Treatment of inoperable elderly head and neck cancer patients

Purpose of review Elderly head and neck cancer (HNC) patients are very rarely enrolled in clinical trials, and even more so in dedicated trials in curative or palliative setting. As a result, no standards of treatment exist for this population and thus, adaptation of standard treatments is commonly used. Recent findings The choice between a monotherapy and a platinum–cetuximab combination is based on the performance status, which is not suitable and/or sufficient to evaluate the patient ability to receive a systemic treatment combined or not with radiotherapy. The evaluation of functional age using geriatric assessment is recommended. However, access to comprehensive geriatric assessment is limited in many centers, and the choice of the type of treatment is often not based on objective and reproducible criteria. As a result, fragile elderly HNC patients may be overtreated with a risk of increased toxicity and fit patients proposed for suboptimal treatment with a risk of failure of tumor control. Summary It is therefore crucial to develop and evaluate customized treatments by enrolling elderly HNC patients in dedicated therapeutics trials, such as the ELAN (Elderly Head and Neck Cancer) studies or new approaches involving promising immunotherapies. To administer the most suitable therapy, a simple and reproducible geriatric assessment could efficiently guide practitioners.
Source: Current Opinion in Oncology - Category: Cancer & Oncology Tags: HEAD AND NECK: Edited by Joël Guigay Source Type: research

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Authors: Kasper S, Hussain T, Virchow I, Stuschke M, Lang S Abstract Treatment of patients with squamous cell carcinoma of the head and neck (SCCHN) is nowadays multidisciplinary. Therapeutic concepts include modern surgical and radiation techniques as well as systemic therapies. However, the prognosis of these patients is still poor for all stages. In the recurrent or metastatic situation after definitive therapy, there is an indication for palliative systemic treatment, whereby classical platinum-based chemotherapy and the monoclonal epidermal growth factor receptor (EGFR) antibody cetuximab are established, and ...
Source: HNO - Category: ENT & OMF Tags: HNO Source Type: research
This article highlights the evidence-based data to support systemic treatment options for patients with head and neck squamous cell carcinoma (HNSCC). The discovery of the human papillomavirus epidemic in HNSCC and its favorable prognosis has led to a major focus of research. Patients are stratified into clinical or pathologic risk categories and enrolled in trials comparing standard treatment paradigms with deintensification, in low-risk disease, or to intensification, in intermediate-risk or high-risk disease. Immunotherapy has proven beneficial in second-line palliative therapy and is under investigation in first-line p...
Source: The Surgical Clinics of North America - Category: Surgery Authors: Tags: Oral Maxillofac Surg Clin North Am Source Type: research
This article highlights the evidence-based data to support systemic treatment options for patients with head and neck squamous cell carcinoma (HNSCC). The discovery of the human papillomavirus epidemic in HNSCC and its favorable prognosis has led to a major focus of research. Patients are stratified into clinical or pathologic risk categories and enrolled in trials comparing standard treatment paradigms with deintensification, in low-risk disease, or to intensification, in intermediate-risk or high-risk disease. Immunotherapy has proven beneficial in second-line palliative therapy and is under investigation in first-line p...
Source: Oral and Maxillofacial Surgery Clinics - Category: ENT & OMF Authors: Source Type: research
hild SI Abstract Head and neck squamous cell carcinoma (HNSCC) is a frequent tumour arising from multiple anatomical subsites in the head and neck region. The treatment for early-stage disease is generally single modality, either surgery or radiotherapy. The treatment for locally advanced tumours is multimodal. For recurrent/metastatic HNSCC palliative chemotherapy is standard of care. The prognosis is limited and novel treatment approaches are urgently needed. HNSCC evades immune responses through multiple resistance mechanisms. HNSCC is particularly characterised by an immunosuppressive environment which include...
