Non-Cisplatin Concurrent Systemic Therapy with Radiotherapy for Locally Advanced Head and Neck Squamous Cell...

Area of Science:

• Oncology
• Radiotherapy
• Cancer Treatment

Background:

• Head and neck squamous cell carcinoma (HNSCC) is a globally prevalent cancer.
• Standard treatment for locally advanced HNSCC involves chemoradiotherapy with cisplatin.
• A significant subset of HNSCC patients are ineligible for cisplatin treatment.

Purpose of the Study:

• To evaluate alternative treatment options for cisplatin-ineligible HNSCC patients undergoing radiotherapy (RT).
• To compare the efficacy and safety of various chemo- and immunotherapies combined with RT.

Main Methods:

• A network meta-analysis of randomized controlled trials (RCTs) was conducted.
• Searched four databases for RCTs assessing overall survival (OS), progression-free survival (PFS), locoregional control (LC), and adverse events (AE).
• Included 28 RCTs with approximately 7000 patients, focusing on RT with non-cisplatin systemic therapies.

Main Results:

• No non-cisplatin systemic agents significantly improved OS, PFS, or LC compared to cisplatin.
• Carboplatin + 5-FU and mitomycin C + 5-FU demonstrated superior LC compared to hyperfractionated accelerated radiotherapy (HART).
• Durvalumab, cetuximab, panitumumab were associated with fewer adverse events (dysphagia, renal impairment, weight loss) compared to cisplatin.

Conclusions:

• Carboplatin + 5-FU and Mitomycin C + 5-FU offer improved locoregional control over HART for HNSCC.
• Targeted therapies and immunotherapies show a favorable safety profile with reduced adverse events compared to cisplatin.