Less Frequent Cisplatin Superior in Head, Neck Cancer

TOPLINE:

A long-term follow-up analysis revealed that cisplatin administered at 100 mg/m² once every 3 weeks provides superior locoregional control and may offer longer overall survival than 30 mg/m² cisplatin once a week in patients with locally advanced head and neck cancer. Aside from hearing dysfunction, adverse events were similar between the two groups.

METHODOLOGY:

• Cisplatin is traditionally administered once every 3 weeks in patients with locally advanced head and neck cancer, but a lower dose option, given once a week, was introduced to reduce the likelihood of adverse events.
• In early findings from a phase 3 trial, researchers reported worse locoregional control but no difference in disease-free or overall survival with the once-a-week schedule. The long-term analysis provides updated findings, with outcomes at a 7-year follow-up.
• The trial enrolled 300 patients with locally advanced head and neck cancer randomly assigned to receive cisplatin either once every 3 weeks (100 mg/m²) or once a week (30 mg/m²) concurrently with radiotherapy. Most patients (90%) had oral cavity cancer and about 90% were men.
• The primary outcome was local or regional progression and secondary outcomes included overall survival, progression-free survival, and late adverse events.

TAKEAWAY:

• At 5 years, researchers reported worse locoregional control rates among patients receiving cisplatin once weekly vs once every 3 weeks (48.09% vs 56.76%, respectively), with a 44% higher risk for failure with the weekly dose (hazard ratio [HR], 1.44; P = .035). This relationship held after adjusting for age and primary site.
• The 5-year overall survival rate was higher in those receiving cisplatin once every 3 weeks (50.55% vs 43.6% for once weekly) and median overall survival was longer for those receiving weekly cisplatin (5.15 vs 3.24 years for once every 3 weeks), but the difference was not statistically significant (HR, 1.21; 95% CI, 0.90-1.62; P = .19).
• Progression-free survival at 5 years was similar between the two groups (HR, 1.12; 95% CI, 0.85-1.49; P = .4).
• On the adverse events front, patients on the once-every-3-weeks dose had higher rates of hearing dysfunction — any grade, 40.3% vs 18.9% and grade 3 and above, 16.1% vs 4.5% — but the rates for all other late adverse events, including dry mouth, skin changes, and dysphagia, were similar between the two groups.

IN PRACTICE:

In patients with locally advanced head and neck cancer undergoing concurrent chemoradiotherapy, the once-every-3-weeks dosing schedule of concurrent cisplatin provides “superior locoregional control, even at 7 years of follow-up,” the authors wrote.

SOURCE:

The study, led by Vanita Noronha, DM, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India, was published online in the International Journal of Radiation Oncology, Biology, Physics.

LIMITATIONS:

The study was conducted at a single center, with a lower weekly cisplatin dose (30 mg/m²) than in a similar Japanese study (40 mg/m²).

DISCLOSURES:

The study did not report receiving funding. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.