Citations 1
Double‐blind, randomized phase 3 trial of low‐dose 13‐cis retinoic acid in the prevention of second primaries in head and neck cancer: Long‐term follow‐up of a trial of the Eastern Cooperative Oncology Group‐ACRIN Cancer Research Group (C0590)
Bhatia, Aarti , Lee, Ju‐Whei, Pinto, Harlan A. , Jacobs, Charlotte, Rubin, Philip, Arusell, Robert M., Dunphy, Eamonn P., Khandekar, Janardan D., Reiner, Seth A., Báez-Díaz, Luis , Celano, Paul , Li, Yi , Burtness, Barbara , Adams, George L. , Pandya, Kishan J., Bhatia, Aarti K , Limburg, Paul J. , Burtness, Barbara , Lee, Ju‐Whei , Li, Shuli
Cancer | August 7, 2017 | Volume: 123 | Issue: 23 | Pages: 4653-4662
BACKGROUND13‐Cis retinoic acid (13‐CRA) is a synthetic vitamin A derivative. High‐dose 13‐CRA in patients with squamous cell cancers of the head and neck (SCCHNs) reduces the incidence of second primary tumors (SPTs). The authors report long‐term results from a phase 3 randomized trial that compared treatment with low‐dose 13‐CRA versus placebo for patients who had early stage SCCHN, with a focus on the development of SPTs and overall survival (OS).METHODSIn total, 176 patients who received treatment for stage I/II SCCHN were randomized to receive either low‐dose 13‐CRA (weight‐based dose of 7.5 mg or 10 mg) or placebo for 2 years. A competing‐risk approach and the log‐rank test were used to compare the time to SPT and OS, respectively, between groups.RESULTS13‐CRA neither significantly reduced the cumulative incidence of SPT (P = .61) nor improved the time to SPT (hazard ratio [HR] for 13‐CRA/placebo; 0.86; P = .61). Despite limited power, there was a trend toward improved OS for the 13‐CRA arm (HR, 0.75; P = .14), particularly among patients whose index tumor was surgically excised (N = 26; HR, 0.50; P = .057) and among women (N = 39; HR, 0.44; P = .065) and never/former smokers (N = 129; HR, 0.61; P = .055), with a median follow‐up of 16 years. The main 13‐CRA related toxicities were dry skin and cheilitis.CONCLUSIONSTreatment with low‐dose 13‐CRA for 2 years did not decrease the incidence of SPT; subset analysis indicates a potential survival advantage among patients who are women and never/former smokers. More targeted interventions based on clinical risk factors and molecular characterization of tumors may yield greater success in future prevention trials. Cancer 2017;123:4653‐4662. © 2017 American Cancer Society.