Trends in chemoradiation use in elderly patients with head and neck cancer: Changing treatment patterns with cetuximab

Baxi, Shrujal S.; O'Neill, Caitriona; Sherman, Eric J.; Atoria, Coral L.; Lee, Nancy Y.; Pfister, David G.; Elkin, Elena B.

doi:10.1002/hed.23961

Cited by 30 publications

(38 citation statements)

References 41 publications

(88 reference statements)

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“…More contemporary increases in CRT use are perhaps reflective of presumed improvements in supportive care, more conformal radiation techniques, or less toxic systemic therapies. In a recent analysis of the linked Surveillance, Epidemiology, and End Results (SEER)— Medicare database, Baxi et al (26) found that CRT use among head and neck cancer patients aged ≥65 years increased from 29% in 2001 to 61% in 2009. Furthermore, older age was associated with decreased likelihood of receiving CRT before 2006 but not afterward, which Baxi et al postulate is because of increased use of cetuximab in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, older age was associated with decreased likelihood of receiving CRT before 2006 but not afterward, which Baxi et al postulate is because of increased use of cetuximab in elderly patients. Specifically, cetuximab was the most commonly used concurrent systemic agent among elderly patients after its Food and Drug Administration approval in 2006, and its rise coincided with the decline in use of platinum agents over the same period (26). Similarly, in our NCDB cohort, the rate of adjuvant CRT use among elderly patients (aged ≥70 years) with ECE or positive surgical margins increased from 13% in the period of 2004 to 2007 to 24% in 2008 to 2012, during which cetuximab was more commonly used.…”

Section: Discussionmentioning

confidence: 99%

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Patterns of Care in Adjuvant Therapy for Resected Oral Cavity Squamous Cell Cancer in Elderly Patients

Pollom

Chin

Lee

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Purpose: To characterize the patterns of care and potential barriers to access to care for elderly patients with oral cavity cancer in the adjuvant setting. Methods and Materials: We performed a retrospective cohort study using the National Cancer Data Base and identified patients with resected oral cavity squamous cell carcinoma diagnosed between 2004 and 2012, who survived for ≥3 months after surgery. We used logistic regression models to assess the association between age (<70, 70–79, and ≥80 years) and the receipt of adjuvant therapy within 3 months of surgery. We additionally assessed the association between patient and tumor characteristics and the receipt of adjuvant therapy among those aged ≥70 years. Results: A total of 25,829 patients were included in the study. Compared with those aged <70 years, older patients were more likely to have no neck dissection or have fewer lymph nodes dissected and were less likely to receive adjuvant therapy than younger patients. Among our cohort, 11,361 patients (44%) had pathologic T3-T4 disease or N2-N3 disease, and 4185 patients (16%) had extracapsular nodal extension or positive surgical margins. In multivariate analyses controlling for comorbidity and demographic characteristics, older age was independently associated with lower odds of receiving adjuvant radiation therapy in the subgroup with T3 or T4 disease or N2 or N3 disease and adjuvant chemoradiation therapy in the positive extracapsular nodal extension or positive surgical margin subgroup. Among elderly patients, both greater patient distance from reporting facility and older age were associated with lower odds of receiving both adjuvant radiation therapy (odds ratio 0.66; 95% confidence interval, 0.55–0.81) and chemoradiation therapy (odds ratio 0.56; 95% confidence interval, 0.40–0.79). Conclusions: In a national hospital-based cohort of patients with oral cavity cancer, elderly patients were less likely to receive adjuvant radiation or chemoradiation therapy. Greater patient distance from reporting facility, in addition to older age, was associated with lower odds of receiving both adjuvant radiation therapy and adjuvant chemoradiation therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patterns of Care in Adjuvant Therapy for Resected Oral Cavity Squamous Cell Cancer in Elderly Patients

Pollom

Chin

Lee

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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“…55 This was predominantly driven by increased use of cetuximab, which accounted for approximately 50% of concomitant systemic therapy regimens in 2009. 58 However, the rising use of cetuximab in the older adult population should be scrutinized closely. As noted previously, the only trial showing a benefit with cetuximab in combination with RT demonstrated no improvement in survival in patients 65 or older.…”

