Institutional Comparison between Radiation with Concurrent Cisplatin Versus Carboplatin/paclitaxel for Squamous Cell Carcinoma of the Head and Neck (SCCHN)

Purpose/Objective(s) For SCCHN patients receiving definitive chemoradiation or adjuvant chemoradiation, cisplatin is the standard systemic agent. Carboplatin/paclitaxel has been considered as an alternative in cisplatin-ineligible patients. No head-to-head trials have been conducted comparing the two regimens. We present a retrospective single institution data comparing the two regimens in the definitive and post-operative setting. Materials/Methods Patients with SCCHN who received at least one dose of cisplatin or carboplatin/paclitaxel were included. We assessed locoregional control (LRC), overall survival (OS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and safety. Descriptive statistics, Kaplan Meier method, Cox proportional hazards model through both univariate and multivariable analysis (MVA) were used. Results Among 308 patients, 157 received carboplatin/paclitaxel and 151 received cisplatin. IMRT (90.6%) was primarily utilized and the median total dose of radiation was 70 Gy. Majority were male (78.6%) and Caucasian (76.3%) with a median age of 63. Oropharynx was the most common primary tumor site (53.2%) with 84.7% being HPV positive. Ninety-seven patients (31.5%) underwent surgery; more carboplatin/paclitaxel (34.0%) patients had positive margins versus cisplatin (16%) patients (p = 0.04). Most of the cisplatin patients received weekly 40 mg/m2 (78.8%) and the median cumulative cisplatin dose was 240 mg/m2. A majority of patients received carboplatin AUC 2 and paclitaxel 45 mg/m2 with a median cumulative paclitaxel dose of 270 mg/m2. More patients in the carboplatin/paclitaxel (68.2%) group had T3/T4 disease versus cisplatin (55.6%) patients (p = 0.024). By MVA, no statistically significant differences were observed for LRC or OS. However, carboplatin/paclitaxel significantly improved DMFS [HR 0.49 (0.24-0.99) p=0.048] with a 5 year DMFS of 86.5% versus 77.2% in the cisplatin group. A trend favoring carboplatin/paclitaxel was seen for PFS [HR 0.62 (0.36-1.08) p = 0.09]. In the subgroup of surgical patients, DMFS [HR 0.39 (0.14-1.08) p = 0.071] and PFS [HR 0.41 (0.17-0.94) p=0.036] favored carboplatin/paclitaxel. Carboplatin/paclitaxel had higher grade 3/4 toxicities for leukopenia, anemia, and dermatitis and more feeding tube placements and hospitalizations. Conclusion Carboplatin/paclitaxel is comparable to cisplatin and may be more beneficial in the post-operative setting. A prospective, randomized trial is needed to determine whether carboplatin/paclitaxel is non-inferior or even superior to cisplatin and to better characterize its safety profile. For SCCHN patients receiving definitive chemoradiation or adjuvant chemoradiation, cisplatin is the standard systemic agent. Carboplatin/paclitaxel has been considered as an alternative in cisplatin-ineligible patients. No head-to-head trials have been conducted comparing the two regimens. We present a retrospective single institution data comparing the two regimens in the definitive and post-operative setting. Patients with SCCHN who received at least one dose of cisplatin or carboplatin/paclitaxel were included. We assessed locoregional control (LRC), overall survival (OS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and safety. Descriptive statistics, Kaplan Meier method, Cox proportional hazards model through both univariate and multivariable analysis (MVA) were used. Among 308 patients, 157 received carboplatin/paclitaxel and 151 received cisplatin. IMRT (90.6%) was primarily utilized and the median total dose of radiation was 70 Gy. Majority were male (78.6%) and Caucasian (76.3%) with a median age of 63. Oropharynx was the most common primary tumor site (53.2%) with 84.7% being HPV positive. Ninety-seven patients (31.5%) underwent surgery; more carboplatin/paclitaxel (34.0%) patients had positive margins versus cisplatin (16%) patients (p = 0.04). Most of the cisplatin patients received weekly 40 mg/m2 (78.8%) and the median cumulative cisplatin dose was 240 mg/m2. A majority of patients received carboplatin AUC 2 and paclitaxel 45 mg/m2 with a median cumulative paclitaxel dose of 270 mg/m2. More patients in the carboplatin/paclitaxel (68.2%) group had T3/T4 disease versus cisplatin (55.6%) patients (p = 0.024). By MVA, no statistically significant differences were observed for LRC or OS. However, carboplatin/paclitaxel significantly improved DMFS [HR 0.49 (0.24-0.99) p=0.048] with a 5 year DMFS of 86.5% versus 77.2% in the cisplatin group. A trend favoring carboplatin/paclitaxel was seen for PFS [HR 0.62 (0.36-1.08) p = 0.09]. In the subgroup of surgical patients, DMFS [HR 0.39 (0.14-1.08) p = 0.071] and PFS [HR 0.41 (0.17-0.94) p=0.036] favored carboplatin/paclitaxel. Carboplatin/paclitaxel had higher grade 3/4 toxicities for leukopenia, anemia, and dermatitis and more feeding tube placements and hospitalizations. Carboplatin/paclitaxel is comparable to cisplatin and may be more beneficial in the post-operative setting. A prospective, randomized trial is needed to determine whether carboplatin/paclitaxel is non-inferior or even superior to cisplatin and to better characterize its safety profile.