How do you approach cisplatin ineligible patients with bulky EBER positive nasopharyngeal SCC for induction chemotherapy?

For patients who are cisplatin-ineligible, I substitute with carboplatin. There have been studies such as the one below which show that the regimen of carboplatin and gemcitabine is effective and well-tolerated.

Lim et al., PMID 23369852

Conclusion: The use of induction carboplatin and gemcitabine f...

I would agree. Substitution of carboplatin for cisplatin when ototoxicity precludes the use of cisplatin is acceptable. Patients with locally advanced virally mediated tumors require more systemic therapy in addition to the chemotherapy that they receive with radiation therapy. While adjuvant chemot...