dose cis-platinum 11, vincristine, and bleomycin. All patients except one were evaluable for drug response and toxicity. The overall toxicity was mild and tolerable except in one patient who had fatal nephrotoxicity. Thirteen patients (48%) had a partial regression, and five with minimal response did improve, giving an overall response rate of 67%. More responses were noted in previously untreated patients, especially those with oral or hypopharyngeal tumors without distant metastases. Definite histological changes were seen in a few patients in remission. Objective tumor response was associated with subjective improvement, and, possibly, a prolonged survival. Cancer 45217-223, 1980. EVERAL CANCER chemotherapeutic agents includ-S ing methotrexate, cis-diamminedichloroplatinum (11) (DDP), cyclophosphamide, Hydroxyurea, vinblastine, Adriamycin, and bleomycin when given singly, have shown antitumor activity in the treatment of advanced head and neck can~er.'",~~*~'' The demonstration of the superiority of combination chemotherapy in the treatment of leukemia and lymphoma led to the use of a similar approach in head and neck cancer with some encouraging ~e s u l t s . ~ The vinca alkaloids (VCR) have shown a striking ability to increase temporarily the population of cells in mitosis by disrupting the mitotic spindle." Bleomycin is most effective in vitro when cells are in mitosis and G, p h a ~e . ~, ~~
The sequential administration of these two agents enhanced their antitumor By adding methotrexate (MTX) to the above combination, three out of 12 (25%) of our patients with advanced head and neck cancer had a remission, two partial and one complete.