1074PPaclitaxel in combination with anti-EGFR therapy as induction chemotherapy for patients unfit for cisplatin with locally advanced head and neck squamous cell carcinoma (LA-HNSCC)

Background: Induction chemotherapy (ICT) followed by bioradiotherapy (BRT) is a validated conservative approach for fit LA-HNSCC patients (pts). However, in pts unfit for cisplatin-based chemotherapy, this treatment strategy remains a challenge. Paclitaxel in combination with anti-EGFR therapy is active and well-tolerated in the recurrent/metastatic setting. This study aims to evaluate this regimen as ICT followed by BRT. Methods: A retrospective single institution analysis (2010-2016) of LA-HNSCC pts unfit for cisplatin-based chemotherapy (≥70 years-old and/or significant comorbidity) was performed. Pts were treated with paclitaxel plus anti-EGFR monoclonal antibody up to 9 weeks followed by radical BRT (IMRT with concurrent anti-EGFR therapy). Overall survival (OS) and progression free survival (PFS) were estimated by Kaplan-Meier method. Results: A total of 44 pts were evaluated: median age 72 years-old (50-83), male 42; tumor location, pts (%): larynx 14 (32), oropharynx 10 (23) (HPV+ 0), hypopharynx 9 (21), oral cavity 7 (16), cervical unknown primary 4 (9); 7thed TNM stage, pts (%): EIII 11 (25), EIVa 19 (43) and EIVb 14 (32). ECOG status 0/1/2: 1/38/5 pts. Response rate to ICT: 32 pts (73%); 5 complete responses (CR) and 27 partial responses (PR). During ICT 5 pts (11%) presented grade 3/4 adverse events, and 1 patient (2%) died due to febrile neutropenia. 37 pts (84%) continued with radical BRT: 20 pts (45%) achieved CR, and 6 of them recurred. Median follow-up: 13.5 (1-52) months. For the whole cohort, median OS and PFS were 15.6 (95% CI 4.7-26.6) and 10.4 (95% CI 7.0-13.7) months, respectively. For the 35 pts who completed ≥6 weeks of ICT, median OS and PFS were 22.2 (95% IC 7.2-37.2) and 15.6 (95% IC 8.4-22.9) months, respectively. Larynx pts showed better outcome in comparison with other locations: median OS not reached (NR) vs 10.7 (p = 0.003) and median PFS NR vs 0 (p = 0.001); 9 pts (64%) preserved a functioning larynx and were alive by the time of the analysis. Conclusions: Paclitaxel plus anti-EGFR therapy was well-tolerated and might be an effective ICT regimen for LA-HNSCC pts unfit for cisplatin. In our cohort, larynx pts obtained the greatest benefit from this regimen. Legal entity responsible for the study: Institut Catala de Oncologia. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.