Combination of post-operative radiotherapy and cetuximab for high-risk cutaneous squamous cell cancer of the head and neck: A propensity score analysis. (March 2018)

• Record Type: Journal Article
• Authors: Palmer, Joshua D.; Schneider, Charles J.; Hockstein, Neil; Hanlon, Alexandra L.; Silberg, Jordan; Strasser, Jon; Mauer, Elizabeth A.; Dzeda, Michael; Witt, Robert; Raben, Adam
• Is Part Of: Oral oncology. Volume 78(2018)
• Page Start: 102
• Page End: 107
• Publication Date: 2018-03
• Subjects: Cutaneous squamous cell carcinoma -- Head and neck -- Post-operative radiotherapy -- Cetuximab -- Survival; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2018.01.015
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Cetuximab targets the extracellular domain of the epidermal growth factor receptor. High-risk cutaneous squamous cell cancers have a high risk of recurrence. Combination of cetuximab and radiation may improve progression free and overall survival. Abstract: Objectives: The objective of this study was to investigate the safety, tolerability and preliminary efficacy of radiotherapy plus cetuximab in high risk CSCC patients. Materials and Methods: Patients with high-risk CSCC diagnosed between 2006 and 2013 were analyzed. Patients were divided into two groups: radiotherapy alone versus radiotherapy plus cetuximab. Among 68 patients meeting study criteria, we identified 29 treated with cetuximab plus RT and 39 with RT alone. Primary analysis examined disease-free and overall survival, freedom from local and distant recurrence in the propensity score matched cohort. Propensity score analysis was performed with weighted factors including: Charlson Comorbidity Index score, age. KPS, primary location, T and N stage, recurrent status, margin status, LVSI, PNI and grade. Toxicity was assessed using the CTCAE v4.0. Results: Median follow-up for living patients was 30 months. Patients in the cetuximab group were more likely to have advanced N stage, positive margins and recurrent disease. After propensity score matching the groups were well balanced. Six patients experienced ≥ grade 3 acute toxicity in the cetuximab group. The 1-year, 2-year and 5-year progression free survival (PFS) for patients in the cetuximab group were 86%, 72% and 66%, respectively. The 1-year, 2-year and 5-year overall survival (OS) for patients in the cetuximab group was 98%, 80% and 80%, respectively. Conclusions: Although limited by small numbers, the combination of cetuximab and radiotherapy in CSCC appears well tolerated there were more long-term survivors and less distant metastasis in the cetuximab group. These promising finding warrant further studies.