Patients with head and neck cancer unfit for cisplatin - what next?

Mené sur 10 patients atteints d'un carcinome épidermoïde de la tête et du cou de stade avancé puis sur 186 patients supplémentaires (durée médiane de suivi : 2,3 ans ; âge médian : 72 ans ; 16 % de femmes), cet essai randomisé multicentrique de phase I/II évalue l'efficacité, du point de vue de la survie sans progression, du durvalumab associé à une radiothérapie chez les patients présentant une contre-indication au cisplatine

Résumé en anglais

Optimal treatment for patients with locally advanced head and neck squamous cell carcinoma (HNSCC) unfit for cisplatin remains undetermined, and an important question in clinical practice. Meta-analyses have consistently shown that concurrent chemoradiotherapy yields a survival benefit over radiotherapy alone for these patients; however, an additional benefit of chemotherapy to radiotherapy for patients aged 70 years and older or with an Eastern Cooperative Oncology Group performance status of 2 or more has not been confirmed. Therefore, radiotherapy alone remains a treatment option for patients unfit for cisplatin. Other options from previous randomised trials include cetuximab plus radiotherapy, carboplatin–fluorouracil plus radiotherapy, and docetaxel plus radiotherapy. However, randomised trials focusing on patients unfit for cisplatin are scarce. A randomised trial done in India that compared docetaxel plus radiotherapy with radiotherapy alone might partially address the issue. Although the trial included both definitive and postoperative settings and was terminated after recruitment of 365 patients against a planned sample of 600—mainly because of slow accrual due to the COVID-19 pandemic—docetaxel plus radiotherapy appeared to be superior to radiotherapy alone, with a hazard ratio (HR) for death of 0·747 (95% CI 0·569–0·980). Hence, although physicians might select one of these options based on their preference, the decision is not supported by clear evidence.