Efficacy of Carboplatin/Paclitaxel-Based Radiochemotherapy in Locally Advanced Squamous Cell Carcinoma of Head and Neck

Abstract

Background: Cisplatin-based chemotherapy (CTX) is commonly used concurrently with radiotherapy for head and neck cancer. The value of CTX regimens other than cisplatin for locally advanced squamous cell carcinoma of head and neck (LASCCHN) has not been well established. Here we compare the outcome of patients treated with different platinum-based chemotherapy regimens. Methods: Medical records from 104 patients with LASCCHN treated with radiochemotherapy (RCTX) between February 2013 and August 2016 were analyzed. Results: All patients were treated with intensity-modulated radiation therapy (51 definitive, 53 postoperative). The median total dose was 66.6 Gy and the median fraction dose was 1.8 Gy. 81 (78%) patients were administered cisplatin CTX, 23 (22%) patients received carboplatin and paclitaxel (CarboTaxol). The rate of recurrence was 38% in patients treated with cisplatin and 30% in CarboTaxol-treated patients (p = 0.6). Regarding the CTX regimens, event-free survival (EFS) was 37 versus 30 months (p = 0.6) and overall survival (OS) was 35 versus 28 months (p = 0.5) in cisplatin group versus CarboTaxol group, respectively. Significantly higher grade 3/4 acute toxicity in terms of dysphagia was observed following cisplatin-based RCTX (p = 0.002). In multivariable analysis, females and patients with early primary tumors (T1-2) have longer EFS and OS, regardless the CTX regimen. Conclusions: Primary or adjuvant RCXT with CarboTaxol is a safe and effective treatment alternative for LASCCHN patients with contraindication to cisplatin-based RCTX.

NCCN Guidelines® Insights: Squamous Cell Skin Cancer, Version 1.2022

“…Vlacich et al 78 reported that the 30-year locoregional control rate with intensity-modulated RT and concurrent carboplatin 1 paclitaxel was 83.2%, with disease-free survival and overall survival rates of 78.8% and 76.5%, respectively. Maring et al 79 reported a recurrence rate of 30% for patients treated with RT plus carboplatin 1 paclitaxel, compared with 38% of those treated with RT 1 cisplatin (P5.6). Event-free survival and overall survival were reported to be 30 and 28 months, respectively, for the RT plus carboplatin 1 paclitaxel group, versus 37 and 35 months, respectively, for the RT 1 cisplatin group.…”

Mode of action of carboplatin via activating p53/miR‐145 axis in head and neck cancers

“…Carboplatin is a chemotherapeutic agent commonly used in the treatment of head and neck cancers. 14,43 The main target of carboplatin is DNA, where it binds and cross-links the bases in the strands. 44 These cross-links inhibit DNA replication and repair, leading to transcription errors and inhibition of cellular functions.…”

“…Carboplatin is a chemotherapeutic agent commonly used in the treatment of head and neck cancers 14,43 . The main target of carboplatin is DNA, where it binds and cross‐links the bases in the strands 44 .…”

“…12,13 High-dose carboplatin in combination with fluorouracil was demonstrated to be effective against late-stage head and neck cancers with low toxicity potential. 14 In the meantime, carboplatin has been shown to cause changes in the microRNA profile of tumor cells. 15,16 However, there is limited study, especially in HNSCC, about the involvement of microRNAs in the cytotoxic affects of carboplatin while it kills the tumor cells, and further exploration is needed to reveal alternative modes of action for carboplatin.…”

“…Carboplatin forms cross‐links on DNA by binding covalently to guanine or adenine bases and causes DNA damage, which inhibits cell proliferation by activating cell signaling pathways involved in cell cycle arrest and apoptosis 12–13 . High‐dose carboplatin in combination with fluorouracil was demonstrated to be effective against late‐stage head and neck cancers with low toxicity potential 14 . In the meantime, carboplatin has been shown to cause changes in the microRNA profile of tumor cells 15–16 .…”