Tumor eradication rate was measured vs. the main toxicities found in the clinical study (lip mucositis and weight loss representing acute dysphagia in mice). The highest therapeutic ratio was achieved with a twice-weekly regimen of gemcitabine, at substantially lower doses than in the once-weekly check details regimen [12]. We have translated

these results into a phase I study of gemcitabine concurrent with RT for locoregionally advanced HNC, which is the subject of this report. On the basis of the preclinical study, we hypothesized that the maximum tolerated dose (MTD) of gemcitabine administered twice weekly concurrent with RT would be close to the MTD of the drug delivered alone twice-weekly: 75-90mg/m2/dose [13] and [14], allowing

potential preservation of the tumor sensitizing properties of gemcitabine in a better tolerated regimen. We have employed in this study several additional strategies to maximize the efficacy of the combined regimen. There is a theoretical advantage of treatment intensification with chemotherapy during the last weeks of radiotherapy, when accelerated tumor cell population growth is thought to take place, and clinical reports support the efficacy of such a chemotherapy “boost” [15], [16], [17] and [18]. We therefore opted to administer the twice-weekly gemcitabine during the last 2 weeks of the radiotherapy course. During this phase, radiation was delivered only to the gross tumor volume, intending Silibinin to minimize radiosensitization of the normal tissue included in target volumes of sub-clinical Natural Product Library order disease treated prophylactically. In addition, radiotherapy was

hyperfractionated, to gain potential tumor-control advantages [19]. We report here the results of a phase I translating our pre-clinical study, seeking the MTD of gemcitabine administered twice a week during the last 2 weeks of a hyperfractionated RT course for loco-regionally advanced, poor prognosis HNC. The trial was approved by the University of Michigan Institutional Review Board, and all patients signed Institutional Review Board–approved informed consent. The study group consisted of patients over 18 years of age with biopsy-proven squamous cell carcinoma of the head and neck who were not candidates for surgery because the tumor was considered nonresectable by tumor-board consensus or resection was expected to result in unacceptable functional or oncological outcomes. Other inclusion criteria were Karnofsky status at least 70, life expectancy at least 6 months, and adequate bone marrow, kidney, and liver function. Patients with a history of previous head/neck radiation or chemotherapy were excluded. Patients underwent a complete history and physical examination, baseline assessment of organ function, documentation of tumor location and size, and pregnancy test for premenopausal women.