Real-World Treatment Patterns of Older Adults with Locally Advanced SCCHN Using SEER-Medicare

Abstract

Roughly 50-67% of patients with squamous cell carcinomas of the head and neck (SCCHN) present with locally advanced (LA) disease and 65% of them relapse after initial therapy. The standard of care for LA SCCHN is definitive therapy (DT), a combination of surgery and or radiation therapy (RT), with or without platinum-based chemotherapy/cetuximab (chemo), that has been shown to optimize long term disease control. Few published analyses have characterized recent real-world treatment (Tx) patterns of older adults with LA SCCHN in the US. We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, a linkage of cancer registry and claims data, to identify patients diagnosed with LA SCCHN (first and only cancer) from 2010 to 2017 who initiated a relevant Tx (Tx initiation date defined as index date) and were continuously enrolled in Medicare Parts A, B, and D from 12 months pre-index until death or 12 months post-index. We used clinical guidelines regarding timing and frequency of treatments to build an algorithm that used Medicare claims to categorize initial Tx as non-DT, non-surgical DT (concomitant chemo+RT (cCRT) or chemotherapy before RT/cCRT), or surgical DT (surgery then RT/cCRT ± prior chemo). We identified 1052 older adults with LA SCCHN (median age 73 years, 37% female, and 81% non-Hispanic white) whose initial treatment was started a median of 26 days after initial diagnosis. Of the 610 patients who received a DT as their initial Tx, 23.3% of patients had a subsequent Tx: 3.8% received immunotherapy-containing regimens (IO), and the most common subsequent Tx were surgery only (7.7%), chemotherapy only (3.6%), and RT only (3.4%). The median time to next Tx (TTNT) differed by DT category and primary tumor site. (Table 1) CONCLUSION: In this descriptive analysis, we provided an update on the Tx patterns of older adults with LA SCCHN in the US, for whom there have been no novel FDA approvals in over a decade. We found that a large proportion (42%) of patients did not receive DT regimens in the real-world setting despite known benefits in LA SCCHN. Roughly a quarter of patients required subsequent Tx. Availability of IO was low due to approvals after 2017. These findings suggest a need for novel therapies that can improve outcomes in LA SCCHN.