Clinical Topics

Lower Dose Cisplatin Preferable in Squamous Cell Carcinoma

by U.S. Medicine

September 22, 2019

PHILADELPHIA—Chemoradiotherapy is commonly used for nonoperative treatment of locally advanced head and neck squamous cell carcinoma. The issue, according to a recent study, is that the standard dose of 100 mg/m2 cisplatin every three weeks is associated with clinically significant toxicity.

The report in the Journal of the National Cancer Institute pointed out that the desire for a more tolerable regimen has led clinicians to use weekly lower dose cisplatin, even though few randomized trials have compared the approaches.1

To remedy that, Michael J. Crescenz VAMC-led researchers examined outcomes of veterans with Stage III-IVb HNSCC treated with definitive intent chemoradiotherapy using either high-dose cisplatin or low-dose cisplatin.

The intent-to-treat analysis, which used population-based VA data, involved patients who were assigned to the HDC vs. LDC group according to the dose of their first cycle.

Researchers said variables potentially influencing treatment decisions were used to generate propensity scores for the use of HDC. Those included:

  • cancer site,
  • stage, and
  • smoking/alcohol use.

With 2,901 patients included in the analysis; 2,200 received HDC at mean initial dose of 100 mg/m2. The mean initial dose of LDC was 40 mg/m2.

Researchers determined that, after PS adjustment, HDC was not associated with improved overall survival over LDC (hazard ratio = 0.94, 95% confidence interval = 0.80 to 1.04).

Adjusting for PS, meanwhile, HDC was associated with an increased risk of acute kidney injury, neutropenia, dehydration/electrolyte disturbance and hearing loss, they said.

“In this large, population-based study of US military veterans, LDC was associated with similar survival to HDC in the nonoperative definitive management of locally advanced HNSCC of the oral cavity, oropharynx, and hypopharynx/larynx,” the authors concluded. “HDC was associated with statistically significantly more toxicity than LDC. Adoption of LDC may reduce toxicity burden while maintaining OS.”

  1. Bauml JM, Vinnakota R, Anna Park YH, Bates SE, et. Al.
  2. Cisplatin Every 3 Weeks Versus Weekly With Definitive Concurrent Radiotherapy for Squamous Cell Carcinoma of the Head and Neck. J Natl Cancer Inst. 2019 May 1;111(5):490-497. doi: 10.1093/jnci/djy133. PubMed PMID: 30239887; PubMed Central PMCID: PMC6510226.


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