Bauml JM, et al. - In the nonoperative management of locally advanced head and neck squamous cell carcinoma (HNSCC), clinically significant toxicity related with the standard dose of 100 mg/m² cisplatin every 3 weeks has led to the widespread use of weekly lower dose cisplatin. This study was carried out to compare patient outcomes between definitive intent chemoradiotherapy using either high-dose cisplatin (HDC) or low-dose cisplatin (LDC) among patients with stage III–IVb HNSCC. For this purpose, population-based Veterans Affairs data was used. According to findings, in the nonoperative definitive management of locally advanced HNSCC of the oral cavity, oropharynx, and hypopharynx/larynx, survival between LDC and HDC was found to be similar in this large, population-based study of US military veterans. Compared with LDC, HDC was linked with statistically significant higher toxicity. Toxicity burden could be attenuated with LDC while maintaining overall survival.

Methods

• Researchers performed an intent-to-treat analysis, including patients assigned to the HDC vs LDC group according to the dose of their first cycle.
• They generated propensity scores (PS) for the use of HDC by using variables potentially influencing treatment decisions including cancer site, stage, smoking/alcohol use, and comorbidities.
• They used Cox regression, adjusting for PS, to compare overall survival (OS) by treatment group.
• Using PS-adjusted logistic regression, they also determined the risk of toxicities.

Results

• They analyzed a total of 2,901 patients; HDC (mean initial dose 100 mg/m²) was received by 2,200 patients; the mean initial dose of LDC was 40 mg/m².
• HDC was not found to be related to improved OS over LDC after PS adjustment (hazard ratio = 0.94, 95% confidence interval = 0.80 to 1.04).
• Adjusting for PS, an increased risk of acute kidney injury, neutropenia, dehydration/electrolyte disturbance, and hearing loss, was observed in relation to HDC.