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Oral Oncol. 2014 Oct;50(10):947-55. doi: 10.1016/j.oraloncology.2014.07.001. Epub 2014 Aug 11.

Efficacy of concurrent cetuximab vs. 5-fluorouracil/carboplatin or high-dose cisplatin with intensity-modulated radiation therapy (IMRT) for locally-advanced head and neck cancer (LAHNSCC).

Author information

1
Memorial Sloan-Kettering Cancer Center, Department of Radiation Oncology, New York, NY, United States.
2
Memorial Sloan-Kettering Cancer Center, Department of Medicine, New York, NY, United States.
3
Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY, United States.
4
Memorial Sloan-Kettering Cancer Center, Department of Surgery, New York, NY, United States.
5
Memorial Sloan-Kettering Cancer Center, Department of Radiation Oncology, New York, NY, United States. Electronic address: leen2@mskcc.org.

Abstract

OBJECTIVES:

We previously reported inferior outcomes for locally-advanced head and neck squamous cell carcinoma (LAHNSCC) patients treated with concurrent cetuximab vs. high-dose cisplatin with intensity-modulated radiation therapy (IMRT). Prior to FDA approval of cetuximab for LAHNSCC, non-cisplatin eligible patients at our institution received 5-fluorouracil (5FU)/carboplatin. We sought to compare concurrent cetuximab vs. 5FU/carboplatin vs. high-dose cisplatin with IMRT for LAHNSCC.

MATERIALS AND METHODS:

Retrospective review was performed for LAHNSCC patients treated at Memorial Sloan-Kettering Cancer Center from 11/02 to 04/08 with concurrent cetuximab (n=49), 5FU/carboplatin (n=52), or cisplatin (n=259) and IMRT. Overall survival (OS), locoregional failure (LRF), distant metastasis-free survival, and late toxicity were analyzed using univariate and multivariate analyses. OS analysis was confirmed by propensity score adjustment.

RESULTS:

Treatment groups were similar with regard to primary tumor site, overall stage, and alcohol and tobacco history. Cetuximab and 5FU/carboplatin patients were older, with lower performance status, more comorbidities, higher T classification, and worse renal function. On multivariate analysis, compared with cisplatin and 5FU/carboplatin, cetuximab was associated with inferior 4-year OS (86.9% vs. 70.2% vs. 40.9%; P<.0001) and 4-year LRF (6.3% vs. 9.7% vs. 40.2%; P<.0001). Late toxicity was highest with 5FU/carboplatin (25.0%) vs. cisplatin (8.0%) vs. cetuximab (7.7%).

CONCLUSIONS:

Although 5FU/carboplatin patients were sicker and experienced greater toxicity than cisplatin patients, no significant difference was found in all endpoints. In contrast, despite similar pretreatment characteristics, outcomes for cetuximab vs. 5FU/carboplatin were significantly worse. We feel that caution should be used with routine use of cetuximab in the management of LAHNSCC.

[Indexed for MEDLINE]
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