At-home 1-week hydration improves tolerance and treatment intensity of high-dose cisplatin in locally advanced head and neck cancer: a retrospective study

Background: High-dose cisplatin (100 mg/m² every 3 weeks for three cycles), administered with radiotherapy for locally advanced head and neck cancer, is associated with acute kidney injury (AKI) in up to 30% of patients and may compromise treatment intensity in 20%. Objective: To assess the impact of a 1-week at-home hydration protocol following each cisplatin cycle on treatment tolerance and chemotherapy dose intensity. Methods: We conducted a retrospective analysis of patients with locally advanced head and neck cancer treated at Gustave Roussy between January 2015 and December 2020. Eligible patients received at least one cycle of high-dose cisplatin (100 mg/m²) with radiotherapy. The institutional hydration protocol included a 3-day hospital stay with intensive intravenous hydration, followed by at-home administration of 0.9% sodium chloride (1 L/12 h) for 1 week after each cycle. Results: A total of 494 patients were included; 470 (95%) were under 70 years old. Of these, 451 (91%) received at least 200 mg/m² of cisplatin, and 242 (49%) completed the full 300 mg/m² dose (median cumulative dose: 280 mg/m²). AKI of any grade occurred in 117 patients (24%), including 14 (3%) with Grade 3 toxicity. Dose reductions were necessary in 252 patients, primarily due to mucositis/vomiting (12%), myelosuppression (11%) or AKI (8%), Conclusion: A 1-week at-home hydration protocol was associated with lower nephrotoxicity and higher chemotherapy dose intensity than historically reported. This strategy appears to be an effective supportive care measure to optimize high-dose cisplatin administration.