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Chemotherapy and Targeted Therapies

Chapter 18 – Head and Neck Cancer in the Elderly

Chemotherapy

Chemotherapy represents the gold standard for recurrent and metastatic SCCHN. The benefit of chemotherapy for senior patients was reported in a landmark study combining data from two phase III trials (ECOG 1393 & ECOG 1395). Both studies used cisplatin-based regimens and showed similar overall survival and loco regional control rates, for both elderly and younger patients. Elderly patients had higher rates of nephrotoxicity, diarrhoea and thrombocytopenia. Toxicity-related death rates were higher for elderly patients than they were for younger patients. However, these differences were not statistically significant.

Targeted Therapies

Cetuximab (monoclonal antibody against Epidermal growth factor receptor [EGFR]),  can be a significant component of front line and salvage treatment in recurrent and metastatic SCCHN, as well as part of multimodality treatment in regionally advanced disease. It is perceived to be better tolerated compared to chemotherapy and as such its use is increasing in the elderly population. Despite trends in clinical practise, evidence for cetuximab favourable safety profile over chemotherapy, in older patients, is limited. While it remains an option, one should not assume that its use is always safe, especially when combined with RT in frail patients.

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