Department of Radiation Oncology.
Department of Medicine, Division of Oncology, and.
J Natl Compr Canc Netw. 2019 Sep 1;17(9):1065-1073. doi: 10.6004/jnccn.2019.7297.
For definitive chemoradiotherapy (chemoRT) of head and neck squamous cell carcinoma (HNSCC), cisplatin is the preferred concurrent agent, with superiority over cetuximab for HPV-associated oropharyngeal squamous carcinoma recently shown in 2 randomized trials (RTOG 1016 and De-ESCALaTE). Patients who are not candidates for cisplatin may be treated with carboplatin instead, but its comparative efficacy is unclear. We analyzed nationwide patterns of care and cancer-specific outcomes after cisplatin- versus carboplatin-based chemoRT.
Patients with locoregionally advanced (stages III-IVB according to the 6th and 7th editions of the AJCC Cancer Staging Manual) squamous cell carcinoma of the oropharynx, larynx, or hypopharynx who received definitive radiotherapy (RT) were identified in the linked SEER-Medicare database. The concurrent chemotherapy regimen was determined through corresponding Medicare claims. Death caused by HNSCC (cancer-specific mortality [CSM]) was analyzed with competing risks. Propensity score analysis and multivariable Fine-Gray regression were used to adjust for baseline differences, including age and comorbidity.
We identified 807 patients who received cisplatin-based chemoRT and 342 who received carboplatin-based chemoRT. Most carboplatin recipients (68%) had combination chemotherapy, predominantly with paclitaxel. Carboplatin- and cisplatin-based chemoRT had similar incidences of death attributable to HNSCC (3-year CSM, 29% vs 26%; P=.19), which persisted in propensity score-matched analysis. In addition, no significant difference in overall survival was seen in the matched cohorts. ChemoRT with either cisplatin or carboplatin was superior to RT alone and RT with concurrent cetuximab. In the multivariable model, the adjusted hazard ratio of CSM for carboplatin relative to cisplatin was 1.01 (95% CI, 0.79-1.28; P=.94).
Definitive carboplatin-based chemoRT was equivalent to cisplatin-based therapy and superior to RT alone and RT with concurrent cetuximab. In light of recent results of the RTOG 1016 and De-ESCALaTE trials, our findings suggest that carboplatin-based regimens warrant prospective investigation as an alternative to cisplatin for patients who are not cisplatin candidates.
对于头颈部鳞状细胞癌（HNSCC）的确定性放化疗（chemoRT），顺铂是首选的联合用药，最近两项随机试验（RTOG 1016 和 De-ESCALaTE）表明，其在 HPV 相关口咽鳞状细胞癌方面优于西妥昔单抗。对于不适合顺铂的患者，可以用卡铂代替，但它的疗效尚不清楚。我们分析了基于顺铂和卡铂的 chemoRT 后全国性的治疗模式和癌症特异性结果。
我们在 SEER-Medicare 数据库中确定了接受确定性放疗（RT）的局部晚期（根据 AJCC 癌症分期手册第 6 版和第 7 版，III-IVB 期）口咽、喉或下咽鳞状细胞癌患者。通过相应的医疗保险索赔确定联合化疗方案。采用竞争风险分析评估因 HNSCC 导致的死亡（癌症特异性死亡率[CSM]）。采用倾向评分分析和多变量 Fine-Gray 回归来调整基线差异，包括年龄和合并症。
我们确定了 807 例接受顺铂为基础的 chemoRT 和 342 例接受卡铂为基础的 chemoRT 的患者。大多数卡铂接受者（68%）接受联合化疗，主要是紫杉醇。卡铂和顺铂为基础的 chemoRT 的 HNSCC 死亡发生率相似（3 年 CSM，29%vs26%；P=.19），在倾向评分匹配分析中也保持一致。此外，在匹配队列中，总生存也没有显著差异。顺铂或卡铂联合化疗 RT 优于单独 RT 和 RT 联合西妥昔单抗。在多变量模型中，卡铂相对于顺铂的 CSM 调整后危险比为 1.01（95%CI，0.79-1.28；P=.94）。
确定性卡铂为基础的 chemoRT 与顺铂为基础的治疗相当，优于单独 RT 和 RT 联合西妥昔单抗。鉴于 RTOG 1016 和 De-ESCALaTE 试验的最新结果，我们的研究结果表明，对于不适合顺铂的患者，卡铂为基础的方案值得前瞻性研究，作为顺铂的替代方案。
