Carboplatin/Paclitaxel can be an effective alternative for cisplatin-ineligible patients with locally advanced HNSCC

Despite considerable therapeutic advances, a significant evidence gap remains regarding optimal treatment strategies for cisplatin-unfit patients and whether carboplatin/paclitaxel represents a valid therapeutic alternative. This study investigates the treatment outcomes of patients receiving various platinum-based chemotherapy regimens.

Between 2012 and 2022, 170 patients with LAHNSCC were included in the analysis. Overall survival (OS) and progression-free survival (PFS), as well as treatment-related toxicities, were evaluated.

The included patients were treated with intensity-modulated radiotherapy (IMRT) at a total dose of 59.4-72 Gy, along with 5-6 cycles of weekly platinum-based chemotherapy. 130 patients received cisplatin (40 mg/m² BSA), while 40 patients received carboplatin (AUC 1) and paclitaxel (40 mg/m² BSA). Median follow-up was 32 months. No significant difference was observed in median PFS (p = 0.14; HR 0.74 [0.44-1.26]) nor OS (p = 0.11; HR 0.62 [0.36-1.10]). Subgroup analysis showed that especially patients < 65 years and patients in the adjuvant setting benefit from the use of cisplatin.

Definitive and postoperative radiochemotherapy for the treatment of LAHNSCC with concurrent administration of carboplatin/paclitaxel can be used as a safe and effective alternative but only for cisplatin-ineligible patients.