Survival Outcomes With Concurrent Systemic Therapy in Patients With a Medical Contraindication to Cisplatin in the Non‐Operative Management of Locally Advanced
HNSCC
, an
NCD
Deniz Can Demircioglu, Sohil Singh, Johnny Belcher, Stuart J. Wong, Joseph Zenga, Musaddiq Awan ABSTRACT
Background
Patients with locally advanced head and neck squamous cell carcinoma who are medically ineligible for cisplatin lack a standard concurrent systemic therapy.
Methods
We used the National Cancer Database to identify patients diagnosed from 2015 onward with non‐metastatic, locally advanced squamous HNSCC treated with definitive radiation therapy and concurrent systemic therapy, receiving either chemotherapy or cetuximab (using immunotherapy as a surrogate for cetuximab in the NCDB). Cisplatin‐ineligibility was defined using the age and comorbidity criteria from NRG‐HN004. Overall survival was compared using Kaplan–Meier analysis and an inverse probability weighted Cox proportional hazards model.
Results
The final cohort included 6045 patients: 5441 receiving chemotherapy and 604 receiving cetuximab. In the weighted Cox model, chemotherapy was not significantly associated with improved overall survival compared to cetuximab (HR, 1.08; 95% CI, 0.94–1.23; p = 0.281).
Conclusions
In this retrospective analysis, no survival advantage was found with chemotherapy over cetuximab in cisplatin‐ineligible patients. Future, randomized trials are necessary to define optimal systemic therapy in this population.