Systemic treatment in elderly head and neck cancer patients: recommendations for clinical practice.

Details

Serval ID
serval:BIB_E76BF67C06EC
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Systemic treatment in elderly head and neck cancer patients: recommendations for clinical practice.
Journal
Current opinion in otolaryngology & head and neck surgery
Author(s)
Szturz P., Bossi P., Vermorken J.B.
ISSN
1531-6998 (Electronic)
ISSN-L
1068-9508
Publication state
Published
Issued date
04/2019
Peer-reviewed
Oui
Volume
27
Number
2
Pages
142-150
Language
english
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Abstract
Despite the constantly growing number of elderly patients with squamous cell carcinoma of the head and neck (SCCHN), the majority of clinical trials have been focusing on their younger counterparts. However, because of age-related changes and the resulting higher prevalence of frailty, senior people need an adapted evidence-based approach.
Recommendations presented in this article proceed from those relevant for the general patient population taking into consideration the individual process of aging. In this respect, categorization into fit, vulnerable and frail elderly patients was used to guide systemic treatment.
The fit and vulnerable subgroups with locoregionally advanced SCCHN may still benefit from curative treatment, whereas for the remaining cases only palliative measures are usually appropriate. Advanced calendar age is not a contraindication for cisplatin making part of the standard regimens in locally advanced (high-dose 3-weekly schedule concurrent with radiotherapy) and recurrent/metastatic disease (in combination with 5-fluorouracil and cetuximab). In the latter setting, modern immunotherapy with immune checkpoint inhibitors, particularly the antiprogrammed cell death protein-1 (anti-PD-1) agents nivolumab and pembrolizumab, changed clinical practice. These drugs have a favourable toxicity profile making them good candidates even for management of vulnerable patients. Regardless of the chosen strategy, attentive supportive care is of paramount importance.
Keywords
Age Factors, Aged, Antineoplastic Agents/administration & dosage, Forecasting, Frail Elderly, Geriatric Assessment, Head and Neck Neoplasms/drug therapy, Head and Neck Neoplasms/pathology, Head and Neck Neoplasms/therapy, Humans, Immunotherapy, Squamous Cell Carcinoma of Head and Neck/drug therapy, Squamous Cell Carcinoma of Head and Neck/pathology, Squamous Cell Carcinoma of Head and Neck/therapy
Pubmed
Web of science
Create date
27/02/2019 12:23
Last modification date
20/08/2019 17:10
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