Section: Methodsmentioning

confidence: 99%

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

Maggiore

Zumsteg

BrintzenhofeSzoc

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Older adults with squamous cell carcinomas of the head and neck (HNSCC) pose unique treatment and supportive care challenges to oncologists and other cancer care providers. The majority of patients with HNSCC present with locoregionally advanced (LA) disease, for which combined modality treatment integrating chemotherapy and radiation therapy is often necessary to maximize tumor control. However, applying these approaches to an older population with concomitant comorbidities and higher risk for functional impairments remains challenging, and is exacerbated by the paucity of studies involving older adults. The purpose of this paper is to identify knowledge gaps in the evaluation and management of older adults with HNSCC and their caregivers, particularly those undergoing concurrent chemoradiation, through a review of the literature conducted by clinicians, researchers, and patient advocates. The findings highlight the importance of a geriatric assessment and the therapeutic paradigms and challenges relevant to this population. Furthermore, we identify the need for additional research and interventions related to key supportive care issues that arise during and after treatment in older adults with LA-HNSCC. Based on our findings, we prioritized these issues to guide future patient-oriented research endeavors to address these knowledge gaps and thus better serve this growing patient population.

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“…The meta-analysis of Kim et al [12], which does not generally support the wide use of cetuximab concurrent to radiotherapy or CRT, highlights that cetuximab could be a reasonable and preferable choice in patients with comorbidities and a decreased performance status. All of these data have produced a substantial increase in chemotherapy and cetuximab plus radiation treatment in HNC as shown recently by the Surveillance Epidemiology and End Results (SEER) database [33]. After 2006, cetuximab became the most commonly used agent in concurrent regimens [33].…”

Section: Discussionmentioning

confidence: 99%

“…All of these data have produced a substantial increase in chemotherapy and cetuximab plus radiation treatment in HNC as shown recently by the Surveillance Epidemiology and End Results (SEER) database [33]. After 2006, cetuximab became the most commonly used agent in concurrent regimens [33]. …”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Cetuximab plus Radiotherapy in Cisplatin-Unfit Elderly Patients with Advanced Squamous Cell Head and Neck Carcinoma: A Retrospective Study

et al. 2019

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Introduction: Concurrent platinum-based chemoradiation currently represents the standard treatment for advanced head and neck cancer (HNC), but it induces a significant toxicity, in particular among elderly patients. Elderly and unfit patients have been underrepresented in clinical trials and there is a need for tailored guidelines. Methods: A retrospective review of clinical data of HNC patients treated at the Operative Oncology Unit of the San Giovanni di Dio Hospital in Frattamaggiore (Naples, Italy) was performed. At study entry, a comprehensive assessment including absolute contraindications for cisplatin use, as well as comorbidities, socioeconomic status, BMI, and weight loss, was performed. The treatment included high-dose radiotherapy plus weekly cetuximab (initially at a dose of 400 mg/m²of body surface area and thereafter at 250 mg weekly during the whole radiotherapy). The aim of this study was to evaluate the activity and toxicity of this schedule in a series of patients aged older than 69 years. Results: Between May 30, 2013, and March 30, 2015, sixty-four patients (age range, 69–87 years; median age, 73.7 years; male/female ratio, 46/18) were treated. The overall response rate was 67% in this series of patients. The disease control rate was 76%. Disease progression was recorded in 25% of the patients. The median duration of loco-regional control was 17 months (range, 15.8–17.7 months). PFS was 14.8 months (range, 13.9–15.5 months). The overall survival was 34 months, with a median follow-up of 41.0 months (range, 31.1–36.8 months). The main grade 3/4 adverse events were acne rash in 52% and radiation dermatitis in 32% of the cases. Conclusion: Cetuximab plus radiotherapy appears to be feasible and active in elderly patients unsuitable for cisplatin treatment. The treatment was supported by a favorable toxicity profile.

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Trends in chemoradiation use in elderly patients with head and neck cancer: Changing treatment patterns with cetuximab

Cited by 30 publications

References 41 publications

Patterns of Care in Adjuvant Therapy for Resected Oral Cavity Squamous Cell Cancer in Elderly Patients

Patterns of Care in Adjuvant Therapy for Resected Oral Cavity Squamous Cell Cancer in Elderly Patients

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

Efficacy and Safety of Cetuximab plus Radiotherapy in Cisplatin-Unfit Elderly Patients with Advanced Squamous Cell Head and Neck Carcinoma: A Retrospective Study

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