Letter to the Editor CDDP and 5-FU after Prior VBM or VBM after Prior CDDP and 5-FU in the Management of Recurrent Squamous Cell Carcinoma of the Head and Neck? A. GRIMALDI, M. MERLANO, G. GARDIN and R. ROSS0 IJtituto Nazionale per la Ricerca ml Cmcro. Genor:a, Italy IT’S LONG been suggested that responses to further chemotherapy arc more difficult to obtain after a patient’s tumor becomes resistant to the first antincoplastic drug regimen administered. Certain drugs more than others seem to produce this phenomenon that has been observed after radio- therapy as well and it has been suggested that agents with known mutagenic effects may induce the emcrgencc of drug resistant clones with a much higher frequency than the natural spontaneous mutation rate [l]. This consideration may hayc important clinical implications mainly in the pal- liative treatment of advanced disease. For example, a drug able to increase the natural mutation rate toward a certain resistant phenotype, should be employed after the use of less mutagenic drugs and thus the possibility of response to further chcmo- therapy may be higher. In this connection, w( present herein a retrospective analysis of two groups of patients with relapsing squamous cell carcinoma of the head and neck. The characteristics of the two series are reported in Table 1, with the main difference being the scqucncc of drug administration. The first group consisted of 14 patients (group A) in which a mrthotrcxatc based regimen followed prior treat- ments including surgery radiation and chcmo- therapy (CDDP + 5FU). The treatment consisted of: Vinblastinc 6 mg/m’, hour 0, Bleomycin 30 C hour 6, methotrcxatc 200 mg hour 24, lcucovorin rcscuc 45 mg hour 48. No objcctivc response was observed and disease progressed in all patients after l-4 courses. The regimen was dropped. The second group (group Arceptcd .5 ,Junc 1986. Corrrspondenw and reprints requests to: ,Ilarco Slerlano, IXv- ision of Medical C)ncology, Istituto Nazionale prr la Rirrrc,l sul Cancru. V. Ic Benedrtto XV IO, 16133, Genoa-a, Itall 1.539 Table 1. Characteristics qf patients I strics II series Male/female 1311 (,/‘1 & Median age (rangr) 58 (3%75) .5ti (45-741 Median PS ECOG scale (range) I (%-2i I il-:$j Sites of rrlapsr: Oropharynx 3 :i Oral cavity 2 2 Hypopharynx I 1 Maxillary sinus 2 Rhinopharynx 2 Soft tissue 1 I Nodes 1 i Previous trratmrnt: s-* KI‘+ CT -i “, S + RT + CT I I s -+ KI‘ + c7 .+ :i s + KI‘ + CI ‘L ‘2 KI‘ -+ (:‘I 2 I CT + RT i s I s d (:I- I Patients responding to prior lO/l~ tiil I chemotherapy S: surgery; RT: radiotherapy: Cl‘: chcmothrrap~. B) consisted of 11 patients in which cisplatin- containing chemotherapy radiation, surgery and chc;oyht ,;&+;n after 1 , (mctho- trexate, Vinblastine, Bleomycin). The cisplatin based treatment was as Mows: CDDP 20 mg/m2 in 2 hr hydration and 5-FU 200 mg/m’ push, [2], daily per 5 consecutive days every third week. Four patients reached an objcc- tivr rcsponsc. This value compared to the 0% of the previous described series, was analyzed accord- ing to the Fisher test [3] for thr small number and the diffcrcncc was statistically significant (P < 0.03). Although difficult to dcmonstratc rvrn in experimental systems, the possibility that the