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Chemotherapy. 2019;64(1):48-56. doi: 10.1159/000500714. Epub 2019 Jun 26.

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

Author information

1
U.O.C. Oncologia, S. Giovanni di Dio Hospital, ASLNA2NORD Frattamaggiore, Naples, Italy, raffaeleaddeo19@gmail.com.
2
Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy.
3
Section of Oncology, Campus Biomedico University, Rome, Italy.
4
U.O.C. Oncologia, S. Giovanni di Dio Hospital, ASLNA2NORD Frattamaggiore, Naples, Italy.
5
U.O.C. ORL, Santa Maria Delle Grazie Hospital, ASLNA2NORD, Pozzuoli, Italy.
6
Dipartimento di Salute Mentale Fisica e Medicina Preventiva, University of Campania "L. Vanvitelli", Naples, Italy.
7
Ear Nose and Throat Unit, AORN Antonio Cardarelli Hospital, Naples, Italy.
8
Radiotherapy Unit, Medicina Futura, Acerra, Italy.
9
Department of Translational Medical Sciences, School of Medicine, University of Campania "L. Vanvitelli", Naples, Italy.

Abstract

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.

KEYWORDS:

Advanced head and neck cancer; Cetuximab; Chronic alcoholism; Comorbidities; Elderly; Radiotherapy

PMID:
31242489
DOI:
10.1159/000500714

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