Majority of the patients of head and neck cancer (HNC) that are treated with anticancer chemotherapy receive platinum based drugs. However, few patients cannot tolerate toxicity of these agents and hence are ineligible for platinum based chemotherapy. Treatment options for such patients are limited and outcomes are usually poor
We conducted a questionnaire based survey in 2016 among oncologists across India to understand routine clinical practice related to management of platinum ineligible patients. A questionnaire of 10 questions was prepared and circulated amongst 50 oncologists across India. Responses from 36 doctors were analysed.
Majority of doctors believe that clinical factors for considering a patient unfit for platinum based chemotherapy are age (61.1%), renal function (58.3%), performance status (33.3%), comorbid conditions (19.4%). Comorbid conditions that are considered before giving platinum based drugs to such patients are age (30.6%), diabetes (27.8%), cardiovascular function (30.6), renal function (38.9%). 91.7% doctors believe that functional age is a critical factor in such patients. Cut off age for platinum based treatment was stated to be 55 by 2.7%, 60 by 19.4%, 65 by 38.8%, 70 by 25% doctors. Methods used to reduce toxicity of platinum based chemotherapeutic agents include hydration (44.4%), supportive measures and drugs (11.1%), using alternative chemotherapy agents like carboplatin (8.3%), diuretics (8.3%), low dose therapy (11.1%). 69.3% doctors believe that additional nutritional support from the time of diagnosis will help convert platinum ineligible patients fit for platinum based treatment. In doctors opinion Carboplatin is given to 21.9% patients, docetaxel in 15.9% patients, paclitaxel in 10.3%, cituximab in 15.1%, nimotuzumab in 36.2% are given to such patients with radiotherapy.15.1% patients receive only radiotherapy.
Several factors render a patient unfit for platinum based chemotherapy. However no standard protocol is available to define patients ineligible for platinum based chemotherapy. Defining criteria for platinum ineligible patients will help in better decision making in day to day clinical practice and improve treatment outcomes
Clinical trial identification
Legal entity responsible for the study
Dr Dilip Pawar
All authors have declared no conflicts of interest.