Comparative study of efficacy, toxicity, and tumor regression of nano-docetaxel+platinum+5FU vs +capecitabine in LA-HNSCC.

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Background: Locally advanced head and neck squamous cell carcinoma (LA-HNSCC) poses challenges due to aggressive disease biology and high treatment-related morbidity. Induction chemotherapy with TPF (docetaxel, cisplatin, 5-fluorouracil) is standard, but significant toxicity limits compliance. Substitution of 5-FU with oral capecitabine (TPX regimen) may improve tolerance and compliance without reducing efficacy. Methods: A prospective comparative observational study was conducted on 100 patients with LA-HNSCC. Fifty patients received TPF (docetaxel + cisplatin + 5-fluorouracil) and Fifty patients received TPX (docetaxel + cisplatin + capecitabine). Toxicities were graded using CTCAE criteria, compliance was defined as completion of the planned chemotherapy cycles, and tumor response was assessed using RECIST 1.1 criteria following three cycles. Results: Both regimens demonstrated comparable tumor regression. Patients on TPF experienced higher rates of grade III–IV neutropenia and mucositis, whereas TPX patients showed better compliance with reduced infusion-related complications. However, TPX was associated with hand-foot syndrome and mild gastrointestinal toxicity. Conclusions: In this small cohort, TPX showed efficacy comparable to TPF with better compliance and a favorable toxicity profile. TPX may serve as a feasible and patient-friendly alternative to TPF in the induction setting for LA-HNSCC.