Infectious Complications in Head and Neck Cancer Patients Treated with Cetuximab: Propensity Score and Instrumental Variable Analysis

Abstract

BackgroundTo compare the infection rates between cetuximab-treated patients with head and neck cancers (HNC) and untreated patients.MethodologyA national cohort of 1083 HNC patients identified in 2010 from the Taiwan National Health Insurance Research Database was established. After patients were followed for one year, propensity score analysis and instrumental variable analysis were performed to assess the association between cetuximab therapy and the infection rates.ResultsHNC patients receiving cetuximab (n = 158) were older, had lower SES, and resided more frequently in rural areas as compared to those without cetuximab therapy. 125 patients, 32 (20.3%) in the group using cetuximab and 93 (10.1%) in the group not using it presented infections. The propensity score analysis revealed a 2.3-fold (adjusted odds ratio [OR] = 2.27; 95% CI, 1.46–3.54; P = 0.001) increased risk for infection in HNC patients treated with cetuximab. However, using IVA, the average treatment effect of cetuximab was not statistically associated with increased risk of infection (OR, 0.87; 95% CI, 0.61–1.14).ConclusionsCetuximab therapy was not statistically associated with infection rate in HNC patients. However, older HNC patients using cetuximab may incur up to 33% infection rate during one year. Particular attention should be given to older HNC patients treated with cetuximab.

Incidence and risk of severe infections associated with anti-epidermal growth factor receptor monoclonal antibodies in cancer patients: a systematic review and meta-analysis

“…Based on a single trial, there was a higher rate of severe infections in patients receiving cetuximab. Then, Lee et al [46] in 2012 conducted a national cohort study of 1,083 head and neck cancer patients and found that cetuximab therapy was not statistically associated with an increased infection rate in head and neck cancer patients. As a result, the incidence and risk of infections associated with anti-EGFR MoAbs has not been well defined.…”

Sepsis in head and neck cancer patients treated with chemotherapy and radiation: Literature review and consensus

“…The panel adopted the nomenclature and definitions for terms used by 2001 International Sepsis Definitions [46,47] and alcohol [48] consumption, malnutrition [82,157], swallowing impairment with aspiration [45], chemotherapy-induced neutropenia [39,158,159], disruption of physiological barriers as a consequence of radiodermitis and mucositis [40,160], gingival pockets and dental caries [161][162][163][164], age [12,165,166], co-morbidities such as diabetes and chronic obstructive pulmonary disease (COPD) [166], and the presence of central venous catheters, gastrostomy and tracheostomy are at a higher risk of infections. Conference (i.e.…”

“…Mortality for pneumonia is reported to occur well beyond 30 days after the end of treatments and a high risk of infection is maintained for several months [6,12]. Indeed, it must be considered that the local damage and nutritional impairment last several months after the end of treatment [150], consequently the risk of infection remains higher well after the end of treatment.…”

“…Treatments enhancing local toxicity seem to be related to a higher degree of severe complications and deaths [11]. (3) Finally, the infectious-related mortality is not limited to the time of CRT administration but can occur several weeks after treatment [12]. Post-treatment infections and deaths are usually not considered treatment-related.…”

Cetuximab in Metastatic Squamous Cell Cancer of the Skin: A Swiss Case Series

“…Infectious complications in patients receiving cetuximab in the context of metastatic head and neck cancer showed no overall increase in infections. However, older head and neck cancer patients >70 years of age using cetuximab showed up to 33% more infections during 1 year under treatment [20]. This is a severe and important observation.…”