Abstract

Objectives: Platinum-based concurrent chemotherapy and radiation has been the standard of care for locally advanced head-and-neck squamous cell carcinoma. Immunomodulators have been our standard treatment option for selected patients not amenable to platinum. Since 2009 we have migrated the treatment of these patients to a cetuximab-based chemotherapy. We aim to report our experience with this new regimen. Methods: We retrospectively analyzed 24 patients treated with a cetuximab-based chemoradiation therapy at the Centre Hospitalier de l’Université de Montréal from July 2009 to May 2011. All patients had non-metastatic head-and-neck squamous cell carcinoma not eligible to receive cisplatinum as a result of an elder age, poor performance status, auditory concern or a high Charlson co-morbidity index. The planned dose for all patients was 66 to 70 Gy. The planned prescription for cetuximab was an initial weekly dose of 400 mg/m2 followed by a maximum of 7 doses of 250 mg/m2. Results: Three patients were treated for a newly diagnosed stage III head and neck squamous cell carcinoma and 21 patients for stage IVa. The median age for patients was 72 years (range: 61-79). Four patients had a Charlson co-morbidity index of 0, eleven with an index of 1, six of an index of 2 and three with an index of 3. Five patients (21%) had a break or did not complete the planned treatment. Of the treatment toxicities, grade ≥3 acneform rash was seen in 3 patients (13%), hypomagnesemia in 10 (42%) and grade ≥ mucitis in 8 (33%). Three (13%) patients presented anemia of which one (4.2%) required a blood transfusion. Ten patients (41%) had loss more then 10% of their body weight requiring nasogastric tube feeding (n= 8, 33%) or a gastrostomy feeding (n=2, 8%) for a mean of 23 days (SD= 47). Seven patients (29%) were hospitalized during treatment for maximum of 12 days with a mean of 2 days (SD= 4). No patients presented febrile neutropenia, ≥ grade 3 neutropenia or ototoxicity. No deaths were noted during treatment. Nineteen patients (79%) had complete locoregional regression. The mean follow-up was 6 months (SD= 5.4). At last follow-up, twenty-two patients (92%) had no evidence of disease. Conclusion: Platinum-based chemoradiation is the gold standard in treating locally advanced HNSCC. Patients who are not eligible to receive standard therapy comprise of an elderly population with comorbidities. Immunomodulators may be a viable option for patients such patients. Cetuximab is a reasonable treatment modality in this elderly population.