Comparing high‐dose cisplatin with cisplatin‐based combination chemotherapy in definitive concurrent chemoradiation setting for locally advanced head and neck squamous cell carcinoma (LAHNSCC)

Abstract

Background High‐dose cisplatin (Cis) is a preferred systemic agent for concurrent chemoradiation (CRT) in locally advanced head and neck squamous cell cancer (LAHNSCC) patients. As some patients are unable to tolerate Cis, this study compares the toxicity and efficacy of weekly cisplatin‐paclitaxel (CP) regimen with Cis. Methods Patients with LAHNSCC receiving definitive chemoradiation either with Cis (Cisplatin—100 mg/m2 q3w x 3) or CP (Cisplatin—20 mg/m2; Paclitaxel—30 mg/m2qw x7) were included. Results Cis and CP groups were comprised of 114 and 111 subjects, respectively. Complete response for Cis versus CP groups was 88% versus 88%, respectively. Median follow‐up for the study was 58.5 months. After adjusting for potential treatment selection bias, no significant differences were evident between Cis and CP groups for overall survival (hazard ratios [HR] 0.85, 95% CI 0.59‐1.21, P = 0.36), progression free survival (HR 0.88, 95% CI 0.62‐1.24, P = 0.46), locoregional control (HR 0.77, 95% CI 0.52‐1.15, P = 0.21), and distant control (HR 0.87, 95% CI 0.61‐1.23, P = 0.42). Patients in the CP group had less acute and chronic toxicities. Conclusions Weekly CP regimen can serve as an alternative systemic therapy with radiation in patients with LAHNSCC who are not fit for Cis.

Cisplatin combined with laser‑activated nanotherapy as an adjuvant therapy for head and neck cancer

“…A previous study compared cisplatin combined with paclitaxel to high-dose cisplatin in patients with locally advanced HNSCC receiving concurrent radiation. That study demonstrated less acute and chronic toxicities at one-fifth of the cisplatin dose with comparable overall survival rates and efficacy (10). In another study that followed patients with locally advanced HNSCC, induction chemotherapy combining docetaxel, cisplatin, and fluorouracil (TPF), in comparison to cisplatin and fluorouracil (PF), demonstrated significant improvement in overall-, median-and progression-free survival without increasing treatment-related toxicity, as measured by tracheostomies and dependence on gastric feeding tubes (18).…”

“…Consequently, normal tissue and healthy cells throughout the body are also affected, resulting in one of the biggest patient-centered challenges with cisplatin: side effects. Not all patients will experience all of the known or listed side-effects, but some of the most common side-effects include nausea, vomiting, nephrotoxicity and ototoxicity, with the latter two being the most severe (10)(11)(12).…”

“…Following the onset of drug resistance, these patients usually do not survive past one year (6,16,17). Poor survival rates and outcomes are among the reasons that the scientific community is beginning to explore strategies to increase the efficacy of cisplatin at lower doses by combining it with other treatment modalities and manipulating the dosing schedule (6,10,(18)(19)(20)(21). Dosing typically depends on the patient's height, weight, general health and any specific health condition.…”

“…The standard cisplatin dose and schedule are usually 3 cycles of 100 mg/m 2 every 3 to 4 weeks when used individually as a monotreatment for HNC patients (22)(23)(24). Recent studies on manipulating the cisplatin dosage have compared high-dose cisplatin with a cisplatin-based combination therapy (radiation, chemotherapy, or other intervention) to decrease side-effects, increase treatment efficacy and improve patient outcomes and overall survival rates (8,10,11,21,(24)(25)(26)(27).…”

Precision Medicine in Head and Neck Cancers: Genomic and Preclinical Approaches

“…The involvement of surgical margins, extra-nodal extension, and perineural invasion are pathological features that describe the group of patients with a higher risk of recurrence. In these cases, radiotherapy and high doses of cisplatin-based chemotherapy improve patient survival [ 45 ]. Conversely, tumours at an advanced stage are commonly treated with CRT.…”