Source: Swiss Medical Weekly - Category: General Medicine Authors: Tags: Swiss Med Wkly Source Type: research
Authors: Schuler PJ, von Witzleben A, Doescher J, Wollenberg B, Dietz A, Hoffmann TK Abstract In recent years, immunotherapy has been shown to be a promising approach for the treatment of various tumor entities. Due to further pharmacological developments and new studies, the checkpoint inhibitors have now arrived in the clinic. To date, patients with cancers in the head and neck region have benefited from these agents as part of a palliative therapy. Current clinical trials are testing other indications for the checkpoint inhibitors as monotherapy or in combination with other therapeutic approaches. The ...
Source: HNO - Category: ENT & OMF Tags: HNO Source Type: research
In patients with locally advanced squamous cell cancer of the head and neck, a multimodality treatment approach is recommended. The addition of platinum-based systemic therapy concurrently with radiation has been shown to be superior to radiation alone and is considered standard therapy for locally advanced disease. No study has shown superiority of induction therapy followed by chemoradiotherapy versus chemoradiotherapy alone. In the adjuvant setting only patients with nodal extracapsular extension or positive margins seem to benefit from chemoradiotherapy versus radiotherapy alone. In the recurrent or metastatic setting,...
Source: Otolaryngologic clinics of North America - Category: ENT & OMF Authors: Source Type: research
LA Jacob, T Chaudhuri, KC Lakshmaiah, KG Babu, L Dasappa, MCS Babu, AH Rudresha, KN Lokesh, LK RajeevIndian Journal of Cancer 2016 53(4):471-477Head and neck squamous cell carcinoma (HNSCC) is now the seventh most common cancer worldwide. The median overall survival for patients with recurrent and/or metastatic (R/M) HNSCC remains <1 year despite modern systemic chemotherapy and targeted agents. Palliative systemic therapy for patients with R/M HNSCC typically includes a platinum-based doublet, with an understanding that the increase in efficacy compared with single agents is primarily related to improved response rate...
Source: Indian Journal of Cancer - Category: Cancer & Oncology Authors: Source Type: research
AbstractMost patients diagnosed with head and neck squamous cell carcinoma (HNSCC) will present with locally advanced disease, requiring multimodality therapy. Despite this curative approach, a significant subset of these patients will develop locoregional failure and/or distant metastases. Despite significant progress in the treatment and subsequent prognosis of locally advanced HNSCC, the prognosis of those patients with recurrent and/or metastatic (R/M) HNSCC is poor, with short-lived responses to palliative chemotherapy and few therapeutic agents available. The discovery of the integral role of epidermal growth factor ...
Source: Drugs - Category: Drugs & Pharmacology Source Type: research
Conclusion: Chemo- and immunotherapy agents improves overall survival in breast cancer at 1-, 5- and 10-years. Chemo-and immunotherapy provides a modest survival benefit to this patient population in Australia when it is used in accordance with guideline recommendations. These outcomes may allow comparison of treatment outcomes in a jurisdiction against what would be considered optimal based on evidence.1. Fong, A., et al., A comparison of systemic breast cancer therapy utilization in Canada (British Columbia), Scotland (Dundee), and Australia (Western Australia) with models of "optimal" therapy. Breast, 2012. 21...
Source: Cancer Research - Category: Cancer & Oncology Authors: Tags: Poster Session Abstracts Source Type: research
is a common aggressive skin cancer. Its numerous genetic mutations have become rich targets for systemic therapy with chemotherapy or immunotherapy. Surgery is the best initial treatment. Completion nodal dissection for sentinel node positive patients decrease regional occurrence but no survival benefit was found in a few studies. Radiotherapy (RT) is used as primary, adjuvant and palliative treatment. Specific scenarios with unknown primary, head and neck melanomas, and distant metastases are discussed. Systemic therapy includes molecular therapy based on diver mutation or immunotherapy. Treatment guidelines should be ut...
Source: Current Cancer Therapy Reviews - Category: Cancer & Oncology Source Type: research
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