Cumulative cisplatin dose in concurrent chemoradiotherapy for head and neck cancer: A systematic review

Strojan, Primož; Vermorken, Jan B.; Beitler, Jonathan J.; Saba, Nabil F.; Haigentz, Missak; Bossi, Paolo; Worden, Francis P.; Langendijk, Johannes A.; Eisbruch, Avraham; Mendenhall, William M.; Lee, Anne W.M.; Harrison, Louis B.; Bradford, Carol R.; Smee, Robert; Silver, Carl E.; Rinaldo, Alessandra; Ferlito, Alfio

doi:10.1002/hed.24026

Cited by 166 publications

(128 citation statements)

References 52 publications

(149 reference statements)

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“…Receipt of more systemic therapy was defined as ≥7 cycles of cetuximab, ≥6 cycles of weekly cisplatin, or ≥2 cycles of cisplatin every 3 weeks. These cutoffs were based on randomized trial evidence and retrospective analyses, which also matched the median number of cycles of each chemotherapy received in our cohort. Patients who received fewer cycles were labeled as having received less systemic therapy .…”

Section: Methodsmentioning

confidence: 99%

Survival of patients with head and neck cancer treated with definitive radiotherapy and concurrent cisplatin or concurrent cetuximab: A Surveillance, Epidemiology, and End Results‐Medicare analysis

Xiang

Holsinger

Colevas

et al. 2018

Cancer

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Background Cisplatin and cetuximab are both systemic therapies commonly used in combination with radiation (RT) for the definitive treatment of head and neck cancers, but their comparative efficacy is unclear. Methods Patients with locoregionally advanced (American Joint Committee on Cancer stage III‐IVB) squamous cell carcinomas of the oropharynx, larynx, or hypopharynx were identified in the Surveillance, Epidemiology, and End Results‐Medicare database. Patients received either cisplatin or cetuximab concurrent with RT, as determined by Medicare claims. The primary study outcome was head and neck cancer‐specific mortality (CSM) analyzed with competing risks. Filtering, propensity score matching, and multivariable Fine‐Gray regression were used to adjust for differences between the cisplatin and cetuximab cohorts, including age, comorbidity, and cycles of systemic therapy received. Results The total cohort consisted of 1395 patients, of whom 786 (56%) received cisplatin and 609 (44%) received cetuximab; the median follow‐up was 3.5 years in the patients who remained alive. In the cetuximab cohort, CSM was significantly higher than in the cisplatin cohort (39% vs 25% at 3 years; P < .0001). In the matched cohorts (n = 414), the adjusted hazard ratio of CSM for cetuximab was 1.65 (95% confidence interval, 1.30‐2.09; P < .0001) relative to cisplatin, corresponding to an absolute difference of approximately 10% in both CSM and overall survival at 3 years. Cetuximab was associated with less dysphagia, more dermatitis, and a similar incidence of mucositis. Conclusions In this sizeable, national patient population, treatment with cetuximab was associated with significantly higher CSM than cisplatin. These results suggest that cisplatin may be the preferred chemotherapeutic agent in this setting.

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Section: Methodsmentioning

confidence: 99%

Survival of patients with head and neck cancer treated with definitive radiotherapy and concurrent cisplatin or concurrent cetuximab: A Surveillance, Epidemiology, and End Results‐Medicare analysis

Xiang

Holsinger

Colevas

et al. 2018

Cancer

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“…92 Finally, a systematic review showed that in 6 definitive radiotherapy phase III trials there was a statistically significant association between cumulative cisplatin dose, and overall survival benefit for higher doses. 93 In summary, 2 or 3 courses of 3-weekly cisplatin could be considered the optimal dose for concurrent CTRT and equivalent doses of carboplatin have also been accepted by expert panels.…”

Section: ãããmentioning

confidence: 99%

A genetic view of laryngeal cancer heterogeneity

2016

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During the recent decades significant improvements in the understanding of laryngeal molecular biology allowed a better characterization of the tumor. However, despite increased molecular knowledge and clinical efforts, survival of patients with laryngeal cancer remains the same as 30 years ago. Although this result may not make major conclusions as preservation approaches were not broadly used until the time of database collection, it seems to be clear that there is still window for improvement.

