Concurrent cisplatin and radiotherapy versus cetuximab and radiotherapy, an unsolved problem
Authors: O.C. Guler, C. Onal, E. Ozyar
Journal: Annals of Oncology (2017)

We read with great interest the paper by Ghi et al. [1.Ghi M.G. Paccagnella A. Ferrari D. et al.Induction tpf followed by concomitant treatment versus concomitant treatment alone in locally advanced head and neck cancer. A phase II-III trial.Ann Oncol. 2017; 28: 2206-2212Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar], reporting the efficacy of induction chemotherapy (IC) followed by concomitant chemoradiotherapy (C-CRT) in patients with locally advanced head and neck squamous-cell carcinoma (LAHNSCC) in a phase II and III trial. The result of this study may potentially change our current practice for LAHNCC patients. However, we have some concerns about the study design, especially on the randomisation of the patients in C-CRT arms. The data presented here are interesting and striking in different ways. First, previous studies demonstrated C-CRT is the standard of care, while IC has no effect on survival [2.Pignon J.P. le Maitre A. Maillard E. et al.Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17, 346 patients.Radiother Oncol. 2009; 92: 4-14Abstract Full Text Full Text PDF PubMed Scopus (2183) Google Scholar]. Second, cisplatin-based C-CRT is standard treatment in LAHNSCC and cetuximab is an alternative treatment option for the patients who cannot receive cisplatin [2.Pignon J.P. le Maitre A. Maillard E. et al.Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17, 346 patients.Radiother Oncol. 2009; 92: 4-14Abstract Full Text Full Text PDF PubMed Scopus (2183) Google Scholar, 3.Magrini S.M. Buglione M. Corvo R. et al.Cetuximab and radiotherapy versus cisplatin and radiotherapy for locally advanced head and neck cancer: a randomized phase ii trial.J Clin Oncol. 2016; 34: 427-435Crossref PubMed Scopus (177) Google Scholar]. Magrini et al. [3.Magrini S.M. Buglione M. Corvo R. et al.Cetuximab and radiotherapy versus cisplatin and radiotherapy for locally advanced head and neck cancer: a randomized phase ii trial.J Clin Oncol. 2016; 34: 427-435Crossref PubMed Scopus (177) Google Scholar] reported that patients treated with concurrent cetuximab and RT had less treatment compliance and also higher rates of acute toxicity compared with patients treated with concurrent cisplatin and RT. They reported that respective 1- and 2-year cause-specific survival rates were 75% and 68% in the cetuximab C-CRT arm 88% and 81% in the cisplatin C-CRT arm. Additionally, 1- and 2-year local control rates were 64% and 53% in the cetuximab C-CRT arm and 84% and 80% in the cisplatin C-CRT arm. Although there was not statistically significance in analysis and the study was closed early because of slow accrual, it is expected that patients treated with cetuximab C-CRT have inferior outcomes compared with cisplatin C-CRT. Hence, investigating the standard and non-standard treatments in same study cohort may raise conflicting results with heterogeneous group of patients while randomizing the patients. In addition to that local progression-free survival for cisplatin C-CRT and cetuximab C-CRT is unknown in both C-CRT and IC followed by C-CRT arms. We believe that subgroup analysis of these patients might have a greater impact of papers intelligibility. None declared.