Weekly Chemotherapy as First Line Treatment in Frail Head and Neck Cancer Patients in the Immunotherapy Era
Abstract Objective: First-line therapy for metastatic squamous cell carcinoma of the head and neck (R/M HNSCC) has been revolutionized by the introduction of anti-checkpoint monoclonal antibodies, that have shown a significant improvement in overall survival (OS) gaining the approval in first line setting. Efficacy and safety of first-line weekly chemotherapy, compared to three-weeks treatment, was retrospectively evaluated in frail patients’ population with R/M HNSCC with the aim to evaluate its role as part of a personalized first-line approach.Methods: A total of 124 patients with locally incurable R/M HNSCC receiving weekly (21) or three-weekly (103) chemotherapy plus cetuximab in first line setting from December 2010 to September 2020 were retrospectively reviewed. Treatment outcomes in terms of objective response rate (ORR), progression-free survival (PFS), OS and toxicities were analyzed.Results: Patients in the three-week subgroup were ECOG PS 0 (39) and 1 (64) while patients (21) in weekly group were all PS 2. No significant differences were reported in terms of age, sex, smoking and previous alcohol abuse considering the two distinct subgroups. Moreover, no statistically significant difference was found in PFS and OS between the two treatment subgroups. The response rate was 35 % (36 patients) and 34 % (7 patients) in three-week and weekly treatment group, respectively. Seventy patients (68%) in the three-week group experienced chemotherapy-related toxicities, predominantly G3. In the weekly group a predominantly low-grade toxicity was found in a lower number of patients (52%).Conclusion: The weekly schedule appears an active and safe strategy in frail patients with R/M HNSCC. Based on our data, the weekly schedule could currently be considered in all frail patients and study of combination of weekly chemotherapy and immunotherapy should be performed.