***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Paclitaxel has been demonstrated to have significant activity in recurrent or metastatic head and neck cancer ( HNC ) . In addition , the combination of paclitaxel and cisplatin is active in untreated patients with inoperable HNC . Substitution of carboplatin for cisplatin allows the treatment to be delivered on an outpatient basis . PURPOSE OF THE STUDY To evaluate the activity and toxicity of the combination of paclitaxel by three-hour infusion and carboplatin as first-line chemotherapy in patients with recurrent or metastatic HNC . PATIENTS AND METHODS From March 1994 until August 1996 , 49 patients with recurrent or metastatic HNC were treated with paclitaxel ( 200 mg/m2 , by three-hour infusion ) followed by carboplatin at an AUC of 7 mg.min/ml , every four weeks . G-CSF was administered prophylactically on days 2 to 12 of each cycle . There were 41 men and 8 women with a median age of 57 years ( range 23 - 73 ) . The majority of the patients were symptomatic and they had recurrent disease locoregionally . Fourteen patients had nasopharyngeal cancer ( NPC ) and 35 had squamous cell cancers of other areas of the head and neck region ( non-NPC ) . RESULTS At the completion of treatment , two patients with NPC demonstrated complete and six partial responses for an overall response rate of 57 % ( 95 % CI 29%-82 % ) . Among patients with non-NPC , the response rate was 23 % ( 95 % CI 9%-37 % ) . After a median follow up period of 15 months , the median time to progression was 4.3 months in the non-NPC group and 16.5 months in the NPC group . At the time of the analysis , median survival had not been reached in NPC while it was 7.3 months in non-NPC patients . Grade 3 - 4 toxicities included anemia ( 2 % ) and leukopenia , thrombocytopenia , stomatitis , nausea/vomiting and diarrhea ( 4 % each ) . CONCLUSIONS The combination of paclitaxel and carboplatin appears to be well tolerated but only moderately active in patients with advanced non-NPC of the head and neck region . However , its activity appears promising in NPC and deserves further investigation OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND The most active chemotherapy regimens in UCNT were those combining anthracyclines ( doxorubicin or epirubicin ) and cisplatin . Our previous pilot study on 37 patients treated with the zorubicin-cisplatin combination with a RR of 67 % and literature data about other anthracyclines such as epirubicin achieving a response rate of over 50 % were the basis of this r and omized study comparing efficacy and toxicity of the combination vs. zorubicin as monotherapy . PATIENTS AND METHODS A total of 80 patients entered the study . The diagnosis of UCNT was confirmed by two independent pathologists . All patients had their primary tumors in the nasopharynx . The patients were r and omized in two groups : group A ( zorubicin 325 mg/m2 , day 1 ) , and group B ( zorubicin 250 mg/m2 , day 1 and cisplatin 30 mg/m2 , days 2 - 5 ) . The inter-cycle interval was four weeks . The two groups were well balanced according to sex , age , stage Ho and TNM stage . RESULTS Group A : 40 patients included , 34/40 evaluable for activity . Activity on evaluable patient basis : CR 4/34 ( 11.75 % ) , PR 4/34 , SD 14/34 , PD 12/34 , response rate 8/34 ( 23.5 % ) ; response rate on intent to treat basis 8/40 ( 20 % ) . TOXICITY granulocytopenia grade 3 - 4 6/40 , thrombocytopenia grade 3 - 4 2/40 , no febrile neutropenias , nausea/vomiting any grade 3/40 , cardiac toxicity any grade ( rhythm ) 3/40 other toxicities minor or absent . Group B : 40 patients included , 36/40 evaluable for activity . Activity on evaluable patient basis : CR 10/36 ( 27.78 % ) , PR 17/36 , SD 3/36 , PD 6/36 , response rate 27/36 ( 75 % ) ; response rate on intent to treat basis 27/40 ( 67.5 % ) . TOXICITY granulocytopenia grade 3 - 4 10/40 , thrombocytopenia grade 3 - 4 8/40 , two febrile neutropenias , nausea/vomiting any grade 13/40 , other toxicities mild or absent . Of the group of patients achieving a CR , four relapsed following 7 , 11 , 22 and 23 months , one was lost to follow-up , one died after six months from fulminant hepatitis B and eight are in complete remission lasting for 30 + to 66 + months . Following CR achievement none received any consolidation radiotherapy , and the projected five years of freedom from relapse for complete responders is about 60 % . CONCLUSION Zorubicin is an effective drug in UCNT and its combination with cisplatin has a significant activity and an acceptable toxicity BACKGROUND Nasopharyngeal carcinoma ( NPC ) is a platinum-sensitive cancer and excision repair cross-complementing group 1 ( ERCC1 ) polymorphisms have been shown to predict survival in several cancers following platinum therapy . PATIENTS AND METHODS This multicenter study evaluated the activity of oxaliplatin and prolonged infusion of gemcitabine ( ' GEMOX ' regimen ) in recurrent NPC . Baseline blood sample s were genotyped for the presence of ERCC1 - 118 gene polymorphisms . RESULTS Forty-two patients