Real‐world evidence of cisplatin versus carboplatin in patients with locally advanced nasopharyngeal carcinoma receiving concurrent chemoradiotherapy: A multicenter analysis

Abstract

Background Though concurrent chemoradiotherapy (CCRT) with cisplatin remains a standard of care for patients with locally advanced nasopharyngeal carcinoma (LA‐NPC), carboplatin has alternatively been used without sufficient supportive evidences. Thus, we evaluated an efficacy and tolerability of carboplatin CCRT compared with cisplatin in LA‐NPC patients. Methods Patients with LA‐NPC treated with CCRT were identified through the Thai multicenter head and neck cancer database. Patient tolerability and survival were analyzed and compared between regimens. Survivals were calculated by using the Kaplan–Meier method, and compared by the log‐rank test. A p‐value of <0.05 was considered statistically significant. Results A total of 135 of 980 patients (13.8%) were treated with carboplatin. Patients treated with carboplatin were significantly associated with older age (p < 0.001), smoking (p = 0.003), more comorbidity (p = 0.014), kidney disease (p = 0.016), and lower baseline creatinine clearance (p < 0.001). Intensity‐modulated radiation therapy was used significantly more in the cisplatin group than carboplatin group (p < 0.001). Patients who received carboplatin were associated with delay (p = 0.049) and hospitalization (p = 0.006), whereas cisplatin CCRT had more dose reduction (p = 0.001). Patients treated with cisplatin had CCRT interruption from grade 3–4 mucositis (p = 0.019) more than carboplatin, whereas carboplatin had more grade 3–4 thrombocytopenia (p < 0.001). The 5‐year overall survival (OS) of patients treated with cisplatin and carboplatin was 59% and 49%, respectively (p = 0.128). Cisplatin or carboplatin CCRT was not a significant predictor for OS and locoregional recurrence‐free survival in multivariate analysis. Conclusions Carboplatin CCRT provided acceptable efficacy and tolerability profiles in real‐world practice. Carboplatin should be considered as an alternative regimen, particularly in cisplatin‐ineligible patients with LA‐NPC treated with CCRT.

Chemoradiation with Cisplatin vs. Carboplatin for Squamous Cell Carcinoma of the Head and Neck (SCCHN)

“…Several studies have compared carboplatin alone and cisplatin alone for the chemoradiation of head-and-neck cancer [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. Some of these studies were additionally included in one or two meta-analyses from 2016 [ 46 , 47 ].…”

“…Since radiotherapy of SCCHN has undergone technical improvements during the last 10 years, including the increasing use of high-precision radiotherapy with VMAT (as in the present study), it appears reasonable to take a separate look at studies published more recently. No randomized trials but several retrospective studies were identified that were published between 2017 and 2023 [ 37 , 38 , 39 , 40 , 41 ]. Three of these studies found that chemoradiation with carboplatin was similarly effective as cisplatin-based treatment [ 37 , 38 , 41 ].…”

“…No randomized trials but several retrospective studies were identified that were published between 2017 and 2023 [ 37 , 38 , 39 , 40 , 41 ]. Three of these studies found that chemoradiation with carboplatin was similarly effective as cisplatin-based treatment [ 37 , 38 , 41 ]. One study suggested similar efficacy for stage I or II disease, but a superiority of cisplatin for stage III disease [ 39 ].…”

“…Promising results regarding chemoradiation with carboplatin alone were also reported by other authors [ 26 , 27 , 28 , 29 ]. Several studies compared chemoradiation with concurrent carboplatin alone to concurrent cisplatin [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ].…”