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Argiris A , Li Y , Murphy BA , Langer CJ , Forastiere AA
Outcome of elderly patients with recurrent or metastatic head and neck cancer treated with cisplatin-based chemotherapy
Journal of Clinical Oncology. 2004 Jan;22(2) :262-268
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Abstract
Purpose To evaluate the outcome of elderly patients with head and neck cancer undergoing palliative chemotherapy. Patients and Methods We analyzed combined data from two mature phase III randomized trials conducted by the Eastern Cooperative Oncology Group (ECOG; trial E1393, which compared cisplatin plus paclitaxel at two dose levels, and trial E1395, which compared cisplatin plus fluorouracil to cisplatin plus paclitaxel) to evaluate the toxicity, objective response rates, and survival of patients 70 years or older versus their younger counterparts. All patients had previously untreated recurrent or metastatic squamous cell carcinoma of the head and neck and ECOG performance status 0 or 1. Results Fifty-three elderly patients were enrolled from a total of 399 eligible participants (13%). Elderly patients had similar objective response rates (28% v 33%) and median time to progression (5.25 v 4.8 months) compared with younger patients. The median survival was 5.3 v 8 months (Wilcoxon P = .06; log-rank P = .17) and the 1-year survival 26% v 33% for elderly and younger patients, respectively. Elderly patients had a significantly higher incidence of severe nephrotoxicity, diarrhea, and thrombocytopenia. A higher rate of toxic deaths was noted in the elderly but did not reach statistical significance (13% v 8%; P = .29). Conclusion Elderly patients were underrepresented in these studies. Fit elderly patients with recurrent or metastatic head and neck cancer sustained increased toxicities with cisplatin-based doublets but had comparable survival outcomes compared with younger patients. Strategies to ameliorate toxicities should be pursued in the elderly.
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English Article KeyWords Plus: SOUTHWEST-ONCOLOGY-GROUP; CELL LUNG-CANCER; COLONY-STIMULATING FACTOR; ACUTE MYELOID-LEUKEMIA; NON-HODGKINS-LYMPHOMA; CLINICAL-TRIALS; BREAST-CANCER; OLDER PATIENTS; ADJUVANT CHEMOTHERAPY; PHASE-II Argiris, A; Northwestern Univ, Div Hematol Oncol, Feinberg Sch Med, 676 N St Clair,Suite 850, Chicago, IL 60611 USA. Research Addresses: Northwestern Univ, Div Hematol Oncol, Feinberg Sch Med, Chicago, IL 60611 USA. Northwestern Univ, Robert H Lurie Comprehens Canc Ctr, Chicago, IL 60611 USA. Dana Farber Canc Inst, Boston, MA 02115 USA. Vanderbilt Univ, Vanderbilt Ingram Canc Ctr, Nashville, TN USA. *Fox* *Chase* Canc Ctr, Philadelphia, PA 19111 USA. Johns Hopkins Oncol Ctr, Baltimore, MD USA. Cited References: SHIPP MA, 1993, NEW ENGL J MED, V329, P987 GRIDELLI C, 1999, J NATL CANCER I, V91, P66 ANDO M, 1999, CLIN CANCER RES, V5, P1690 BALDUCCI L, 2000, CANC CONTROL, V7, P539 BALDUCCI L, 2000, HEMATOL ONCOL CLIN N, V14, P193 BALDUCCI L, 2000, HEMATOL ONCOL CLIN N, V14, P1 BEGG CB, 1980, CANC CLIN TRIALS, V3, P369 BENSON AB, 1991, J CLIN ONCOL, V9, P2067 CHRISTMAN K, 1992, JAMA-J AM MED ASSOC, V268, P57 CHUNG M, 1996, CANCER, V77, P97 CRIVELLARI D, 2000, J CLIN ONCOL, V18, P1412 DEES EC, 2000, CANCER INVEST, V18, P521 0732-183X