In the JCOG 1008 trial, the weekly cisplatin arm had better outcomes despite a lower total drug dose. This suggests that maintaining consistent drug levels for radiosensitization throughout radiation is potentially more critical than the overall cumulative dose, which was higher in the less effective three-weekly arm.
The JCOG 1008 trial defined treatment completion as receiving at least five of seven planned weekly cisplatin doses (200 mg/m²). This provides clinicians with a practical, data-supported minimum target when managing patient toxicity, helping to balance efficacy against the need to push for all seven doses.
The JCOG 1008 trial exclusively studied cisplatin-eligible patients. Therefore, the weekly regimen should be seen as an alternative schedule for those who can tolerate cisplatin, not as a less toxic option to enable treatment for patients who are truly ineligible due to poor renal function, hearing loss, or other comorbidities.
The true value of weekly cisplatin's non-inferiority is not the simple comparison. Its more manageable acute toxicity profile may allow more high-risk patients, who might otherwise only receive radiation, to successfully complete effective postoperative chemoradiotherapy, thus broadening access to the standard of care.