Comparison of 3-weekly cisplatin versus 3-weekly carboplatin in patients with locally advanced nasopharyngeal carcinoma receiving concurrent chemoradiotherapy: A multicentre analysis

Abstract

Background Although concurrent chemoradiotherapy (CCRT) with high-dose cisplatin remains a standard of care for patients with locally advanced nasopharyngeal carcinoma (LA-NPC), carboplatin has alternatively been used, particularly for cisplatin-ineligible patients. However, the comparable efficacy of these two regimens remains unclear. The present study aimed to evaluate the efficacy and tolerability of 3-weekly carboplatin and 3-weekly cisplatin therapies.Methods From May 2005 to November 2014, we identified patients with LA-NPC treated with CCRT from a Thai multicentre head and neck cancer database. The patients were administered a chemotherapy (CT) regimen of either cisplatin (75-100 mg/m 2 ) or carboplatin (AUC-5 or 6). Patient tolerability and survival were analysed and compared between regimens.Results Overall, 780 patients with LA-NPC were identified. Of these, the 76 patients (9.7%) treated with carboplatin showed significantly more comorbidity and lower baseline creatinine clearance than those treated with cisplatin. Compared with the cisplatin group, a higher number of patients in the carboplatin group completed three planned cycles of CT during CCRT (88.2% vs 52.0%; p <0.001) and three planned cycles of adjuvant CT (92.1% vs 78.7%; p =0.004). Furthermore, 28% of patients in the cisplatin group, as opposed to only 2.8% in the carboplatin group, required a dose reduction of CT in the subsequent cycle due to toxicities (p <0.001). At the time of analysis, the 5-year disease-free survival rate was 59.0% and 59.0% (p =0.935) and the 5-year overall survival rate was 64.0% and 66.0% (p =0.530), in the cisplatin and carboplatin groups, respectively.Conclusions Carboplatin provided comparable efficacy to that of cisplatin but with better tolerability and could be considered as an alternative regimen, particularly in cisplatin-ineligible patients with LA-NPC. These findings still warrant a randomised phase III study to compare these two CT regimens.

Combination Treatment With Paclitaxel, Carboplatin, and Cetuximab (PCE) as First-Line Treatment in Patients With Recurrent and/or Metastatic Nasopharyngeal Carcinoma

“…Despite the higher age of enrolled patients in the current study compared to GEM+CDDP (median 59.6 vs. 47 years), which potentially correlates with severe toxicity ( 24 , 25 ), the toxicity profile of PCE is considered equivalent to or partially more favorable than that of the historical GEM+CDDP cohort (e.g., current study vs. GEM+CDDP in grade 3 or above AE: neutropenia, 21.4 vs. 21%; anemia, 0 vs. 3%; thrombocytopenia, 0 vs. 11%) ( 2 ). Accumulating evidence has shown better tolerability with similar efficacy of CBDCA over CDDP in NPC ( 26 , 27 ). Furthermore, because the regimen was administered weekly, the chemotherapy dose can be adjusted immediately when adverse events arise.…”