were recruited , of whom most ( 61 % ) had metastatic disease . Of the 40 patients evaluated for response , the respective overall response and disease control rates were 56.1 % and 90.2 % . At a median follow-up of 14.8 months , the respective median overall survival and time to progression were 19.6 months [ 95 % confidence interval ( CI ) = 12.8 - 22 months ] and 9 months ( 95 % CI = 7.3 - 10 months ) . Grade 3 - 4 toxic effects were uncommon . The distribution of ERCC1 - 118 genotypes from 29 patients was C/C ( n = 17 , 40.5 % ) , C/T ( n = 10 , 23.8 % ) and T/T ( n = 2 , 4.8 % ) . No differences in survival or response rates were found between genotypes . CONCLUSIONS GEMOX is active in the treatment of recurrent NPC . Detection of single-nucleotide gene polymorphisms from genomic DNA in peripheral blood is feasible in NPC and further studies are warranted OBJECTIVE The purpose of this article is to compare the recently published revised Response Evaluation Criteria in Solid Tumors ( RECIST ) guidelines ( version 1.1 ) to the original guidelines ( RECIST 1.0 ) for advanced non-small cell lung cancer ( NSCLC ) after erlotinib therapy and to evaluate the impact of the new CT tumor measurement guideline on response assessment . MATERIAL S AND METHODS Forty-three chemotherapy-naive patients with advanced NSCLC treated with erlotinib in a single-arm phase 2 multicenter open-label clinical trial were retrospectively studied . CT tumor measurement records using RECIST 1.0 that were generated as part of the prospect i ve clinical trial were review ed . A second set of CT tumor measurements  was generated from the records to meet RECIST 1.1 guidelines . The number of target lesions , best response , and time to progression were compared between RECIST 1.1 and RECIST 1.0 . RESULTS The number of target lesions according to RECIST 1.1 decreased in 22 patients ( 51 % ) and did not change in 21 patients ( 49 % ) compared with the number according to RECIST 1.0 ( p < 0.0001 , paired Student 's t test ) . Almost perfect agreement was observed between best responses using RECIST 1.1 and RECIST 1.0 ( weighted kappa = 0.905 ) . Two patients with stable disease according to RECIST 1.0 had progressive disease according to RECIST 1.1 criteria because of new lesions found on PET/CT . There was no significant difference in time to progression between RECIST 1.1 and RECIST 1.0 ( p = 1.000 , sign test ) . CONCLUSION RECIST 1.1 provided almost perfect agreement in response assessment after erlotinib therapy compared with RECIST 1.0 . Assessment with PET/CT was a major factor that influenced the difference in best response assessment between RECIST 1.1 and RECIST 1.0 PURPOSE To evaluate the role of aggressive combination chemotherapy in patients with poorly differentiated carcinoma of the nasopharynx ( NPC ) . PATIENTS AND METHODS In a prospect i ve phase I/II study , 90 chemotherapy-naive patients with NPC ( 21 with very advanced locoregional disease , 18 with locoregional persistent and /or recurrent disease postradiotherapy , and 51 with metastatic disease ) were treated with cyclophosphamide , doxorubicin , cisplatin , methotrexate , and bleomycin ( CAPABLE ) . Two schedules of this regimen were used over a 9-year period , with the second schedule being a modification of the first in an attempt to minimize treatment-related toxicity . RESULTS Of 21 patients with very advanced local disease , one had a complete response ( CR ) and 17 had partial responses ( PRs ) ( response rate , 86 % ) . Seventeen of these 21 patients had subsequent radiotherapy . Of 17 patients with measurable locoregional disease either persistent and /or recurrent postradiotherapy , there were four CRs and three PRs ( response rate , 41 % ) . Of 44 patients with measurable metastatic disease , there were three CRs and 32 PRs ( response rate , 80 % ) . The median survival duration s for these three groups of patients were 47 , 16 , and 14 months , respectively . The two chemotherapy schedules had similar received dose-intensities ( RDIs ) and produced similar response rates and survival . Toxicity was severe with frequent mucositis and myelosuppression . Overall , 37 patients required at least one hospital admission for management of toxic side effects and there were seven drug-related deaths . Three of the deaths were due to fulminant hepatitis , likely from reactivation of hepatitis B. CONCLUSION This aggressive regimen provides a high rate of tumor response , but limited palliation for most patients with recurrent or metastatic NPC . The results with chemotherapy followed by radiotherapy for patients with very advanced local disease are encouraging , but proof of benefit would require evaluation in a r and omized trial 
    Output:
    
Conclusions Among four commonly used first-line chemotherapy regimens for R/M NPC , triplet combination regimen showed best short-term efficacy but failed to improve prognosis .
TP regimen demonstrated fairly good short-term efficacy and best long-term efficacy , followed by GP regimen , while FP regimen was the lowest