Hematological Toxicities of Concurrent Chemoradiotherapies in Head and Neck Cancers: Comparison Among Cisplatin, Nedaplatin, Lobaplatin, and Nimotuzumab

Abstract

BackgroundCisplatin-based concurrent chemoradiotherapy is standard of care for locally advanced head and neck cancers (LAHNC). Nedaplatin, lobaplatin and nimotuzumab have shown anti-cancer effect with less gastrointestinal toxicity and nephrotoxicity. However, the profile of hematological toxicities of these agents in combination with radiotherapy has not been fully illustrated.MethodsWe retrospectively collected the clinical data of consecutive LAHNC patients treated by cisplatin-, nedaplatin-, lobaplatin-, and nimotuzumab-based concurrent chemoradiotherapy. Routine blood cell counts were obtained every 4 to 7 days. Hematological toxicities were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0.ResultsA total of 181 eligible LAHNC patients were assigned to nimotuzumab group (n = 34), cisplatin group (n = 52), nedaplatin group (n = 62) or lobaplatin group (n = 33). Among the four groups, nimotuzumab group displayed lightest hematological toxicities, followed by cisplatin group, nedaplatin group, and lobaplatin group. Lobaplatin was more likely to produce grade 3/4 leukopenia compared with cisplatin (48.5% vs 25.0%). Compared with cisplatin, nedaplatin and lobaplatin were more likely to cause grade 3/4 thrombocytopenia (nedaplatin 19.4% vs cisplatin 3.8%; lobaplatin 30.3% vs cisplatin 3.8%). Similarly, nimotuzumab group showed highest nadir levels among the four groups, followed by cisplatin, nedaplatin, and lobaplatin group. Moreover, concurrent platinum treatment and induction chemotherapy were risk factors of developing grade 3/4 hematological toxicities.ConclusionNimotuzumab-based concurrent chemoradiotherapy in head and neck cancers produced the lightest hematological toxicities, followed by cisplatin, nedaplatin, and lobaplatin. Patients should be given specific attention during concurrent chemoradiotherapy, particularly in the presence of previous induction chemotherapy.

A phase III randomized, controlled trial of nedaplatin versus cisplatin concurrent chemoradiotherapy in patients with cervical cancer

“…More severe hematologic toxicity of nedaplatin than cisplatin was also shown in a study in head and neck tumors. 21 The clinical outcomes in a retrospective study from Wuhan University did not support the use of nedaplatin as an alternative to cisplatin in CCRT for locally advanced cervical cancer patients. Their results did not demonstrate the substitutability between cisplatin and nedaplatin.…”

Clinical performance evaluation of O-Ring Halcyon Linac: A real-world study

“…Most patients had radiation toxicities related to haematological reactions, but their symptoms subsided over time. Myelosuppression was closely related to the irradiation site, and the main reason for the occurrence of myelosuppression in most patients is likely the administration of concurrent chemotherapy or other therapies, which definitely exacerbate haematological toxicity[ 30 , 31 ]. Although we made great efforts in the planning design and machine performance, late toxic reactions are inevitable due to the physics of radiation and the proximity to OARs[ 32 , 33 ].…”

Influence of chemical structure and mechanism of hydrolysis on pharmacological activity and toxicological profile of approved platinum drugs

“…Compared with Cisplatin, Nedaplatin has lower nephro-, neuro-oto-and gastrointestinal toxicity, and leukopenia. Dose-limiting toxicity is myelosuppression: thrombocytopenia, neutropenia, and anemia (Wu et al 2021).…”

“…The side effects of the drug are thrombocytopenia, leucopenia, neutropenia, and granulocytopenia (Wu et al 2021).…”

“…The dose-limiting effects of approved for chemotherapy platinum complexes are: 1) Cisplatin -nephrotoxicity, ototoxicity (Oun et al 2018), neuropathy (Krarup-Hansen et al 2007); 2) Carboplatin -neurotoxicity, myelosuppression (Schmitt et al 2010); 3) Oxaliplatin -neurotoxicity (Gamelin et al 2002), hematological and gastrointestinal toxicity (Oun et al 2018); 4) Nedaplatin -myelosuppression (Wu et al 2021); 5) Heptaplatin -nephrotoxicity (Ahn et al 2002); 6) Lobaplatin -myelosuppression (Wu et al 2021); 7) Satraplatin -myelosuppression (Bhargava and Vaishampayan 2009).…”