Induction TPF Followed by Concomitant Treatment versus Concomitant Treatment Alone in Locally Advanced Head and Neck Cancer: A Phase II–III Trial

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Citation: Ghi MG et al. Induction TPF followed by concomitant treatment versus concomitant treatment alone in locally advanced head and neck cancer: a phase II–III trial. Annals of Oncology, 1 September 2017; 28(9): 2206–2212. DOI: 10.1093/annonc/mdx299
  • Key Findings:
    • Design:
      • A randomized phase II–III study comparing:
        Induction TPF (docetaxel, cisplatin, 5‑FU) followed by concomitant treatment (either chemoradiation [CCRT] or cetuximab/RT),
        versus concomitant treatment alone (CCRT or cetuximab/RT without induction)
    • Participants:
      • 414 patients analyzed (206 in the induction arm, 208 in the no‑induction arm)
    • Outcomes (median follow-up ~ 44.8 months):
      • Overall Survival (OS):
        • Significantly improved with induction:
          • Hazard Ratio (HR) 0.74; 95% CI, 0.56–0.97; P = 0.031
      • Progression-Free Survival (PFS):
        • Significantly better in the induction (IC) arm (P = 0.013)
      • Complete Response Rates:
        • Higher in the induction arm (P = 0.0028)
      • Locoregional Control:
        • Also significantly improved (P = 0.036)
      • Treatment Compliance:
        • Not adversely affected by induction therapy 
  • Summary for Head and Neck Surgeons
    • Publication:
      • This is an official, peer-reviewed publication, no longer merely an abstract
    • Significance:
      • It remains the only phase II–III trial reporting a statistically significant survival benefit (OS, PFS), better response rates, and improved locoregional control when adding TPF induction before chemoradiation, without harming treatment compliance
    • Clinical Interpretation:
      • These results strengthen the hypothesis that carefully administered TPF induction can offer meaningful benefit:
        • But they differ from the negative phase III findings of PARADIGM and DeCIDE
      • This raises important questions about variations in trial populations, concurrent treatments (cisplatin vs. cetuximab), and trial settings
    • Regulatory and Guideline Context:
      • While promising, broader adoption must weigh this one positive study against other evidence
      • Induction TPF remains non-standard but can be considered within multidisciplinary discussions:
        • Especially for patients with high-risk features or when organ preservation is a priority



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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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