Meet me halfway

Despite many attempts to de-escalate concurrent high-dose cisplatin (100mg/m2 q3 weeks) during radiation for head and neck (H&N) cancers, it has demonstrated improved cancer outcomes time and time again. To get even more specific, most protocols call for cisplatin on Mondays or Tuesdays “to maximize overlap of daily radiation with cisplatin exposure.” This retrospective look at outcomes among 435 patients receiving definitive H&N chemoradiation at MSKCC asks two pragmatic questions: 1) is cisplatin really better on Mondays and Tuesdays, and 2) can the 100mg/m2 dose be given over two sequential days (i.e. 50 mg/m2 over 2 days, every 3 weeks)? The rationale with 2-day cisplatin administration, by the way, was increased opportunity for supportive care. This obviously wasn’t a randomized trial, but answer 1 appears to be no as locoregional failure wasn’t different depending on the day of the week: 6.7% on M/T versus 7.1% on W/R/F. Answer 2 was yes, locoregional control was similar for patients who got 100 mg/m2 over two sequential days compared to 100 mg/m2 on one day. In multivariate analysis, neither treatment delivery factor was associated with survival outcomes. | Kang, Int J Cancer 2021