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“…Mean cumulative doses of administrated cisplatin significantly differed between the muscle‐wasted and non‐wasted population, namely, 230 vs. 268 mg/m 2 , respectively ( P = 0.011). However, only three patients received <200 mg/m 2 , considering the effective cumulative dose (two non‐wasted and one wasted) …”

Section: Resultsmentioning

confidence: 99%

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

Willemsen

Hoeben

Lalisang

et al. 2019

J cachexia sarcopenia muscle

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Background Chemoradiation or bioradiation treatment (CRT/BRT) of locally advanced head and neck squamous cell carcinoma (LAHNSCC) comes with high toxicity rates, often leading to temporary tube feeding (TF) dependency. Cachexia is a common problem in LAHNSCC. Yet changes in body composition and muscle weakness during CRT/BRT are underexplored. Strong evidence on the effect of TF on body composition during treatment is lacking. The aim of this cohort study was to assess (i) the relationship of fat‐free mass index (FFMI) and handgrip strength (HGS) with CRT/BRT toxicity and outcome, (ii) body composition in patients treated with chemoradiation (cisplatin) vs. bioradiation (cetuximab), and (iii) the effect of the current TF regime on body composition and muscle strength. Methods Locally advanced head and neck squamous cell carcinoma patients treated with CRT/BRT between January 2013 and December 2016 were included (n = 137). Baseline measurements of body composition (bioelectrical impedance analysis) and HGS were performed. Toxicity grades (Common Terminology Criteria for Adverse Events) were scored. In a subset of 69 patients, weight loss, body composition, and HGS were additionally assessed during and after CRT/BRT. TF was initiated according to the Dutch guidelines for malnutrition. Results In this cohort (68% male, mean age 59 ± 8 years), the incidence of baseline muscle wasting, defined as FFMI < P10, was 29%. Muscle wasting was present in 23 of 100 (23%) chemoradiation patients and 17 of 37 (46%) bioradiation patients (P = 0.009). Muscle‐wasted patients required more unplanned hospitalizations during CRT (P = 0.035). In the chemoradiation subset, dose‐limiting toxicity was significantly higher in wasted vs. non‐wasted patients (57% vs. 25%, P = 0.004). Median follow‐up was 32 months. Multivariate Cox regression analysis identified muscle wasting as independent unfavourable prognostic factor for overall survival [hazard ratio 2.1 (95% CI 1.1–4.1), P = 0.022] and cisplatin as favourable prognostic factor [hazard ratio 0.3 (95% CI 0.2–0.6), P = 0.001]. Weight and HGS significantly decreased during CRT/BRT, −3.7 ± 3.5 kg (P < 0.001) and −3.1 ± 6.0 kg (P < 0.001), respectively. Sixty‐four per cent of the patients required TF 21 days (range 0–59) after CRT/BRT initiation. Total weight loss during CRT/BRT was significantly (P = 0.007) higher in the total oral diet group (5.5 ± 3.7 kg) compared with the TF group (3.0 ± 3.2 kg). Loss of FFM and HGS was similar in both groups. Conclusions In LAHNSCC patients undergoing CRT/BRT, FFMI < P10 is an unfavourable prognostic factor for overall survival, treatment toxicity, and tolerance. Patients experience significant weight and FFM loss during treatment. Current TF regime attenuates weight loss but does not overcome loss of muscle mass and function during therapy. Future interventions should consider nutritional intake and additional strategies specifically targeting metabolism, loss of muscle mass, and function.

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Cumulative cisplatin dose in concurrent chemoradiotherapy for head and neck cancer: A systematic review

Abstract: Results support the conclusion that the cumulative dose of cisplatin in concurrent chemoradiation protocols for HNSCC has a significant positive correlation with survival. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2151-E2158, 2016.

Cited by 166 publications

References 52 publications

Survival of patients with head and neck cancer treated with definitive radiotherapy and concurrent cisplatin or concurrent cetuximab: A Surveillance, Epidemiology, and End Results‐Medicare analysis

Survival of patients with head and neck cancer treated with definitive radiotherapy and concurrent cisplatin or concurrent cetuximab: A Surveillance, Epidemiology, and End Results‐Medicare analysis

A genetic view of laryngeal cancer heterogeneity

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

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