Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland.
Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, Freiburgstrasse, 3010, Bern, Switzerland.
Strahlenther Onkol. 2019 Jun;195(6):468-474. doi: 10.1007/s00066-018-1400-5. Epub 2018 Nov 21.
The second primary cancer (SPC) incidence after treatment with platinum-based chemotherapy and cetuximab in combination with radiotherapy has not been previously reported. Our aim was to compare SPC risk following radiotherapy in combination with these agents for the treatment of head and neck squamous cell carcinoma (HNSCC).
The charts of 296 cases treated for loco-regionally advanced HNSCC between 2009 and 2015 were retrospectively reviewed for patient, tumor, and procedural characteristics. All patients were planned to undergo radiotherapy either with platinum compounds (group: Platinum) or monoclonal antibody cetuximab (group: Cetuximab). A third group of patients switched from platinum compounds to cetuximab due to toxicity (group: Switch). Treatment groups were evaluated for the incidence of SPC with log-rank test. Possible confounders were investigated with multivariate Cox's proportional hazards model. All tests were two-sided, and a p < 0.05 was set to indicate statistical significance.
Median follow-up was 36 months. Platinum, Cetuximab, and Switch groups consisted of 158, 101, and 37 patients, respectively. Three-year overall survival in the whole cohort was 70%. The rate of SPC was comparable between Platinum (9.2%) and Cetuximab (11.5%) groups (p = 0.98), whereas the patients in the Switch group were exposed to a significantly higher incidence of SPC (23.3%) in 3 years (p = 0.01). The multivariate model indicated Switch to be the only variable correlating with an increased risk for SPC.
The Switch strategy may expose the patients to an increased risk of developing SPC. The use of switch should be advocated with caution until robust pre-clinical and clinical data are available.
铂类化疗联合西妥昔单抗联合放疗后第二原发癌（SPC）的发生率尚未见报道。我们的目的是比较这些药物联合放疗治疗头颈部鳞状细胞癌（HNSCC）后 SPC 的风险。
回顾性分析 2009 年至 2015 年间局部晚期 HNSCC 患者 296 例的病历、肿瘤和手术特点。所有患者均计划接受铂类化合物（铂类组）或单克隆抗体西妥昔单抗（西妥昔单抗组）放疗。由于毒性，第三组患者从铂类化合物转为西妥昔单抗（转换组）。用对数秩检验评估 SPC 的发生率。用多变量 Cox 比例风险模型分析可能的混杂因素。所有检验均为双侧检验，p<0.05 为差异有统计学意义。
中位随访时间为 36 个月。铂类、西妥昔单抗和转换组分别有 158、101 和 37 例患者。全组 3 年总生存率为 70%。铂类组（9.2%）和西妥昔单抗组（11.5%）SPC 发生率无差异（p=0.98），而转换组患者 3 年 SPC 发生率明显升高（23.3%）（p=0.01）。多变量模型表明转换是唯一与 SPC 风险增加相关的变量。
转换策略可能使患者发生 SPC 的风险增加。在获得强有力的临床前和临床数据之前，应谨慎使用转换策略。
