CRT including three cycles of cisplatin is considered the standard of care for LA-HNSCC. Around one third of the patients cannot complete cisplatin due to toxicity. Carbo-5FU can be used as an alternative. The aim of this study was to compare tolerability and efficacy between CRT with carbo-5FU and cisplatin.
This is a retrospective analysis of patients with LA-HNSCC treated with concomitant CRT in two Dutch cancer centers between 2007-2016. All patients received intensity modulated radiotherapy. One center routinely administered carboplatin 300-350 mg/m2 at day 1, 22 and 43 followed by 5FU 600mg/m2/day for 96 hours. The other center used cisplatin 100 mg/m2 at day 1, 22 and 43. Primary endpoint was chemotherapy completion rate. Secondary endpoints included: reason for discontinuation, number of unplanned admissions, overall survival (OS) and disease free survival (DFS). Associations between clinicopathological parameters and OS were determined with multivariate Cox regression analyses.
In the carbo-5FU cohort (n = 190), 61.6% of the patients completed chemotherapy versus 76.7% (p = 0.001) of the patients in the cisplatin cohort (n = 223). Discontinuation caused by chemotherapy specific toxicity occurred twice as often in the carbo-5FU cohort (odds ratio 2.2, 95%CI, 1.38-3.5). Patients in the cisplatin cohort were more likely to have an unplanned admission (OR 2.96, 95%CI, 2.21-4.27). The risk of death was higher in the carbo-5FU cohort (HR 1.50, 95%CI, 1.06-2.12, p = 0.02) with a three-year OS of 64.6% compared to 76.6% in the cisplatin cohort. Similar results were observed for DFS (HR 1.39, 95%CI, 0.99-1.93, p = 0.06). T-classification, N-classification, smoking and p16 status were independently associated with OS, but chemotherapy regimen was not (HR 1.04, 95%CI, 0.72-1.51, p = 0.84).
Patients treated with carbo-5FU less frequently completed chemotherapy because of chemotherapy specific toxicity. Better OS was observed in the cisplatin cohort, but chemotherapy regimen was not independently associated with OS.
Clinical trial identification
Legal entity responsible for the study
J.A. Gietema: Research grant to institution: Roche, Siemens. B.E.C. Plaat: Research grant to institution: Olympus NL. J.A. Langendijk: Coporate sponsored research with RaySearch, Phillips, Mirada and IBA. S.F. Oosting: Research grant to the institutuion from Pfizer. All other authors have declared no conflicts of interest.