Long-Term Outcomes of Weekly Cisplatin Versus Carboplatin and Paclitaxel for Head and Neck Cancer

PURPOSE National Comprehensive Cancer Network guidelines recommend weekly cisplatin and weekly carboplatin with paclitaxel as alternative concurrent systemic therapy regimens among patients with head and neck cancer undergoing definitive chemoradiation. However, there is a paucity of literature comparing outcomes with these two regimens. We performed an observational cohort study of patients with head and neck cancer treated with definitive chemoradiation receiving either cisplatin or carboplatin with paclitaxel. METHODS A single-institution database was queried for patients with head and neck cancer diagnosed between October 2011 and December 2023 who underwent chemoradiation with either once a week cisplatin (40 mg/m 2 ) or once a week carboplatin (AUC 1) with paclitaxel (30 mg/m 2 ). Cox multivariable analysis (MVA), Kaplan-Meier, Fine-Gray MVA, logistic MVA, and propensity score matching were performed to evaluate treatment outcomes. RESULTS A total of 488 patients were identified. Median follow-up was 43.1 months (95% CI, 41.0 to 45.4). The majority of patients received at least five cycles. Those with older age, former smoking history, and worse performance status were more likely to undergo carboplatin and paclitaxel. Carboplatin and paclitaxel were associated with no statistically significant overall survival (adjusted hazards ratio [aHR], 1.12 [95% CI, 0.69 to 1.82]; P = .64), progression-free survival (aHR, 1.45 [95% CI, 0.96 to 2.19]; P = .08), locoregional failure (aHR, 1.91 [95% CI, 0.85 to 4.32]; P = .12), and distant failure (aHR, 1.33 [95% CI, 0.70 to 2.54]; P = .39) compared with cisplatin. Similar findings were noted on 109 matched pairs as well as subgroups stratified by p16 status. CONCLUSION Our study suggested that those treated with weekly carboplatin and paclitaxel had no statistically significant survival and tumor control outcomes compared with those with weekly cisplatin. Older age and poor performance status were independently associated with the receipt of weekly carboplatin and paclitaxel.