P. Szturz MD, PhD

The role of chemoradiotherapy in elderly patients with locoregionally advanced head and neck cancer

Paralleled by rising cancer burden, recent global demographic changes have been marked by a constantly growing number of people aged 65 or more. In the United States, presently 54% of malignant head and neck cancer cases occur in the geriatric population, and by 2030, this proportion is expected to attain 66%. Despite the obvious importance of addressing specific needs of elderly patients, these individuals have often been undertreated and refrained from geriatric assessment in clinical practices and underrepresented in prospective trials. Unfortunately, many health care professionals still believe that older patients cannot tolerate intensified treatment regimens. In this paper, we focused on concurrent chemoradiation as definitive or post-operative treatment in locoregionally advanced squamous cell carcinoma of the head and neck. Although confirmatory data from large randomised phase III trials conducted in the elderly are lacking, available evidence from meta-analyses of prospective trials and retrospective reviews of population-based cross-sectional registries indirectly support this approach, primarily in the definitive treatment setting. However, irrespective of calendar age, distinction between fit and frail senior patients is of paramount priority. In this respect, several geriatric screening tools have been developed for use by practicing physicians to help select which patients need a comprehensive geriatric assessment, who requires a specific examination only (e.g. focused on certain comorbid conditions, cognition, nutritional status, social support, or psychological state), and where no further testing is warranted.

(BELG J MED ONCOL 2018;12(3):110–117)

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Recurrent and metastatic non-nasopharyngeal head and neck cancer: state of the art of systemic treatment

Summary

The majority of patients diagnosed with recurrent and/or metastatic squamous cell carcinoma of the head and neck are deemed ineligible for surgery or irradiation. Their management prioritise symptom control and quality-of-life improvement. According to patient’s performance status, medical comorbidities and symptoms, recommended treatment options include supportive care only, mono- or multi-drug chemotherapy or cetuximab (epidermal growth factor receptor inhibitor) either alone or as an adjunct to cytotoxic drugs. Despite achieving response rates superior to single-agents, doublet and triplet regimens incorporating cisplatin and/or taxanes did not increase overall survival and were often difficult to tolerate. The platinum (cisplatin or carboplatin)/5-fluorouracil/cetuximab regimen is the only regimen showing significant survival improvement over PF alone in a large randomised trial, and therefore is the only approved new standard systemic treatment today. However, the very poor overall survival of six to ten months expected in this patient population, remains a continuous challenge and novel anticancer therapies are urgently needed. The potential to induce durable responses with manageable toxicity has propelled immunotherapy to the forefront of cancer research, yet its validation in phase III clinical trials is pending. Another crucial task is the identification of reliable, prospectively confirmed prognostic and predictive biomarkers. Mounting evidence from retrospective analyses suggests that human papillomavirus status with p16 immunohistochemical positivity as its surrogate represent promising candidates for this role.

(BELG J MED ONCOL 2016;10(6):207–214)

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