Neoadjuvant Capecitabine in Operable HPV‐Negative Head and Neck Cancer: Fortuitous Findings in a Resource Constrained Setting

Objective Limited progress has occurred in treating operable human papillomavirus (HPV)‐negative head and neck squamous cell carcinoma (HNSCC). Accessing timely care remains challenging in public health care systems, potentially resulting in disease progression before treatment initiation. Study Design A prospective cohort of patients receiving neoadjuvant capecitabine (NC) was compared to stage‐matched patients undergoing standard of care (SC). Setting This study was performed at 2 academic centers in Montreal, Canada. Methods To ascertain the effect of 2 cycles of NC in operable HPV‐negative HNSCC patients on clinical‐to‐pathologic stage migration. Comparison to an SC group was performed to site and TNM stage matched patients. Pathologic treatment response was measured using the modified Ryan score. Results We compared 16 NC patients (11 oral cavity, 3 skin, 2 larynx) with 32 SC patients. Ten NC patients exhibited a pathologic response (1 complete, 3 major, 6 minor). Clinical‐to‐pathologic stage migration differed significantly between NC and SC groups: downstage (6 vs 1), upstage (3 vs 14), no change (7 vs 17, P = .0047). There was no severe treatment toxicity related to capecitabine. All patients in the NC group underwent surgery. Conclusion NC followed by surgery demonstrates measurable pathologic response in HPV‐negative HNSCC, suggesting potential utility in resource‐limited health care settings.