Treatment Outcome of Pharmacokinetics-Based Dosing of Docetaxel and Fluorouracil in Advanced Head and Neck Cancer Patients

Introduction: Docetaxel, Cisplatin and 5-Fluorouracil (DPF) became the standard induction chemotherapy in advanced Headand Neck Cancer (HNC) but associated with high toxicity rate. Severalstudies reported higher response rates with better tolerability whenchemotherapy dose is calculated based on Pharmacokinetics (PK) versusconventional Body Surface Area (BSA). Patients and Methods: Thirty ninepatients with stage III and IV HNC who received induction DPF were included inthe study. Dose of cycle 1 was BSA-based then Docetaxel and 5-FU doses werePK-adjusted starting from cycle 2 whereas Cisplatin dose was BSA-basedthroughout the study. Results: After median follow up period of 14months the median overall survival (OS) and progression free survival (PFS)were 15.1 and 10.6 months respectively. Twenty nine patients were available forresponse assessment. Seven patients (24.1%) achieved complete response whilepartial response encountered in 19 patients (65.5%) with and Overall responserate of 89.6%. Both treatment related side effects and mortality significantlydecreased after the application of PK dose adjustments (p-value 0.007 and 0.01respectively). Conclusion: PK-guided dose adjustments of 5-FU andDocetaxel in DPF regimen can significantly decrease the treatment related sideeffects and mortality without compromising the tumor response rate. Arandomized clinical trial is needed to compare the PK-guided dose adjustmentwith the standard BSA based protocol.