Department of Medical Oncology, Centre Antoine Lacassagne, FHU OncoAge, Université Côte d'Azur, Nice.
Service d'oncologie médicale, Centre Hospitalier de Saint-Brieuc, Saint-Brieuc, France.
Curr Opin Oncol. 2019 May;31(3):152-159. doi: 10.1097/CCO.0000000000000526.
Elderly head and neck cancer (HNC) patients are very rarely enrolled in clinical trials, and even more so in dedicated trials in curative or palliative setting. As a result, no standards of treatment exist for this population and thus, adaptation of standard treatments is commonly used.
The choice between a monotherapy and a platinum-cetuximab combination is based on the performance status, which is not suitable and/or sufficient to evaluate the patient ability to receive a systemic treatment combined or not with radiotherapy. The evaluation of functional age using geriatric assessment is recommended. However, access to comprehensive geriatric assessment is limited in many centers, and the choice of the type of treatment is often not based on objective and reproducible criteria. As a result, fragile elderly HNC patients may be overtreated with a risk of increased toxicity and fit patients proposed for suboptimal treatment with a risk of failure of tumor control.
It is therefore crucial to develop and evaluate customized treatments by enrolling elderly HNC patients in dedicated therapeutics trials, such as the ELAN (Elderly Head and Neck Cancer) studies or new approaches involving promising immunotherapies. To administer the most suitable therapy, a simple and reproducible geriatric assessment could efficiently guide practitioners.
目的综述：老年头颈部癌症（HNC）患者很少被纳入临床试验，更不用说在根治或姑息治疗的专门试验中了。因此，针对这一人群没有治疗标准，因此通常采用标准治疗方法的调整。
最近发现：在单药治疗和铂类-西妥昔单抗联合治疗之间的选择基于患者的体能状态，但该状态不适合和/或不足以评估患者接受联合或不联合放疗的全身治疗的能力。建议使用老年评估来评估功能性年龄。然而，在许多中心，综合老年评估的获取是有限的，并且治疗类型的选择往往不是基于客观和可重复的标准。因此，脆弱的老年 HNC 患者可能会接受过度治疗，增加毒性风险，而适合治疗的患者可能会接受不太理想的治疗，肿瘤控制失败的风险增加。
总结：因此，通过专门的治疗试验（如 ELAN [老年头颈部癌症] 研究或涉及有前途的免疫疗法的新方法）招募老年 HNC 患者来开发和评估定制治疗方案至关重要。为了给予最合适的治疗，简单且可重复的老年评估可以有效地为医生提供指导。
