Not so weakly cisplatin.
Top Line: Weekly cisplatin concurrent to head and neck radiation is back.
The Study: This is an oft-used approach for patients in whom a more consolidated high dose (100 mg/m2) given every 3 weeks is likely to lead to unwanted treatment breaks, something that happens in roughly 40% of cases. A previous randomized trial at Tata Memorial failed to demonstrate non-inferiority of weekly cisplatin at 30 mg/m2 for locoregional control in the (mostly) adjuvant setting for (mostly) oral cavity cancer. We now have a Japanese trial to assuage the biggest critique of the former design: the weekly cisplatin dose was simply too low. Here 261 patients were randomized to cisplatin at either 100 mg/m2 q3 weeks or 40 mg/m2 concurrent to adjuvant radiation following resection of head and neck squamous cell carcinoma with high-risk features (read: presence of positive margins or extracapsular extension). At a median follow-up of 2.2 years, weekly cisplatin at 40 mg/m2 indeed resulted in non-inferior overall survival when compared to 3-weekly cisplatin at 100 mg/m2 per the prespecified confidence interval upper limit. Estimated survival at 2 years for weekly versus 3-weekly cisplatin was 78% versus 74%, respectively and at 3 years was 72% versus 59%. What’s more, weekly cisplatin resulted in less renal compromise, hearing impairment, and neutropenia.
TBL: Weekly cisplatin at 40 mg/m2 results in non-inferior survival and favorable toxicity when compared to the standard 3-weekly cisplatin at 100 mg/m2 when delivered concurrent to adjuvant radiation for high-risk head and neck cancer. | Kiyota, J Clin Oncol 2022