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Cisplatin vs. Cetuximab: Which is the Better Treatment for Head and Neck Cancer?

Mira Elwood in Health & Wellness December 2025 • 4 min read.

"A large study sheds light on the comparative effectiveness of two common chemoradiation therapies for head and neck cancer, offering crucial insights for treatment decisions."

Head and neck cancers are a significant health concern, with tens of thousands of new cases diagnosed each year. A common treatment approach for these cancers, particularly when they are locally or regionally advanced, involves a combination of radiation therapy (RT) and systemic therapy to improve cancer control and survival rates.

Cisplatin and cetuximab are two systemic therapies frequently used alongside radiation. Cisplatin, a platinum-based chemotherapy drug, has long been a standard option. Cetuximab, a monoclonal antibody targeting the epidermal growth factor receptor (EGFR), offers an alternative, especially for patients who may not tolerate cisplatin well. However, it has been unclear which of these therapies provides superior outcomes.

A recent study delved into this question by comparing the effectiveness of cisplatin and cetuximab when administered concurrently with radiation therapy for head and neck cancers. Using data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, researchers analyzed a large, national cohort of patients to assess real-world treatment patterns and survival outcomes.

Cetuximab Linked to Higher Cancer-Specific Mortality

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The study, encompassing 1,395 patients with locoregionally advanced squamous cell carcinomas, revealed a significant difference in cancer-specific mortality (CSM) between the two treatment groups. Patients treated with cetuximab alongside radiation had a notably higher CSM compared to those who received cisplatin with radiation. Specifically, at three years, 39% of the cetuximab group had died from head and neck cancer, compared to only 25% in the cisplatin group.

To account for potential differences between the groups, such as age and other health conditions, the researchers used propensity score matching, creating balanced cohorts for a more accurate comparison. Even after this adjustment, cetuximab was still associated with a significantly higher hazard ratio for CSM – 1.65 (95% confidence interval, 1.30-2.09; P < .0001). This translates to an approximate 10% absolute difference in both CSM and overall survival at three years.

Study Findings: A retrospective analysis of 1,395 patients using SEER-Medicare data compared cisplatin and cetuximab in combination with definitive radiotherapy for head and neck cancers.
Primary Outcome: Head and neck cancer-specific mortality (CSM).
Key Result: Cetuximab was associated with significantly higher CSM compared to cisplatin.
Adjustments: Propensity score matching and multivariable regression were used to adjust for differences in patient characteristics.
Toxicity Analysis: Cetuximab was associated with less dysphagia, more dermatitis, and similar rates of mucositis.

Interestingly, the study also examined the acute toxicities associated with each treatment. Cetuximab was linked to less dysphagia (difficulty swallowing) but more dermatitis (skin inflammation). The incidence of mucositis (inflammation of the mucous membranes) was similar between the two groups.

Implications for Treatment Decisions

This study, with its substantial sample size and national scope, suggests that cisplatin may be the preferred chemotherapeutic agent when combined with radiation for head and neck cancers. The findings highlight the importance of carefully considering the potential risks and benefits of each treatment option.

While cetuximab may be better tolerated in some patients due to its association with less dysphagia, the increased risk of cancer-specific mortality raises concerns. Clinicians should weigh these factors, along with individual patient characteristics, when making treatment decisions.

Further research is needed to confirm these findings and explore the underlying reasons for the observed differences in survival. Ongoing randomized trials comparing cisplatin-based and cetuximab-based chemoradiation may provide additional clarity in the future.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1002/cncr.31708, Alternate LINK

Title: Survival Of Patients With Head And Neck Cancer Treated With Definitive Radiotherapy And Concurrent Cisplatin Or Concurrent Cetuximab: A Surveillance, Epidemiology, And End Results‐Medicare Analysis

Subject: Cancer Research

Journal: Cancer

Publisher: Wiley

Authors: Michael Xiang, F. Christopher Holsinger, A. Dimitrios Colevas, Michelle M. Chen, Quynh‐Thu Le, Beth M. Beadle

Published: 2018-10-17

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Everything You Need To Know

1

What is Cisplatin and why is it important in the treatment of head and neck cancer?

Cisplatin is a platinum-based chemotherapy drug, a standard systemic therapy used alongside radiation therapy in treating head and neck cancers. The study found that patients who received Cisplatin combined with radiation had a significantly lower cancer-specific mortality (CSM) compared to those treated with Cetuximab. The implications are that Cisplatin, in the context of this research, appears to be a more effective treatment option for improving survival rates in head and neck cancer patients.

2

What is Cetuximab and what role does it play in treating head and neck cancer?

Cetuximab is a monoclonal antibody that targets the epidermal growth factor receptor (EGFR). It is another systemic therapy used with radiation for head and neck cancers, particularly for patients who cannot tolerate Cisplatin well. However, the study showed that patients treated with Cetuximab and radiation had a significantly higher cancer-specific mortality rate than those treated with Cisplatin. This suggests Cetuximab might not be as effective as Cisplatin for this specific type of cancer treatment.

3

What does cancer-specific mortality (CSM) mean, and why was it important in this study?

Head and neck cancer-specific mortality (CSM) refers to the death rate specifically attributed to head and neck cancer. The study's primary outcome was CSM, and it revealed a significant difference between the two treatment groups: Cisplatin and Cetuximab. The study indicated that those treated with Cetuximab had a higher CSM than those treated with Cisplatin, underscoring the importance of choosing the appropriate treatment to improve patient survival.

4

How did the researchers conduct the study to compare Cisplatin and Cetuximab?

The study utilized a retrospective analysis of 1,395 patients, using data from the SEER-Medicare database. It compared Cisplatin and Cetuximab in combination with definitive radiotherapy for head and neck cancers. Researchers used Propensity score matching and multivariable regression. These methods are crucial because they help to account for potential differences in patient characteristics, such as age and health conditions, ensuring a more accurate comparison of the two treatments. This adjustment ensures the study's findings are more reliable and reflective of real-world scenarios.

5

What were the differences in side effects between Cisplatin and Cetuximab, and why are they important?

The study compared the toxicities associated with Cisplatin and Cetuximab. Cetuximab was associated with less dysphagia (difficulty swallowing) but more dermatitis (skin inflammation). The incidence of mucositis (inflammation of the mucous membranes) was similar between the two groups. These findings help clinicians and patients understand the potential side effects of each treatment, enabling more informed decisions. The study underscores the need to balance treatment efficacy with its impact on a patient's quality of life, especially when managing head and neck cancer.