Capecitabine-based triplet (TPX) as induction chemotherapy in advanced head and neck cancer: a daycare-based cohort study.

BACKGROUND

Head and neck squamous cell carcinoma (HNSCC) remains a global health burden. Induction chemotherapy using the regimen docetaxel, cisplatin and 5-fluorouracil (TPF) improves outcomes in advanced cases but requires continuous 5-FU infusion, limiting feasibility in daycare settings. Capecitabine, an oral prodrug of 5-FU, offers a convenient alternative. This study evaluates the efficacy and tolerability of a capecitabine-based triplet regimen docetaxel, carboplatin, capecitabine (TPX) as induction chemotherapy in a resource-limited, outpatient setting.

METHODS

This retrospective cohort study included 52 patients with stage IVA-IVB HNSCC treated between August 2023 and March 2025 at a Medical college in West Bengal, India. Patients were intended to receive four cycles of TPX every 21 days. Tumour response was assessed using Response Evaluation Criteria in Solid Tumours, version 1.1 after induction and following definitive therapy (surgery or chemoradiotherapy (CTRT)). Toxicities were recorded per Common Terminology Criteria for Adverse Events, version 5.0. Primary outcomes were response rates and toxicity; secondary outcome was feasibility of proceeding to curative treatment.

RESULTS

The cohort (median age 46 years; 65.4% male) had 38.5% oral cavity tumours. Following induction chemotherapy, the overall response rate (ORR) was 84.6%, with 100% ORR after definitive treatment. Oral cavity tumours showed 80% partial response (PR) post-induction; ten patients underwent successful surgery, while others received CTRT. In non-oral cavity cancers, 75% had a PR and 12.5% achieved a complete response post-induction. Toxicity was manageable; grade 3/4 neutropenia occurred in 9.6%, high-grade non-hematologic toxicity was also meagre and no treatment-related deaths were reported. Most patients (76.9%) completed all four cycles.

CONCLUSION

The TPX regimen is a well-tolerated and effective alternative to TPF for induction chemotherapy in advanced HNSCC, especially in daycare settings. It enables high response rates and facilitates curative treatment while avoiding the logistical challenges of infusional 5-FU. Further prospective studies are warranted to confirm survival benefits and support broader adoption.