Q&A: Treating Larynx Cancer With Chemotherapy Alone

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In certain cases, cancer of the larynx (voicebox) can be treated successfully with chemotherapy alone, according to a recent study at M. D. Anderson.

Chris Holsinger, M.D., associate professor in the Department of Head and Neck Surgery, was co-author of the study, which is the first of its kind in the United States. He answers questions about this groundbreaking research that may provide hope for some patients.

How has the treatment for larynx cancer evolved over the past few decades?

Thirty years ago, the only option for cancer of the larynx, also called laryngeal cancer was surgical removal of part of the larynx. In the 1970s, treatment moved away from surgery and more toward radiation. Then we began to combine radiation and chemotherapy.

What are some of the disadvantages of treating cancer of the larynx with radiation?

Radiation can have side effects, especially long-term toxicity. In many patients, the cancer returns.

Sometimes, radiation therapy saves the larynx and trachea (windpipe), but they do not work as well. This requires some patients to have a tracheotomy (a surgical procedure that makes an incision in the trachea to open a direct airway) or gastrostomy (surgical opening into the stomach).

If patients who have radiation need surgery later, they often have more surgical complications and lower survival rates.

What inspired you to look at treating larynx cancer with chemotherapy?

While the treatment of larynx cancer was evolving in the United States, another story was unfolding in Paris. Two doctors, Henri Laccourreye and his son, Olivier, were treating larynx cancer with chemotherapy alone and having amazing results.

It was controversial and experimental, but they published a paper in 1996 that showed a third of their patients had complete recovery.

In the first year of my fellowship at M. D. Anderson, Olivier spoke here. I was in the back of the room, but what he said captured my imagination.

I received a Fulbright Scholarship and went to Paris to study with them for four months. It was an incredible watershed experience in my life.

What are some of the advantages of treating larynx cancer with chemo only?

The most important advantage is that all options are still on the table. If the chemo does not succeed, the patient usually still can have radiation or surgery. And, if we can treat the tumor with chemotherapy, patients usually function better.

What was your objective with this study?

We wanted to determine if chemotherapy alone or followed by voice-sparing surgery would achieve lasting remission for certain patients. Voice-sparing surgery also is called CLS (conservation laryngeal surgery), and it maintains the ability for speech and swallowing.

How did you carry out the research?

We recruited 31 patients with stage II to IV laryngeal cancer who had not been treated. All the patients were eligible for CLS.

Each patient received 3-4 cycles of TIP chemotherapy, which contains:

•    Cisplatin
•    Mitoxana® (ifosfamide)
•    Taxol® (paclitaxel)

Patients who had a complete response received three more cycles of TIP and no other treatment.

Patients who had a partial response had CLS.

What were the results?

One patient was not able to finish treatment, but all other patients responded to treatment.

Eleven patients (37%) had a complete response. Ten of these patients remain cancer-free five years later.

Nineteen (63%) of the patients treated with chemotherapy alone had a partial response.

We were able to save the larynx in 83% of the patients. Five patients required postoperative radiation therapy. No patient required a gastrostomy or tracheotomy.

Can you put these results into perspective?

While these results are promising, we want to emphasize that further multi-institutional Phase II validation is required before this approach is widely used. This approach should be done with great care and only in the setting of a clinical trial.

What's next for your research?

We would like to study new chemotherapy regimens, which may give even better results.

Our ultimate goal is true personalization of therapy for cancer of the larynx. In the future, other studies may identify biomarkers that will help identify who will benefit from chemotherapy alone. Then, we'll be able to do a biopsy, and study tumors and genes to find the best method of treatment for each patient.

We hope to identify those patients who do not need to have this delicate organ -- so important to social function -- altered.

Related article:
Chemotherapy Alone Works for Larynx Cancer Patient

M. D. Anderson resources:
Head and Neck Center

Additional resources:

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