1007P - Cetuximab and concurrent radiation (CTX-RT) for squamous cell carcinoma of the head and neck (SCCHN) in elderly and multi-morbid patients

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Geriatric Oncology
Head and Neck Cancers
Surgery and/or Radiotherapy of Cancer
Presenter Hector Callata Carhuapoma
Citation Annals of Oncology (2014) 25 (suppl_4): iv340-iv356. 10.1093/annonc/mdu340
Authors H.R. Callata Carhuapoma1, C. Aguado1, G. Vazquez1, S. Cabezas Camarero2, M. Sotelo Lezama3, M.C. Iglesias Moreno1, A. Manzano2, D. Acosta1, E. Díaz-Rubio3, P. Perez Segura1
  • 1Oncology, Hospital Clinico Universitario San Carlos, 28040 - Madrid/ES
  • 2Medical Oncology, Hospital Clínico San Carlos, 28040 - Madrid/ES
  • 3Medical Oncology, Hospital Universitario Clínico San Carlos, 28040 - Madrid/ES

Abstract

Aim

Treatment with CTX-RT in patients (pts) with locally advanced or recurrent SCCHN has shown benefits in overall survival (OS) and locoregional control, versus radiation alone (Bonner 2006). In elderly pts and those with comorbidities management is a clinical practice challenge due to the associated toxicity.

Methods

We performed a retrospective analysis of pts over 65 years who were treated with CTX-RT (cetuximab 400mg/m2 first infusion, followed by 250mg/m2 weekly with concurrent radiation). We evaluated response rate, clinical benefit rate, progression-free survival (PFS), overall survival (OS), toxicity and comorbidities. Charlson's scale (cerebrovascular disease, diabetes, COPD, ischemic heart disease, dementia, peripheral arterial disease, chronic renal failure and cancer) was used to define the comorbidity level.

Results

Twenty-three pts were included (20 male). All pts had ECOG 0-1. The median age was 71. Median number of cycles of cetuximab was 8 (range: 4-9). Median RT dose was 50 Gy. Treatment indications were due to: local relapse (2), post-operative treatment (9) and radical treatment for organ preservation (12). Overall response rate was 87% (10 CR and 10 PR). Median PFS and OS were 13 months and 29 months, respectively. 14 (60%) pts had a high level of comorbidity (Charlson's scale ≥ 3). The most common grade 3-4 toxicities included radiodermitis 43% (11), mucositis 26% (6) and acneiform rash 9% (2). Treatment was discontinued because of toxicity in 5 pts. Charlson's scale was found to be a prognostic factor for overall survival (HR: 0.18 p = 0.035). There was a significant association between the comorbidity level by Charlson's scale and grade of mucositis (p = 0.025).

Conclusions

Treatment with CTX-RT has an acceptable tolerability in older SCCHN cancer pts with comorbidities, with optimal outcomes in survival and response rate, supporting its therapeutic activity in this group of pts. We found a significant correlation between grade of mucositis and Charlson's scale comorbidity level. Charlson's scale is shown to be a prognostic factor for overall survival. Further prospective studies are needed to confirm these results.

Disclosure

All authors have declared no conflicts of interest.