Cetuximab As An Alternative Treatment Modality In Elderly Patients With Locallyadvanced head and neck squamous cell carcinoma | Cureus

Cetuximab As An Alternative Treatment Modality In Elderly Patients With Locallyadvanced head and neck squamous cell carcinoma


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.
Poster
non-peer-reviewed

Cetuximab As An Alternative Treatment Modality In Elderly Patients With Locallyadvanced head and neck squamous cell carcinoma


Author Information

Moein Alizadeh Corresponding Author

Centre Hospitalier de l'Université de Montréal, Centre Hospitalier de L'Université de Montréal


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