Head and Neck Cancer
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s): While cisplatin is the preferred platinum agent given with radiation (RT) for head and neck cancer, carboplatin is sometimes used instead in patients who are unable to tolerate cisplatin. We analyzed nation-wide patterns of care, outcomes, and toxicities associated with cisplatin or carboplatin-based chemoradiation.
Materials/Methods: Patients with locally or regionally advanced (AJCC Stage III-IVB) squamous cell carcinoma of the oropharynx, oral cavity, larynx, or hypopharynx diagnosed from 2004 to 2011 were identified in the SEER-Medicare database. Patients received either cisplatin or carboplatin concurrent with RT, as determined by their Medicare claims. The primary study outcome was head and neck cancer-specific mortality (CSM) analyzed with competing risks. Propensity score matching and multivariable Fine-Gray regression were used to adjust for baseline differences. Toxicity was analyzed by the cumulative incidence of hospitalizations and diagnosis codes corresponding to treatment-related side effects.
Results: The total cohort consisted of 1138 patients, of which 779 (68%) received cisplatin and 359 (32%) received carboplatin. In the carboplatin cohort, 64% received combination chemotherapy (predominantly with paclitaxel), and the remainder (36%) received carboplatin alone. Carboplatin recipients were older and more likely to have comorbidities, including chronic kidney disease and neuropathy, than cisplatin recipients. Median follow-up time was 2.3 years (3.5 years in living patients). CSM was not significantly different between cisplatin and carboplatin recipients (27% vs 30% at 3 years; P = 0.33), and this was unchanged on subgroup analyses (tumor and nodal stage, disease site, definitive versus postoperative) or propensity score matching. Single-agent carboplatin had a non-significant trend toward increased CSM compared to carboplatin combination chemotherapy (34% vs 28% at 3 years; P = 0.60). In the multivariable model, the adjusted hazard ratio of CSM for carboplatin relative to cisplatin was 0.99 (95% CI, 0.77-1.27; P = 0.92). Cisplatin recipients were more likely to be hospitalized with electrolyte disorders, nausea/vomiting, acute kidney injury, and syncope, while carboplatin recipients had more hospitalizations for urinary tract infection and a non-significant trend toward increased neutropenia and oral Candidiasis. The incidence of other toxicities was similar.
Conclusion: In this large, national, population-based database reflecting real-world patterns of care and outcomes, there was no significant difference in CSM between carboplatin and cisplatin, although the 95% confidence interval allowed up to a 27% increased risk of CSM.
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