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Missing weekly cisplatin cycles was associated with worse OS in patients with head and neck cancers, particularly for those with p16-negative tumors.
Missed weekly cisplatin cycles was associated with worse OS in head and neck cancers.
Among patients with head and neck cancers who received definitive chemoradiation, those with p16-negative tumors who missed weekly cisplatin cycles demonstrated a lower overall survival (OS) compared with those who received seven to eight cycles; however, the OS was comparable between these groups for p16-positive tumors, according to study findings published in JAMA Network.
Additionally, the most common reason for cisplatin interruption was cytopenia, meaning a reduced blood cell count.
CURE® spoke with lead study author Dr. Sung Jun Ma, a radiation oncology specialist and an Assistant Professor in the College of Medicine at Ohio State University Comprehensive Cancer Center (OSUCC), OSUCC — James, in Columbus, during an email interview to gain further insight to the study’s implications for patients with head and neck cancer.
Overall survival (OS): the length of time from diagnosis to death from any cause.
Progression-free survival (PFS): the length of time from diagnosis to either death or disease progression.
Locoregional failure: the recurrence of cancer in the original tumor site or nearby lymph nodes.
Distant failure: the spread of cancer to parts of the body far from the original tumor site.
“For patients, it suggests that everyone's experiences may be different as they receive treatments. Being unable to receive chemotherapy [on] certain weeks is common,” said Jun Ma. “Following up closely with medical oncologists and their teams would be important to make sure treatment interruptions can be minimized.”
After a median follow-up of 46.8 months, patients who missed weekly cisplatin cycles had worse OS compared with those who received seven to eight cycles. Progression-free survival (PFS) was also worse for this group. Cancer control outcomes were similar between the groups, including locoregional failure and distant failure.
In patients with p16-negative tumors, missing weekly cisplatin cycles was associated with significantly worse compared with receiving seven to eight cycles. However, no statistically significant differences in OS were observed for patients with p16-positive tumors who missed weekly cycles versus those who completed seven to eight cycles.
“Our finding of worse outcomes among those who missed several chemotherapy treatments was also seen among those who had p16-negative cancer, but not p16-positive cancer. There could be many potential reasons, but we know that those with p16-negative cancer generally have poor prognosis and it's possible that completing the full treatment course may be more important for such aggressive cancer,” said Jun Ma.
He continued by emphasizing the importance of closely monitoring patients with p16-negative tumors, as these tumors typically have a poorer prognosis. Oncologists may need to pay special attention to these patients and their side effects to ensure they are tolerating treatments well. Completing all treatments is particularly critical for patients with p16-negative tumors to improve outcomes, Jun Ma emphasized.
Regarding patient reported outcomes, Jun Ma shared that some chemotherapy side effects may overlap with radiation side effects, and challenges may include nausea, vomiting, feeling weak in general and fever.
This retrospective cohort study analyzed 142 patients (mean age, 59) treated with definitive chemoradiation and weekly cisplatin (40 milligrams per square meter) at OSUCC from December 2011 to March 2020. All patients received intensity-modulated radiation therapy and completed at least five cycles of cisplatin. Patients who underwent surgery, radiation alone or alternative treatment regimens were excluded.
Patients received a total of five, six or seven to eight cisplatin cycles. Study outcomes included OS, PFS, locoregional failure and distant failure.
“Other alternative chemotherapy regimens can be considered, such as carboplatin and paclitaxel. For those who are unable to tolerate chemotherapy at all, radiation therapy alone can be considered instead,” Jun Ma concluded.
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“Weekly Cisplatin Cycles and Outcomes for Chemoradiation in Head and Neck Cancer,” By Dr. Sung Jun Ma, et al. Jama Network.
