(0666) Induction Chemotherapy Prior to Surgical Resection in Advanced Oral Cavity Squamous Cell Carcinoma

Introduction: The standard of care for locally advanced oral cavity squamous cell carcinoma (OCSCC) remains surgery followed by adjuvant therapy based on pathology. The role of induction chemotherapy (IC) for locoregionally advanced OCSCC remains understudied.

Methods: A retrospective chart review was performed to identify patients with stage III-IV OCSCC treated with IC prior to surgical resection from January 1995 to January 2024 at a tertiary care center. Patient demographics and clinicopathologic characteristics, indications for IC, surgical management, tumor response, and survival outcomes were collected.

Results: A total of 30 patients were identified (60% male) from a surgical database. The most common anatomic subsites were oral tongue (53%), mandibular alveolar ridge (30%), and maxillary alveolar ridge (10%). Cited reasons for IC were 1) rapid progression of tumor (46.6%) 2) anticipated morbidity of surgical resection (16.7%) 3) medical stabilization required prior to surgery (20%) 4) delay in timing of surgery (6%) and 5) socioeconomic factors (6%). IC regimens included Carpoplatin+Taxol (60%), Cisplatin+Docetaxel+Fluoruracil (23.3%), or other combination of platin/taxane therapy (16.6%). In regards to tumor response to IC, 4 patients had progression, 7 had no response, 8 had a partial response, and 12 responded well. Most cases required free flap reconstruction (86.6%). A majority of patients received adjuvant radiation (77%) and 57% received adjuvant chemotherapy. Median follow-up was 45 months. At follow-up, 12 patients (40%) recurred (6 local, 1 regional, 5 distant). Two-year overall survival was 63.3% (95% CI 47.5%-84.4%). Two-year disease-free survival was 60.4% (95% CI 43.7% - 83.4%). Both OS (log-rank; p = 0.032) and DFS (p = 0.007) were significantly different across tumor response patterns.

Conclusions: IC in patients with locoregionally advanced OCSCC may offer benefit in terms of organ preservation and disease burden. Additional prospective clinical trials, with particular attention to the role of immunotherapy in combination with chemotherapy in the neoadjuvant setting are needed.