Treatment outcomes of standard (high dose) cisplatin and non-standard chemotherapy for locally advanced head and neck cancer
- Author(s)
- Alamgeer, M; Coleman, A; McDowell, L; Giddings, C; Safdar, A; Sigston, E; Wang, Y; Subramaniam, A;
- Journal Title
- Cancer Reports
- Publication Type
- Research article
- Abstract
- INTRODUCTION: Concurrent chemoradiotherapy with high-dose (HD) cisplatin is the standard treatment for locally advanced head and neck squamous cell carcinoma (LA-HNSCC). Due to the higher treatment-related adverse effects with standard therapy, alternative regimens (non-standard therapy), namely, lower dose weekly cisplatin, carboplatin/paclitaxel, or cetuximab are considered. There is, however, no consensus on non-standard regimens. We aimed to investigate the efficacy and safety profile of these regimens. METHODS: This single centre retrospective cohort study included all consecutive adult patients with newly diagnosed LA-HNSCC treated with either standard or non-standard regimens between January 2016 and April 2021. The primary outcome was 2-year failure-free survival (FFS). The secondary outcomes included acute toxicities, hospitalisation rates, dose modifications, treatment failure rates (TFR), and overall survival. RESULTS: About 235 patients were included in the final analysis; median age was 61 years (IQR 55-67), and 87% were male. Most had oropharyngeal tumours (85.5%) and p16-positivity was frequent (80%). About 56% received non-standard regimens: weekly cisplatin = 79 and non-cisplatin = 48. These patients had higher Charlson Comorbidity Index (CCI; p < .001) and lower European Cooperative Oncology Group (ECOG)-0 (p = .003). There was no difference in 2-year FFS (hazard ratio [HR] = 1.16; 95% confidence interval - [CI] 0.65-2.05), hospitalisation and grade-3 toxicity rates between the two regimens. Nausea and vomiting were lower in the non-standard regimen (3.0% vs. 16%, p < .001). Dose reductions, adjusted for age, sex, and CCI, were less likely in the non-standard regimen (OR = 2.36; 95%-CI: 1.01-5.49, p = .007). CONCLUSIONS: We demonstrated similar efficacy of lower dose weekly cisplatin and carboplatin/paclitaxel regimens and better safety profile of weekly cisplatin compared to standard HD cisplatin regimens for LA-HNSCC. Multicenter randomised control trials are required in HD cisplatin-ineligible patients.
- Publisher
- Wiley
- Keywords
- Adult; Humans; Male; Middle Aged; Female; *Cisplatin; Carboplatin; Squamous Cell Carcinoma of Head and Neck/drug therapy; Retrospective Studies; *Head and Neck Neoplasms/drug therapy; Treatment Outcome; Paclitaxel/adverse effects
- Department(s)
- Radiation Oncology; Radiation Oncology
- PubMed ID
- 35792145
- Publisher's Version
- https://doi.org/10.1002/cnr2.1674
- Open Access at Publisher's Site
https://doi.org/10.1002/cnr2.1674- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2023-03-30 04:17:51
Last Modified: 2023-08-17 04:02:03