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SINGLE AGENTS THAT ARE ACTIVE:
Methotrexate
Cisplatin
5FU
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Carboplatin + 5FU
Carboplatin 400 mg/m2 IV on DAY 1
FLUOROURACIL 5000 mg/m2 CI over 120 hours
Repeat Q21 days

REF:JCO 13:1493, 1995
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CARBOPLATIN + 5FU + XRT (OROPHARYNX)

CARBOPLATIN 70 mg/m2/day X 4
5FU 600 mg/m2/day X 4 (CVI) days 1, 22, 43
XRT 35 fractions (70 Gy)

French Trial. Data presented in abstract. Trial was XRT +/- chemo. 3 year OS 51% vs 31% (P=.002) 3 year DFS 42% vs 19% (p=.003) Locoregional control 66% vs 42%. High grade 3/4 mucositis.

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Cisplatin + 5FU
CISPLATIN 100 mg/m2 IV on DAY 1
FLUOROURACIL 5000 mg/m2 CI over 120 hours
REPEAT Q21 days

REF: JCO 13:1493, 1995
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Paclitaxel + Ifosfamide + MESNA + Cisplatin

PACLITAXEL 175 mg/m2 over 3 hours on DAY 1
IFOSFAMIDE 1000 mg/m2 over 2 hours on DAYS 1-3
MESNA 400 mg/m2 IV before ifosfamide and 200 mg/m2 IV 4 hours after ifosfamide
CISPLATIN 60 mg/m2 IV on DAY 1

REF: JCO 16:1325, 1998

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CARBOPLATIN + TAXOL
3 courses of
paclitaxel 150-265 mg/m2
carboplatin AUC 7.5.
Q 21 days
Those who achieved CR or PR at the primary received definitive XRT to the primary tumor & those with LN disease received neck dissection followed by XRT to the regional LNs.

REF:Cancer 2001 Mar 1;91(5):940-948
N=62; 74% Stage IV; ORR=66%; Responses were observed at all anatomic sites: oropharynx 20 of 33 (61%); hypopharynx 8 of 12 (67%); and larynx 13 of 17 (76%). Organ preservation was achieved in 28 of 62 (45%) of patients at all anatomic sites: oropharynx 39%, hypopharynx 42%, larynx 59%. Seventeen of 28 (61%) patients had their primary organ site preserved for a mean duration of 78 weeks (range, 13-238 weeks).
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CARBOPLATIN + TAXOL (Recurrent)
Paclitaxel 175 mg/m2
Carboplatin AUC 6

REF: Oncology 2001;60(1):66-71
N=27
ORR= 29.6%; median response duration=4.2 months (range 1-5.7 months). Stable & progressive disease = 11.1 & 48.1% of patients, respectively. Median overall survival=7.2 months (range 0.5-10.9 months).
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CISPLATIN + TAXOL

CISPLATIN 75 mg/m2
PACLITAXEL 135 mg/m2 IV over 24 hours

Median surivival 6.8 months. CR 12% (ORR=36%). The stduy was comparing two different doses of taxol. Comparion with Cisplatin+5FU is in progress.

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Common molecular abnormalities:
1. EGF receptor overexpression- 90%
2. P53 mutation 50-70%
3. HPV-16 genome