# Retrospective Trial on Cetuximab Plus Radiotherapy in Elderly Patients with Head and Neck Squamous Cell Cancer

## TL;DR

This study shows that combining cetuximab with radiotherapy is a feasible and well-tolerated treatment for elderly patients with head and neck cancer.

## Contribution

The study provides evidence that cetuximab-radiotherapy is effective and safe in elderly patients, a group often understudied in clinical trials.

## Key findings

- Median overall survival was 58 months, comparable to younger patients.
- Toxicity was manageable, with no significant link between severe adverse events and age or lifestyle factors.
- Folliculitis was significantly associated with better overall survival.

## Abstract

Elderly patients affected by head and neck squamous cell carcinomas often receive fewer intensive treatments; even though age alone does not mean frailty, this group of patients is often understudied and only few data report on the possible efficacy of cetuximab-radiotherapy combination in locally advanced head and neck carcinoma. We decided to retrospectively analyze our experience in patients over 65 years treated with this combination. We found a median overall survival comparable to what previous publications present for younger patients, with an overall compatible profile of toxicity. Our study, pending further research, suggests the possibility of using Cetuximab Radiotherapy in the elderly.

Background: A wide percentage (25–40%) of patients affected by head and neck squamous cell carcinoma (HNSCC) are over 70 years old, and they present with different characteristics if compared to younger patients. Elderly patients often receive less intensive, non-surgical, and non-multimodal treatments. Although age does not mean frailty, the elderly are at a higher risk of developing toxicity. In fact, several studies enrolling patients treated with cisplatin + radiotherapy (CISPLATIN + RT) or cetuximab + radiotherapy (Cet + RT) showed reduced efficacy over 65 years. Methods: We conducted a multicenter retrospective analysis in patients with Locally Advanced HNSCC aged over 65 years, who underwent Cet-RT, diagnosed in the period between 2017 and 2024. The primary endpoint was to describe Overall Survival (OS), the secondary endpoints were Progression Free Survival (PFS) and the percentage and type of Adverse Events (AEs). Patients received a geriatric assessment using the G8 questionnaire. Results: Data regarding Eighty-Two (82) patients were analyzed, median age was 74 years (range 65–84), most patients had oral cavity (26.8%) and laryngeal cancer (37.8%). Fifty-six point one (56.1%) of patients were smokers, and 17.1% reported alcohol consumption. All patients completed radiotherapy, and 80.5% of them developed AEs, which in 25.6% of cases were G3–4 toxicities. No relationship was found between G3–4 AEs and age (p = 0.596), G8score < 14 (p = 0.804), and smoking (p = 0.245)/drinking habits (p = 0.341). Median OS was 58 months, with a slightly non-significant positive trend in OS for patients who were non-smokers and those who did not develop G3–4 AEs (p = 0.786 and 0.799, respectively). Association between folliculitis and OS was statistically significant (p = 0.001). Conclusions: In elderly patients, Cet-RT represents a feasible, well-tolerated option, although further prospective studies are needed.