Medicare advantage.

Top Line: If the last few years of head and neck trials have taught us anything, it’s that concurrent cisplatin is key to achieving optimal outcomes with definitive radiation.

The Study: But we also have to remember that the motivation for these trials was difficulty many patients have in tolerating radiation and cisplatin–particularly older patients. In fact, a SEER analysis of patients 65 or older receiving definitive radiation (15-30 years ago) suggested concurrent chemo was detrimental to survival. SENIOR is a large collaborative effort across 12 international centers that pooled outcomes for 1044 patients ages 65 and older receiving definitive radiation between 2005-2019. They sought to determine if older adults derive the same benefits from concurrent chemotherapy or cetuximab as seen in clinical trials. Roughly one-quarter (22%) received radiation alone with the remaining three-quarters receiving concurrent systemic therapy consisting of either chemo (65%) or cetuximab (13%). Those receiving chemoradiation had a significantly lower risk of death (HR 0.61) compared to RT alone. However, this was not true for concurrent cetuximab (HR 0.94). The benefit in survival with the addition of chemo appeared to be largely driven by distant disease control and the benefit diminished with increasing age: age 65-69 (HR 0.52), 70-79 (HR 0.60), ≥80 (HR 0.89).

TBL: Compared to radiation alone, the addition of concurrent chemotherapy improves overall survival for older adults (as old as 80) with locally advanced head and neck cancer. | Rühle, JAMA Netw Open 2023