I had TPF Induction Chemo..Taxotere, Cisplatin and 5-FU, aka as neoadjunct chemo, in 2009 that did not go well, so I was not able to complete the other two induction cycles, and the 7 weeks of chemoradiation that followed as planned. As a result, I had numerous recurrences, but the 5 days of induction chemo killed all the cancer, almost killed me too, but it doesn't last if used alone, and cancer usually returns in less than a year, and it did with me, not that this was the planned way to go, but was not medically stable for further treatment after the 5 days of Induction. My situation is probably unusual.
Induction chemo has been around for a while. after the success of Cisplatin, and used mainly in organ preservation for larynx, hypopharyngeal, BOT cancer. I believe it was initially used just with PF, then Taxotere was added, and found to make it work better, and now is used with other induction combinations, including
Erbitux. It is controversial, being it has a high rate of toxicities, which may delay the real curative treatment, which is radiation and surgery, and the possibly of too much chemo hampers tumor kill, but otherwise it is very effective for tumor control, distant metastases, but overall survival is not improved, in some studies, mainly done in the 80's-90's, and no real head to head comparison were completed yet with this vs chemoradiation, and some doctors are waiting for this, but others are using it outside clinical trials for treatment being it is effective.
There is also renewed interest witn Induction chemo with rise in
HPV in HNC, which shows better response to treatments, plus these patient are younger, have less comorbities, and are able to handle a more aggressive treatment regimine. Dr Posner, now at Mt. Sinai, did a study with
HPV pos vs non
HPV, with induction chemo, and showed an improved response rate, and OS with
HPV postive vs negative.
The NCCN added Induction Treatment to their Head and Neck Cancer Treatment Protocol for advanced Oropharyngeal cancer, and a lengthy discussion about it can be read.
http://oralcancerfoundation.org/treatment/pdf/head-and-neck.pdf
