Treatment of head and neck cancer in the elderly

ABSTRACT

Introduction: Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide and the majority of patients present with advanced stage disease. Chemotherapy is an important component of head and neck cancer treatment regimens and has shown beneficial effects in locally advanced and recurrent/metastatic stages of disease. Approximately 25% of HNSCC patients are aged 70 and older, often associated with co-morbid medical conditions. Most clinical trials exclude patients of advanced chronological age such that valid information about the efficacy and safety of drugs and treatment regimens in elderly patients is not available.

Areas covered: Surgery, radiotherapy and particularly chemotherapy with the six FDA-approved chemotherapeutic agents for head and neck cancer treatment are discussed with a focus on age, performance status, comorbidities. New targeted therapies and the field of immune checkpoint inhibitors are evaluated in the context of elderly populations.

Expert opinion: Surgery, radiotherapy and administration of cytotoxic chemotherapeutic agents are largely safe and effective in elderly patients. Targeted therapies are mostly well tolerated. Clinical studies should be designed to include elderly patients (>70 years). Immune checkpoint inhibitor therapies may exert age-related effects, since substantial functional changes in T cell responses increase during the aging process.

KEYWORDS:

• HNSCC
• chemotherapy
• elderly
• immunotherapy
• immune checkpoint inhibitors
• age
• performance status
• comorbitidy
• head and neck cancer

Article highlights

• Chemotherapy is a major part in treatment of locally advanced and recurrent/metastatic Head and Neck Squamous cell carcinoma (HNSCC)

• Approximately 25% of the HNSCC patients are 70 years and older and this population is under-represented in historical trials

• Cisplatin is, with respect to known contraindications, effective also in the elderly and has a managable short-term and long-term safety profile

• Monoclonal antibodies, in particular cetuximab, are powerful alternatives in patients, who are unable to receive cisplatin-containg therapies

• Recent trials include patients without age-limit, but with respect to performance status

• It is to be seen, whether immune checkpoint inhibitor therapies are affected by the age-related decrease in T cell functionThis box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was funded by the American Cancer Society, grant CRP-13-308-06-COUN and the Interdisciplinary Center for Clinical Research, Würzburg, grant Z-2/59.