Carboplatin–capecitabine in concurrent chemoradiation for LA-HNSCC: could it be a safer alternative to high-dose cisplatin?

This letter discusses the findings of the CARCAP-HN trial by Mohanty et al , which compared concurrent chemoradiation (CRT) with carboplatin plus capecitabine versus standard 3-weekly high-dose cisplatin in locally advanced head and neck squamous cell carcinoma (LA-HNSCC). The Phase II randomized study demonstrated that the experimental regimen offered comparable efficacy in terms of progression-free survival and objective response rates while significantly reducing severe toxicities, including grade ≥3 oral mucositis, vomiting, and nephropathy. Importantly, the carboplatin–capecitabine arm showed fewer treatment interruptions, addressing a critical factor for therapeutic success in LA-HNSCC. We highlight the potential of this regimen as a safer, effective alternative for cisplatin-ineligible patients, leveraging the radiosensitizing properties of capecitabine and the favorable toxicity profile of carboplatin. However, heterogeneity in patient baseline characteristics and the single-center nature of the study warrant cautious interpretation. We advocate for future large-scale, multi-center Phase III trials incorporating quality-of-life metrics and molecular subtyping to validate these findings. If confirmed, this regimen could become a standard of care for vulnerable populations, offering improved compliance and outcomes.