Carboplatin: The Better Platinum in Head and Neck Cancer?

Abstract

\s=b\ Chemotherapeutic regimens containing cisplatin are the most effective ones in the treatment of squamous cell carcinoma of the head and neck. Because of the high rate of dose-limiting side effects of cisplatin, carboplatin, a second-generation cisplatin analogue, was tested in a phase II trial with fluorouracil in 55 previously untreated patients with advanced carcinoma of the head and neck. Among the 52 patients who completed the study, there were 17 complete responses (33%), 28 partial responses (54%), five patients with no change (10%), and two with progressive disease (4%). Toxic side effects of all courses summed together included leukopenia in 65% of courses, thrombocytopenia in 45% of courses, nausea or vomiting in 29% of courses, and change in serum creatinine level in 3% of courses. These data were compared with the results of our study with cisplatin and fluorouracil in comparable patients and indicated that carboplatin and fluorouracil is better for induction chemotherapy in the treatment of head and neck cancer than cisplatin and fluorouracil due to similar effectiveness but less toxic effect.

Concomitant Radiotherapy and Daily Low-Dose Carboplatin in Locally Advanced, Unresectable Head and Neck Cancer Definitive results of a phase I-II study

“…Leukopenia was the only dose-limiting side-effect. From this point of view, the actual treatment schedule was noticeably better tolerated than monthly carboplatin doses (13) and well comparable with other fractionated schedules in which the total dose of the drug was 15-25% lower than in our trial (10,(13)(14)(15). Oral and pharyngeal mucositis were moderate in the majority of patients.…”

“…NO additional advantages seem to have been observed by using other fractionated carbo-platin schedules and irradiation with 2 fractions daily ( 15,25). I n our series, surgical resection of residual tumor mass played an important role; after salvage survery the CR rate increased considerably with minimal complications.…”

Induction chemotherapy by superselective intra-arterial high-dose carboplatin infusion for head and neck cancer

“…Carboplatin seems to present an antitumor activity comparable to that of cisplatin and a toxicology profile that has less renal and gastrointestinal effects [4,10,21,27]. We administered doses of carboplatin far higher than that used by Vieitez et al [25] and Padolecchia et al [16] but comparable to the cisplatin "decadoses" used by Robbins et al [17][18][19][20], without resorting to the simultaneous intra-arterial administration of 5-fluorouracil to potentiate the effects of carboplatin and without relying on a simultaneous intravenous treatment aimed to achieve systemic carboplatin neutralization.…”

Second-line chemotherapy in head and neck cancer: what should we expect?

“…Cisplatinum is particularly well known for its oto-and nephrotoxicity, whereas carboplatin is more hematotoxic [33]. 5-FU produces stomatitis in higher dosages.…”