The Study (rationale): This week, an NRG press release says: it can’t. What we lack in results, we’ll make up for in background. First, a series of small international trials in the 90s demonstrated a consistent survival benefit with the addition of platinum chemo (namely cisplatin 100 mg/m q3 weeks) to definitive radiation. Next we learned in 2006 with the Bonner trial that concurrent cetuximab also improves survival compared to radiation alone. Radiation schedules got weird for a while, but then in 2012 GORTEC 99-02showed that change-ups in radiation can’t make up for cisplatin, and, if you’re getting cisplatin, different radiation schedules don’t really change anything. Finally we’ve learned the adding cetuximab to cisplatin-radiation doesn’t help, but adding cisplatin to cetuximab-radiation does...indicating that cisplatin is probably the bigger driver of outcomes.
Bottom Line: After almost 1000 patients enrolled and 5 years follow-up, high-dose cisplatin results in longer overall survival than does cetuximab concurrent to IMRT conventionally fractionated at 6 treatments weekly for p16(+) oropharyngeal cancer (details TBA with live reporting from ASTRO 2018). | NRG 2018