Cyclophosphamide, adriamycin, and cis-diamminedichloroplatinum (II) in the treatment of patients with advanced head and neck cancer

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Abstract
Twenty-seven patients with measurable or evaluable, regionally advanced or metastatic head and neck cancer were given a combination of cyclophosphamide (C), Adriamycin (A), and cis-diamminedi-chloroplatinum (II) (P). Most patients had received extensive prior surgery and/or radiation therapy. Among 25 evaluable patients, the overall response rate was 64% (16/25) with 3/25 complete responders and 13/25 partial responders. The median survival for the entire group of 25 patients and the median response duration for the subset of 16 patients experiencing tumor regression were 8.1 and 7.0 months, respectively. Responders lived significantly longer than nonresponders (11 months vs. six months, P < 0.01). According to covariate analysis, the difference seems to reflect the influence of response to treatment and not other confounding variables. Almost all patients experienced anorexia, nausea, vomiting, and a pervasive feeling of ill-health. In fact, six patients declined further treatment and five of these had objective tumor regressions. Recurrent disease was detected three months following discontinuation of chemotherapy in four of these five patients and seven months later in the fifth. Myelosuppression was clinically acceptable and there was in this dosage and schedule no evidence of hepatic or renal impairment. Although the CAP regimen has substantial antitumor activity, the program is clinically rigorous and should remain an investigational treatment modality at the present time.