TPF: a rational choice for larynx preservation?

For many years, the standard approach for the treatment of resectable squamous cell carcinoma of the head and neck was surgery, with or without subsequent radiotherapy. However, the morbidity associated with this approach, particularly for patients requiring total laryngectomy, can severely impair a patient's quality of life. The finding that patients whose tumors responded to chemotherapy showed a good response to subsequent radiotherapy opened up the possibility of a new organ-preserving management strategy for patients with resectable disease. Randomized studies demonstrated that induction chemotherapy with a cisplatin-5-fluorouracil (5-FU) doublet (PF) prior to radiotherapy enabled larynx preservation in a substantial proportion of patients, compared with surgery plus radiotherapy, without compromising survival. The benefit in terms of larynx preservation when using platinum-based doublet induction chemotherapy followed by radiotherapy, compared with concurrent chemotherapy and radiotherapy, is less clear, although the sequential approach appears to be better tolerated. Adding the taxane docetaxel to PF, to create the TPF triplet regimen, led to significantly higher larynx preservation and laryngectomy-free survival rates than with the PF doublet. TPF is now the accepted standard induction chemotherapy regimen for future clinical trials in resectable disease. Methods for improving postinduction treatment strategies are being explored.