Evaluation of Concomitant Systemic Treatment in Older Adults With Head and Neck Squamous Cell Carcinoma Undergoing Definitive Radiotherapy

Abstract

ImportanceThe number of older adults with head and neck squamous cell carcinoma (HNSCC) is increasing, and these patients are underrepresented in clinical trials. It is unclear whether the addition of chemotherapy or cetuximab to radiotherapy is associated with improved survival in older adults with HNSCC.ObjectiveTo examine whether the addition of chemotherapy or cetuximab to definitive radiotherapy is associated with improved survival in patients with locoregionally advanced (LA) HNSCC.Design, Setting, and ParticipantsThe Special Care Patterns for Elderly HNSCC Patients Undergoing Radiotherapy (SENIOR) study is an international, multicenter cohort study including older adults (≥65 years) with LA-HNSCCs of the oral cavity, oropharynx/hypopharynx, or larynx treated with definitive radiotherapy, either alone or with concomitant systemic treatment, between January 2005 and December 2019 at 12 academic centers in the US and Europe. Data analysis was conducted from June 4 to August 10, 2022.InterventionsAll patients underwent definitive radiotherapy alone or with concomitant systemic treatment.Main Outcomes and MeasuresThe primary outcome was overall survival. Secondary outcomes included progression-free survival and locoregional failure rate.ResultsAmong the 1044 patients (734 men [70.3%]; median [IQR] age, 73 [69-78] years) included in this study, 234 patients (22.4%) were treated with radiotherapy alone and 810 patients (77.6%) received concomitant systemic treatment with chemotherapy (677 [64.8%]) or cetuximab (133 [12.7%]). Using inverse probability weighting to attribute for selection bias, chemoradiation was associated with longer overall survival than radiotherapy alone (hazard ratio [HR], 0.61; 95% CI, 0.48-0.77; P < .001), whereas cetuximab-based bioradiotherapy was not (HR, 0.94; 95% CI, 0.70-1.27; P = .70). Progression-free survival was also longer after the addition of chemotherapy (HR, 0.65; 95% CI, 0.52-0.81; P < .001), while the locoregional failure rate was not significantly different (subhazard ratio, 0.62; 95% CI, 0.30-1.26; P = .19). The survival benefit of the chemoradiation group was present in patients up to age 80 years (65-69 years: HR, 0.52; 95% CI, 0.33-0.82; 70-79 years: HR, 0.60; 95% CI, 0.43-0.85), but was absent in patients aged 80 years or older (HR, 0.89; 95% CI, 0.56-1.41).Conclusions and RelevanceIn this cohort study of older adults with LA- HNSCC, chemoradiation, but not cetuximab-based bioradiotherapy, was associated with longer survival compared with radiotherapy alone.

Outcomes of definitive local therapy with intensity‐modulated radiation therapy in elderly patients ≥70 years with HPV‐associated oropharyngeal cancer

“…On univariate analysis, both ECOG 0‐1 and CCI < 6 was associated with improved OS, and on multivariate analysis only the CCI < 6 was associated with improved OS. In a large multi‐institutional study of head and neck cancer patients ≥65 years, the patients who most benefited from CRT were those who had a better ECOG PS 16 . In an older study of the Surveillance, Epidemiology, and End Results database, CCI was shown to be associated with survival and inferior OS with higher scores 17 .…”

“…In a large multi-institutional study of head and neck cancer patients ≥65 years, the patients who most benefited from CRT were those who had a better ECOG PS. 16 In an older study of the Surveillance, Epidemiology, and End Results database, CCI was shown to be associated with survival and inferior OS with higher scores. 17 Given the importance of identifying elderly head and neck cancer patients at risk for adverse outcomes, there has been increasing interest in incorporating geriatric assessments to stratify patients who may be suitable for aggressive treatment.…”

Transethosome‐Based Topical Administration Systems with Enhanced Penetration and Dual Actions for Treating EGFR‐Overexpressed Cutaneous Squamous Cell Carcinoma

“…[ 4,5 ] Radiation therapy offers hope for lesions that are challenging to remove surgically, while it often introduces additional issues, such as skin inflammation and fibrosis. [ 6 ] Moreover, the limited success and severe adverse effects associated with chemotherapy further underscore the need to develop a safer and more effective treatment strategy for CSCC. [ 7,8 ]…”

Reply to Topkan et al. Toxicities and prognostic factors in elderly HPV‐associated oropharyngeal cancer patients treated with radiotherapy or chemoradiotherapy

“…Our team has been part of a larger multinational effort to define the optimal chemotherapy regimens in elderly patients with locoregionally advanced HNSCC. 3,4 These efforts to leverage large datasets in a multicenter patient cohort will provide the power to determine important prognostic factors in HNSCC. Finally, outcomes after progression and the use of salvage therapies would be interesting but were beyond the scope of the current study.…”