RTOG 0522: Adding Cetuximab to Cisplatin – Chemoradiation (CRT) in Locally Advanced Head and NEck Squamous Cell Carcinoma (LA-HNSCC)

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Design:
    • Phase III, 891 analyzable patients with stage III to IV HNSCC randomized to:
      • Accelerated RT + cisplatin (100 mg / m² D1 and D22) with or without cetuximab (400 mg / m² load then 250 mg / m² weekly)
    • Primary endpoint: 
  • Result (no efficacy gain, more acute toxicity):
    • 3-yr PFS: 
      • 61.2% (CRT) vs 58.9% (CRT + cetuximab), P = 0.76
    • 3-yr OS: 
      • 72.9% vs 75.8%, P = 0.32
    • LRC:
      • No difference
    • DM:
      • No difference
    • Treatment delivery: 
      • Similar cisplatin given (mean 191.1 vs 185.7 mg / m²):
        • But more RT interruptions with cetuximab (26.9% vs 15.1%). PubMed
    • Toxicity signal:
      • Higher grade 3 to 4 mucositis (33% vs 43%), skin reactions (in- and out-of-field), fatigue, anorexia, and hypokalemia with the triplet
      • Late grade ≥ 3 toxicity not increased PubMed+1
  • Biomarkers / subgroups:
    • p16+ OPSCC had better outcomes overall:
      • But no benefit from adding cetuximab (no predictive effect)
    • EGFR expression:
      • Did not distinguish outcomes:
        • An age interaction noted in exploratory analysis is not practice-changing PubMed
  • Exam / clinic pearl:
    • Do not “stack” an EGFR inhibitor onto standard cisplatin – CRT:
      • No improvement in OS / PFS / LRC and more acute toxicity
    • If a patient is cisplatin-ineligible:
      • Switch the partner (e.g., RT+cetuximab):
        • But don’t add cetuximab to cisplatin PubMed
  • References:
  • Bottom line: 
    • Adding cetuximab to cisplatin – CRT:
      • Does not help and harms tolerability:
        • Reserve cetuximab as an alternative when cisplatin cannot be given
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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