Key takeaways:
- Survival outcomes didn’t differ for sufferers with HNSCC who acquired radiotherapy with carboplatin-paclitaxel vs. cisplatin.
- Fewer sufferers who acquired carboplatin-paclitaxel had remedy interruptions.
Sufferers with head and neck squamous cell carcinoma who acquired radiotherapy with carboplatin-paclitaxel as an alternative of cisplatin resulting from tolerability issues achieved related outcomes as those that acquired customary care.
Outcomes of a retrospective research confirmed no distinction in locoregional recurrence-free survival, PFS, distant metastases-free survival or OS between the remedies, and carboplatin-paclitaxel might have security advantages.

Information derived from Abousaud M, et al. JAMA Otolaryngol Head Neck Surg. 2025;doi:10.1001/jamaoto.2025.1706.

Nabil F. Saba
“These outcomes are encouraging,” Nabil F. Saba, MD, FACP, professor and vice chair within the division of hematology and medical oncology, and director of the top and neck most cancers medical oncology program at Winship Most cancers Institute of Emory College, informed Healio.
“It additionally raised the query whether or not carboplatin-paclitaxel may probably be confirmed superior to cisplatin,” he added.
‘Sturdy monitor report’
Greater than 300,000 people die of HNSCC all over the world yearly, in keeping with research background.
Cisplatin-radiotherapy has been customary of look after HNSCC for greater than 25 years.
Nevertheless, adversarial occasions associated to cisplatin, together with kidney issues, listening to loss and neuropathy, make sure sufferers ineligible for the remedy.
Cetuximab (Erbitux, Eli Lilly & Co.) gained FDA approval instead choice with radiation in 2006, however some research have proven it to be “inferior” to cisplatin, curbing its use, Saba stated.
“We’re left with no clear go-to for sufferers who can not take cisplatin,” he defined.
Carboplatin-paclitaxel has a “sturdy monitor report” in different malignancy reminiscent of esophageal and lung most cancers, and single-arm research have proven it to be a “believable” various radio sensitizing choice to cisplatin for HNSCC, Saba stated.
It has subsequently grown extra well-liked amongst U.S. oncologists.
“But it surely has by no means been in contrast head-to-head with cisplatin when it comes to effectiveness and tolerability,” Saba stated.
Saba and colleagues evaluated 308 adults with HNSCC who acquired definitive radiotherapy plus both carboplatin-paclitaxel or cisplatin at Winship Most cancers Institute to research.
In all, 51% of the research inhabitants acquired carboplatin-paclitaxel (median age, 67 years; vary, 24-89; 75.8% males; 73.3% white; 68.2% T3/T4 illness) and 49% acquired cisplatin (median age, 58 years; vary, 26-78; 81.5% males; 79.5% white; 55.6% T3/T4 illness).
Locoregional recurrence-free survival served as the first endpoint. PFS, distant metastases-free survival, OS and security served as secondary endpoints.
‘Fortunately shocked’
Sufferers who acquired carboplatin-paclitaxel had related 3-year locoregional recurrence-free survival (96.2%) as those that acquired cisplatin (97%).
The carboplatin-paclitaxel group additionally had related 3-year PFS (79.8% vs. 77.5%), 3-year distant metastases-free survival (86.8% vs. 83.4%) and 3-year OS (92.9% vs. 90.8%).
People who acquired carboplatin-paclitaxel had larger charges of grade 3 or 4 leukopenia (49.7% vs. 36.4%), anemia (21.7% vs. 6.6%) and dermatitis (79.6% vs. 50.3%).
Moreover, that they had larger charges of hospitalization (47.8% vs. 25.8%) and feeding tube placement (79.6% vs. 68.9%).
Nevertheless, the carboplatin-paclitaxel group had a decrease frequency of remedy interruptions (14.6% vs. 30.5%) and adjustments in systemic remedy (17.2% vs. 0%).
Listening to loss or tinnitus occurred in 27.2% of sufferers handled with cisplatin.
Researchers acknowledged research limitations, together with its retrospective nature and the variations in age and tumor stage between the 2 teams.
“We have been fortunately shocked as a result of we have been working with the premise that cisplatin is the go-to drug primarily based on these section 3 research from 20-something years in the past,” Saba stated. “It was good to see that [carboplatin-paclitaxel] might be considerably much less poisonous in sure elements. … It is a routine price pursuing.”
Therapy evolving with immunotherapy
The info ought to “reassure” physicians carboplatin-paclitaxel can be utilized for sufferers who’re ineligible for cisplatin, Saba stated.
A randomized potential trial involving each remedies would provide extra perception into the effectiveness of this routine in sufferers who’re eligible to obtain cisplatin.
“There are some information from earlier research {that a} taxane-based routine may probably be higher than cisplatin,” Saba stated. “These, nonetheless, werenot powered to particularly reply this query. These have been older research, however that led to the design of some research which might be presently ongoing within the postoperative setting. That research won’t reply the query for definitive sufferers.”
Saba is not sure randomized trials will occur within the cisplatin ineligible inhabitants, evaluating the authorized agent cetuximab to paclitaxel and carboplatin, but is hoping this is able to be pursued. Given the ever rising curiosity in immunotherapy in HNSCC this query has taken second stage.
Healio beforehand reported sufferers with domestically superior HNSCC who acquired adjuvant nivolumab (Opdivo, Bristol Myers Squibb) plus customary chemoradiotherapy had a 24% enchancment in DFS vs. those that didn’t.
Moreover, KEYNOTE-689 discovered people with stage III or IVA resected, locally-advanced illness who acquired neoadjuvant and adjuvant pembrolizumab (Keytruda, Merck) had a 27% enchancment in EFS.
Healio additionally reported on a research that confirmed doublet brokers improved response charges in contrast with single-agent remedies for HNSCC.
“Immunotherapy is barely going to get higher,” Saba stated. “We’re simply scratching the floor of what immunotherapy can do. … Do I believe radiation shall be phased out fully within the subsequent 10 years? No. Nevertheless, I believe it’s a stepwise course of.
“We’re extra prone to attain a radiation-free method in HPV-positive illness as a result of these tumors normally are extra responsive and extra curable. Whenever you come to HPV-negative illness, we’ve got probably not had any main adjustments for the final 30 years. We nonetheless use cisplatin and radiation because the go-to routine. There are ongoing trials which might be incorporating immunotherapy right here.”
Saba stated he’s hopeful physicians can “deescalate” use of radiation sooner or later.
“I definitely stay up for a day when the remedy for head and neck most cancers wouldn’t end in a lot toxicity for sufferers,” he stated. “That’s definitely reachable. Possibly it should take greater than 20 years to realize, however definitely we’re on a monitor that can lead us to enchancment in outcomes — and hopefully enchancment in our remedy modalities.”
For extra data:
Nabil F. Saba, MD, FACP, will be reached at nfsaba@emory.edu.