Phase II trial of paclitaxel, ifosfamide, and cisplatin in patients with recurrent head and neck squamous cell carcinoma

Purpose: To assess the activity and toxicity profile of combined taxol (paclitaxel), ifosfamide, and platinum (cisplatin) (TIP) in patients with recurrent or metastatic squamous cell carcinoma (SCC) of the head and neck. Patients and Methods: Recurrent or metastatic head and neck SCC patients received paclitaxel 175 mg/m² in a 3-hour infusion on day 1; ifosfamide 1,000 mg/m² in a 2-hour infusion on days 1 through 3; mesna 600 mg/m² on days 1 through 3; and cisplatin 60 mg/m² on day 1, repeated every 3 to 4 weeks. All were premedicated with dexamethasone, diphenhydramine, and cimetidine. Prophylactic hematopoietic growth factors were not permitted. Results: Fifty-two patients were assessable for response and toxicity; 53 for survival (local-regional recurrence alone in 57% and distant metastasis with or without local-regional recurrence in 43%). Overall response rate was 58% (30 of 52) of patients; complete response rate was 17% (nine of 52) of patients, with six complete responses that continued for a median 15.7 + months. Median follow-up of all patients was 17.7 months. Median survival was 8.8 months (95% confidence interval [CI] 8.1 to 17.5 months). Toxicity was relatively well tolerated and caused no deaths. The most frequent moderate- to-severe toxicity (90% of patients) was transient grades 3 to 4 neutropenia; neutropenic fever occurred in 27%. Grade 3 peripheral neuropathy occurred in three patients, none had grade 4. Grade 3 mucositis occurred in only one patient, none had grade 4. Conclusion: TIP had major activity in this setting, with a 58% objective response rate, 17% complete response rate, durable complete response (six of nine persisting), and relatively well- tolerated toxicity, with no toxic deaths. The activity of TIP, a novel taxol- cisplatin-based regimen, in recurrent or metastatic head and neck SCC should be confirmed in a phase III trial.