890P - Real-world survival outcomes and survival risk factors in elderly patients with locally advanced squamous cell carcinoma of the head and neck

Background

Treatment options for locally advanced squamous cell carcinoma of the head and neck (LA SCCHN) include definitive non-surgical treatment with radiotherapy (RT) ± chemotherapy (CT) or primary resection followed by adjuvant RT ± CT. We aim to understand survival outcomes and survival risk factors in elderly patients with LA SCCHN who receive treatment.

Methods

The SEER-Medicare database (patients ≥65 years) was used. Patients with ≥1 year of baseline information and a diagnosis of stage III, IVa, or IVb SCCHN of the oral cavity, oropharynx, hypopharynx, or larynx between January 2014 and December 2017 were included. Patients were followed until death, subsequent cancer, health plan enrollment change, or December 2019. We examined overall survival (OS) and used Cox proportional hazards models to estimate the association of baseline characteristics with survival.

Results

2,303 patients were identified, with a mean age of 73.4 years. Of these patients, 64.6% received definitive non-surgical treatment, 32.7% received primary resection, and 2.7% received CT alone. In patients who received definitive non-surgical treatment, median OS was 15.3 mo for oral cavity cancer, 34.1 mo for hypopharyngeal cancer, and 34.6 mo for laryngeal cancer. In patients who were treated with primary resection, median OS was 30.6 mo for oral cavity cancer and 30.0 mo for laryngeal cancer. There were too few patients with hypopharyngeal cancer who received primary resection to report. Median OS in patients with oropharyngeal cancer was not reached in either treatment group. Age ≥70 (age ≥70 vs. <70, hazard ratio [HR], 1.2; P<.05); advanced disease stage (stage IVa vs stage III, HR, 1.4; P<.05; stage IVb vs stage III, HR, 2.8; P<.05) and higher National Cancer Institute (NCI) comorbidity scores (per unit; HR, 1.1; P<.05) were associated with worse survival.

Conclusions

Survival outcomes in elderly patients with LA SCCHN, and especially in patients ≥70 years, with advanced disease stage, and with higher NCI comorbidity scores, are poor. Innovative, effective treatments are needed for the elderly LA SCCHN patient population.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Merck (CrossRef Funder ID: 10.13039/100009945).

Funding

Merck (CrossRef Funder ID: 10.13039/100009945).

Disclosure

N.F. Saba: Financial Interests, Personal, Advisory Board: AstraZeneca, Pfizer, Merck & Co, Kenilworth, NJ, GSK, Novartis, Inovio, EMD Serono, Vaccinex, Kura, Celldex, Eisai, Exelixis, CUE, Fulgent, Akeso, Seagen; Financial Interests, Personal, Principal Investigator: Exelixis, BMS; Financial Interests, Personal, Other, Speaking, publishing honoraria: Onclive, REACH MD, Uptodate, WebMD, Springer. E. Lu: Financial Interests, Personal, Full or part-time Employment: EMD Serono Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA. M. Danese: Financial Interests, Institutional, Funding: Amgen, Merck, BMS, Mirati. S. Bobiak: Financial Interests, Personal, Full or part-time Employment: EMD Serono Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA. A. Schroeder: Financial Interests, Personal, Full or part-time Employment: Merck Healthcare KGaA, Darmstadt, Germany. S.M. Salmio: Financial Interests, Personal, Full or part-time Employment: Merck Healthcare KGaA, Darmstadt, Germany. All other authors have declared no conflicts of interest.