The Study: Nedaplatin is a second-generation platinum agent developed to be less toxic and easier to administer than cisplatin. So let's see how it holds up in this noninferiority trial. Over 400 patients with locally-advanced NPC were randomized to intensity modulated radiation (IMRT) with concurrent nedaplatin versus cisplatin, each administered every 3 weeks. 64-70 Gy was prescribed to the primary tumor and nodal mets including a small margin with roughly 60 Gy to a 1 cm expansion around gross disease and 54-56 Gy to a low risk volume--all in 30-33 fractions. The primary endpoint of progression-free survival at 2 years was noninferior with nedaplatin. What’s more, nedaplatin significantly reduced several acute toxicities such as nausea, vomiting, and weight loss on top of slightly lowering the rate of long term hearing loss. Too good to be true? This editorial thinks maybe so and raises concerns about the statistical design and variations in radiation delivery.
Bottom Line: This imperfect data demonstrates that nedaplatin concurrent to radiation for NPC reduces acute toxicity and long-term hearing loss without forfeiting disease control when compared head-to-head with the standard cisplatin.