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

Abstract

BackgroundAlthough 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.MethodsFrom 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/m2) or carboplatin (AUC-5 or 6). Patient tolerability and survival were analysed and compared between regimens.ResultsOverall, 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.ConclusionsCarboplatin 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.