Age-dependant outcome in EXTREME-regimen – a factor to consider in palliative chemotherapy?

Background Palliative chemotherapy (pallChT) is the first choice in recurrent, metastatic (R/M) squamous cell carcinoma of the head and neck (HNSCC) when curative therapy is not possible. So far the EXTREME-regimen (cisplatin/5-FU/cetuximab) is standard of care. After the KEYNOTE-048 trial, Pembrolizumab is the new first choice for certain groups of patients but the EXTREME-protocol remains standard in CPS<1. We analyzed the outcome of the EXTREME-protocol and other 1^st line pallChT options in R/M HNSCC.

Methods 131 patients with pallCHT have been identified. Kaplan-Meier-Plots und multivariate Cox regression was used for the identification of subgroups with different OS.

Results Within the subgroup of patients not eligible for 1^st line pallChT following the EXTREME-protocol, patients younger than 50 years showed the worst median OS (3.3 months). However, patients older than 70 years benefited from a 1^st line pallChT other than EXTREME (median OS: 11.3 months). Within the subgroup eligible for a 1^st line pallChT with EXTREME, reciprocal Results were noticed: younger patients showed a median OS of 10.7 months, while older patients had a worse outcome with a median OS of 4.3 months.

Conclusion The reciprocity seen in multivariate analyses leads to the assumption that age may exert a significant influence on the efficacy of pallChT. In search for new therapy options, this effect should be considered to find out the optimal therapy stratification for the R/M HNSCC patient and to avoid overtreatment by chemotherapy in elderly R/M HNSCC patients.

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Publication History

Article published online:
10 June 2020