Top Line: What systemic agent do you use concurrent with definitive head and neck radiation for cisplatin-ineligible patients?
The Study: Despite this being a common problem, we still lack data demonstrating a clear winner. We know cetuximab is better than nothing and that durvalumab can’t stand up to cetuximab. While carboplatin remains an unchallenged contender, this phase 3 trial is here to throw docetaxel in the ring. It randomized 356 patients ineligible for cisplatin to definitive radiation alone versus concurrent with docetaxel 15 mg/m2 once weekly. The primary endpoint of disease-free survival at 2 years was significantly improved from 30% to 42% with the addition of docetaxel. What’s more, median overall survival was increased from 15 to 25 months and overall survival at 2 years from 40% to 50%. This all came at the cost of increased G3+ mucositis (22 → 50%), odynophagia (34 → 53%), and dysphagia (33 → 50%). Who’s up for a carbo versus docetaxel comparison..?
TBL: The addition of docetaxel concurrent to definitive head and neck radiation for cisplatin-ineligible patients significantly prolongs survival at the cost of more mucosal toxicity.
- Patil, J Clin Oncol 2023