Prospective Study of Cetuximab, Carboplatin, and Radiation Therapy for Patients With Locally Advanced Head and Neck Squamous Cell Cancer Unfit for Cisplatin

Abstract

To report on the outcomes of a novel treatment regimen for patients with locally advanced head and neck squamous cell carcinoma who were fit for curative treatment but not fit for cisplatin. Single-arm phase 1/2 study of previously untreated patients with biopsy-proven SCC of the oropharynx, larynx, or hypopharynx. The primary endpoint was feasibility of the regimen, defined as the proportion of patients successfully completing treatment. Secondary endpoints were locoregional control (LRC), failure-free survival (FFS), overall survival (OS), and treatment toxicities. Sixty patients were included in the study. Their mean age was 66years (range, 42-87years); 28% of patients were >70years. The median follow-up time was 4years. Compliance with treatment was very high: feasibility was 55/60 (91.7%, 90% CI: 83.3%-96.7%), which satisfied the predefined criteria. The 4-year LRC was 82% (95% CI: 71-94), the FFS was 72% (95% CI: 60-85), and the OS was 77% (95% CI: 66-90). The cumulative incidences of first failure of any type at 4years were 5.2% local, 1.8% local and distant, 8.5% regional, 1.7% regional and distant, 3.5% distant, and 7.7% death (any cause). The 4-year FFS in the patients aged ≤70years and >70years were 71% (95% CI: 58-88) and 73% (95% CI: 54-100), respectively (log-rank P=.801). Their 4-year OS was 79% (95% CI: 66-93) and 73% (95% CI: 53-100), respectively (log-rank P=.708). Significant late treatment toxicities were very few. This treatment regimen was feasible and safe in this patient cohort unfit for cisplatin, 28% of whom were older than 70years. Carboplatin-based and cetuximab-based chemoradiation regimens warrant further investigation in patients with a contraindication to cisplatin.