936P - Outcome and toxicity in older patients with locoregionally-advanced head and neck cancer: Relevance of an oncogeriatric approach

Background

The number of older patients (pts) with head and neck cancer (HNC) is increasing. Comprehensive geriatric assessment (CGA) is the Gold Standard tool to classify pts based on frailty profile in order to individualize the treatment. The aim of this study is to evaluate the outcome and toxicity of older pts treated lining up CGA.

Methods

We conducted a prospective cohort study of older (>70 years) HNC pts with locoregionally-advanced (LA) disease. All pts underwent CGA and were classified as “fit” (F), “medium fit” (MF) or “unfit” (UF). We evaluated final treatment plan, treatment completion rate (TCR), objective response rate (ORR) by RECIST 1.1 and toxicity according to CGA classification.

Results

From January 2018 to March 2020 69 pts were included. Median age was 80 (71-96). According to CGA, 26 (37,7%), 30 (43,5%) and 13 (18,8%) pts were classified as F, MF and UF respectively. Treatment received after CGA: multimodality therapy 40pts (58%; 55% F, 42,5% MF, 2,5% UF); RT alone 7 pts (10,1%; 16,7% MF, 15,4% UF); surgery alone 9 pts (13%; 11,5% F 13,3% MF, 15,4% UF); BSC 13 pts (18,8%; 3,8%F, 13,3% MF, 61,5% UF). TCR was 47 pts (87%) for the whole cohort (46,8% F, 42,6% MF, 10,6% UF) (p = 0,32). At May 15^th 61 pts were evaluable for response, ORR: complete response 38 pts (62,3%; 34,2% F, 55,3% MF, 10,5% UF); partial response 5 pts (8,2%; 60% F, 20% MF, 20% UF); stable disease 7 pts (11,5%; 57,1% F, 42,9% MF); disease progression 11 pts (18%; 45,5% F, 27,3% MF, 27,3% UF) (p=0.5). In terms of toxicity, 36 pts (64,3%) presented G1-2 toxicity (47,2% F, 47,2 %MF, 5,6%UF) (p=0,49); and 8 pts (14,3%) presented G3 toxicity (50% F, 37,5% MF, 12,5% UF) (p=0,84). No G4 toxicity was reported. Only one MF patient died due to toxicity. Mortality rate was 33,8% (38,5% F, 26,7% MF, 41,7% UF). Tumor progression was the major cause of death in F and MF pts (75% and 50%, respectively), whereas it was comorbidity in UF pts (40%).

Conclusions

In this study we showed no outcome or toxicity differences between F, MF and UF patients, supporting the relevant role of CGA for clinical decision-making in older adults with LA-HNC.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Catalan Institute of Oncology.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.