Personalization of Treatment Based on Fitness in Elderly Patients With Head/Neck Cancer
Posted: Wednesday, November 6, 2019
According to research presented at the European Society for Medical Oncology (ESMO) Congress 2019 (Abstract 1110O), patients older than age 70 who have head and neck squamous cell cancer may benefit from a personalized treatment regimen based on their level of fitness. “We developed a large prospective clinical program named ELAN to improve the management of elderly [patients with] head and neck squamous cell carcinoma using an adapted geriatric evaluation feasible in daily practice and to set new standards of care for these patients,” noted Joel Guigay, MD, PhD, of Université Côte d’Azur, France, and colleagues.
To evaluate the effects of treatments on patients of varying fitness levels, researchers established the ELAN FIT and UNFIT trials. Patients at least 70 years of age with recurrent or metastatic head and neck squamous cell carcinoma were first enrolled in the ELAN–ONCOVAL study, then categorized as fit or unfit using the ELAN geriatric evaluation. A total of 78 patients qualified for the FIT trial and received a combination treatment of cetuximab, carboplatin, and fluorouracil known as the EXTREME regimen. The 82 patients enrolled in the UNFIT trial were randomly assigned to receive cetuximab (n = 41) or methotrexate (n = 41).
In the ELAN FIT trial, the 12-week objective response rate was 40%, with a median overall survival of 14.7 months and a progression-free survival of 7.2 months. At 1 year, the overall survival rate was 58%, and the progression-free survival rate was 24.9%. A total of 24% of patients reported adverse events of at least grade 4. Overall, fit elderly patients had comparable outcomes with younger patients.
In the ELAN UNFIT trial, the 12-week objective response rate was 12% with cetuximab and 15% with methotrexate. Both treatment arms reported a median overall survival of 4.6 months; median progression-free survival was 2.4 months with cetuximab versus 2.8 months with methotrexate. At 1 year, the cetuximab group had an overall survival rate of 22.5% and a progression-free survival rate of 7.5%, whereas those rates were 14.6% and 7.3%, respectively, for the methotrexate group. When the two arms were considered together, patients with an Eastern Cooperative Oncology Group performance status of 0 or 1 had longer median overall and progression-free survival as well as improved 1-year survival rates compared with patients with a performance status of 2.
Disclosure: For full disclosures of the study authors, visit esmo.org.