Head and Neck Cancer

PV 02 - Poster Viewing Q&A - Session 2

MO_21_2851 - Patient Reported Nausea Associated with Concurrent Weekly Versus Bolus Cisplatin in Patients Treated for Head and Neck Cancer

Monday, September 16
10:45 AM - 12:00 PM
Location: ASTRO Innovation Hub

Patient Reported Nausea Associated with Concurrent Weekly Versus Bolus Cisplatin in Patients Treated for Head and Neck Cancer
M. Arbab1,2, Y. H. Chen3, S. Criscitiello3, J. Glass4, J. A. Fugazzotto4, J. H. Killoran1, G. J. Hanna3, J. Lorch3, R. I. Haddad3, D. N. Margalit3, R. B. Tishler3, and J. D. Schoenfeld3; 1Brigham and Women's Hospital, Boston, MA, 2Indiana University, Department of Radiation Oncology, Indianapolis, IN, 3Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, 4Dana-Farber Cancer Institute, Boston, MA

Purpose/Objective(s): Concurrent chemotherapy is administered to advanced head and neck cancer (HNC) patients (pts) receiving radiotherapy (RT). Most evidence and practice guidelines support concurrent bolus cisplatin (B-CP, 100 mg / m2 q3wks); however, weekly cisplatin (W-CP, 40 mg / m2) is commonly used. We investigated patient reported outcomes (PRO) related to nausea in HNC pts receiving B-CP versus W-CP with IMRT.

Materials/Methods: We reviewed records from HNC pts treated with IMRT and CP between January 2015 and January 2018 at a single institution who completed institutionally-developed electronic PRO questionnaires at baseline and weekly during RT. We evaluated associations between PRO emesis/loss of appetite (LOA) measured on a 1-10 scale and B-CP versus W-CP. Significance (p<0.05, two-sided) was determined using the rank-sum test and Fisher's exact test.

Results: We identified 101 patients with median age of 59 years (IQR 55-65 years) who completed at least 3 questionnaires at beginning, middle and end of treatment. Most pts were male (84%) with baseline ECOG 0 (86%). The most common subsite treated was the oropharynx (n=65, 64%), of which 83% (n=54) were HPV-associated. IMRT was delivered postoperatively in 21% (n=21). B-CP was administered to 24%, while 76% received W-CP. The median dose of cisplatin in the B-CP and W-CP groups were 300 mg/m2 and 280 mg/m2, respectively, and 92% of patients received >=200mg/m2 CP in both groups. There were no significant differences between B- and W-CP patients in the subsite treated or percentage who received postoperative versus definitive treatment. There were 59% of patients in the W-CP group and 70% in the B-CP group who had a PEG placed before or during RT. Regarding PROs, there were no significant differences in baseline, end of treatment (EOT) or change from baseline to EOT scores for either emesis or LOA (mean baseline/EOT/difference scores for emesis: B-CP 1.1/3.1/1.8, W-CP 0.6/3/2.3, p=0.17/0.58/0.49; and for LOA: B-CP 3.1/5.9/2.5, W-CP 2.8/6.1/3.3, p=0.62/0.70/0.46). There were also no significant differences in the percentages of patients hospitalized during RT (n=6, 25% B-CP; n=18, 23%, W-CP, p=1.0), or with PEG dependence at 3 or 6 months (3 months: n=7/29% B-CP, n=31/40%, W-CP, p=0.47; 6 months: n=2/8% B-CP, n=10/13% W-CP, p=0.73).

Conclusion: There remains uncertainty about the tradeoffs regarding efficacy and toxicity when recommending B-CP versus W-CP to patients receiving HNC treatment. In this retrospective study focused on PRO of nausea / LOA in patients receiving IMRT, we find both B-CP and W-CP lead to similar decrements on treatment. We also find similar rates of hospitalization and PEG-dependence at 3 and 6 months. These data suggest that from a patient perspective, both B- and W-CP result in similar short-term toxicities.

Author Disclosure: M. Arbab: None. Y. Chen: Employee; Flagship VL59 Inc, Constellation Pharmaceuticals. Stock; Constellation Pharmaceuticals. S. Criscitiello: None. J. Glass: Advisory Board; Merck. J. Fugazzotto: None. G.J. Hanna: Advisory Board; EMD Serono, Bristol-Myers Squibb. Honoraria; Society for Immunotherapy of Cancer. J. Lorch: Honoraria; Bristol-Myers Squibb, Genentech, Bayer. Research Grant; Takeda, Bayer, Novartis. R.I. Haddad: Advisory Board; Celgene, merck, eisai, loxo. Consultant; Boehringer ingelheim, BMS, astra zeneca, ISA therapeutics, Nanobiotix, genentech, pfizer, decibel. Research Grant; Boehringer ingelheim, merck, BMS, astra zeneca, genentech, pfizer, kura. CHAIR THYROID PANEL; NCCN. R.B. Tishler: Advisory Board; Oragenics (PSI Pharma Support America, Inc), Regeneron, Izun Pharmaceuticals, EMD Serrono. J.D. Schoenfeld: Advisory Board; BMS, Debiopharm, AstraZeneca, Nanobiotix. Consultant; Tilos. Research Grant; Merck, BMS. Travel Expenses; BMS. Translational PI; NCI Match Subprotocol Z1D.

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