ESTRO 2025 - Abstract Book

S56

Invited Speaker

ESTRO 2025

Consensus guidelines from several cancer organisation recommend routine comprehensive geriatric assessment for the older cancer patient. One limitation with this approach is that many patients in this age group nowadays present as biologically much younger, while performing a CGA on all patients older than 65 years can be time consuming and not practical. Additionally, there is limited evidence as to what the modification to standard of care should be with increasing frailty. As a result, routine use of CGA’s for the older patients has not been universally adopted. Alternative approaches such as a self-administered CGA and pre-CGA screening tools offer practical solutions in integrating evaluation of the older patient in the clinical decision-making process. However, a comprehensive geriatric assessment (CGA) does provide important information regarding the likelihood of functional decline and treatment-limiting complications. It can also provide estimates of survival as a function of their overall wellbeing, and therefore the value regarding long-term benefits of aggressive treatments.

The algorithm for the integration of prognostic factors and geriatric assessment in guiding the therapeutic options of the older head and neck patient will be described in the presentation.

4738

Speaker Abstracts Tailoring systemic treatment in platin-unfit patients: Lessons learnt from the recurrent-metastatic setting Sjoukje F. Oosting Medical Oncology, University Medical Center Groningen, Groningen, Netherlands

Abstract:

Cisplatin ineligibility and age

Since decades cisplatin is the pillar of systemic treatment for head and neck squamous cell carcinoma (HNSCC). However, due to its toxicity profile, a relevant proportion of the patients with HNSCC is deemed unfit for cisplatin. Cisplatin ineligibility is defined by absolute criteria including impaired renal function, hearing loss, neuropathy and performance status, but also by relative contraindications such as cardiovascular co-morbidity and poor nutritional status. Older age alone does not render patients ineligible for cisplatin, but it is associated with a higher risk of co morbidity, reduced organ reserve, polypharmacy and frailty. Consequently there is a significant overlap between older patients and cisplatin ineligible patients. Carboplatin can be used as an alternative for cisplatin, together with fluorouracil as chemotherapy backbone, in combination with cetuximab or with pembrolizumab. This strategy has been used in randomized phase III trials and is standard care. A single arm study in older patients who were deemed fit according to geriatric evaluation, showed that carboplatin, fluorouracil plus cetuximab was feasible and resulted in similar overall survival as was demonstrated in younger patients in the landmark trials. Carboplatin has also been used with paclitaxel as chemotherapy backbone for combination with cetuximab or immune checkpoint inhibitors. Preliminary results from a single arm trial with weekly carboplatin plus paclitaxel and durvalumab in cisplatin ineligible patients with recurrent or metastatic HNSCC showed a high response rate and favourable overall survival. A single arm study with 3-weekly carboplatin, paclitaxel and pembrolizumab also showed promising antitumor activity that was similar in younger and older patients. It should be noted that only patients with an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 were eligible for participation in these trials. Furthermore, the European Medicines Agency (EMA) has restricted the indication for Chemotherapy combinations