Abstract
Since the introduction of cisplatin into clinical use, remarkable progress has been achieved in chemotherapy for head and neck cancer. Subsequently, the multi-drug combination therapies using cisplatin as the main drug have become the main therapy. We used a regimen which combines cisplatin and peplomycin with moderate amount of methotrexate for the treatment of advanced and recurrent cancer of the head and neck. Almost simultaneously we also used the regimen combining cisplatin and 5-FU, which has been reported to be highly effective. In the present study these two regimen were compared to determine the clinical efficacy of the combination chemotherapy consisting of cisplatin, methotrexate and peplomycin.
As to clinical results obtained with PPM therapy, the overall response rate was 76%. Complete response was rated in 12% of the cases. Similar results were obtained with PF therapy with response rate of 65%. Complete response was obtained in 9% of the cases.
Detailed analysis concerning each background factor revealed no difference between PPM therapy and PF therapy. As the factors which give influences on the results of chemotherapy, performance status, whether the evaluable lesion is single or not, stage of TNM and possibility of operative resection were considered important.
The secondary effect was compared by Kaplan-meier method based on cumulative survival rate. In terms of prognosis at 24 months the secondary efficacy rate was 32% for PPM therapy and 21% for PF therapy, indicating that PPM therapy is similar or even superior to PF therapy. The stratified analysis by factor which gives influences revealed little or no difference between the two regimens. Even the results contrasting to the primary efficacy were obtained for some factors. Thus, the short duration of response was indicated.
From these results it is considered that the combination chemotherapy consisting of cisplatin, peplocycin and methotrexate is presently a multi-drug regimen well expected to be effective for the treatment of head and neck cancer.
