ESTRO 2025 - Abstract Book

S57

Invited Speaker

ESTRO 2025

pembrolizumab in first line as either monotherapy or as combination with platinum and fluorouracil, in patients with unresectable recurrent or metastatic HNSCC with PD-L1 expression (combined positive score ≥1).

Monotherapies

Immune checkpoint inhibitors are well tolerated as single agents, and subgroup analyses and real-world data have shown that fit older patients derive at least similar benefit from pembrolizumab and nivolumab compared to younger patients. Single agent carboplatin, docetaxel, paclitaxel, methotrexate and cetuximab are well tolerated and can induce tumour responses in patients with recurrent or metastatic HNSCC, but overall response rates are low and a survival benefit has not been demonstrated. A randomized phase II trial in older patients who were unfit according to geriatric evaluation, showed that these patients do not derive benefit from methotrexate or cetuximab. These patients have a poor prognosis, especially if ECOG performance status is ≥2. For these patients best supportive care alone is an appropriate choice.

Conclusion

There are multiple treatment options for cisplatin ineligible patients with recurrent or metastatic HNSCC. Geriatric assessment and performance status are crucial for optimal treatment selection. Fit older patients with a good performance status can benefit to the same extend as younger patients from combination chemotherapy regimens with cetuximab or immunotherapy.

4739

Speaker Abstracts Tailoring radiation fundamentals in older patients: Aiming for cure or palliation? Sarbani Ghosh Laskar 1 , Shwetabh Sinha 2 , Asesh Samanta 1 1 Radiation Oncology, Tata Memorial Hospital, Mumbai, India. 2 Radiation Oncology, Tata Memorial Centre, Mumbai, India

Abstract:

Tailoring radiation fundamentals in older patients: Aiming for cure or palliation?

The ASCO guidelines on managing patients with geriatric cancers talk about treating the elderly on three guiding principles: Determining age-related vulnerability using geriatric assessment (GA), considering the benefits and harms of cancer treatments in light of their vulnerability and considering patients’ values, preferences and trade offs. The last principle is as important as the other two, and shared decision-making in this population is an essential and very important concept. It is crucial to understand and value the involvement of all stakeholders in the care pathway, and this must consider what the patient expects at the end of the day. Nowhere is the importance of Quality of Life (QoL) and patient-related outcomes in Oncology more important than in this vulnerable population. The appropriate use of outcome prioritization tools is equally important, with an understanding that universal health outcomes involve trade-off principles, alignment of treatment, and perhaps a lower focus on the impact of treatment. In the interest of decision-making, it is important to discuss with the subject the best case and worst case scenarios and their impact on QoL.

There are no established guidelines for managing older patients with head and neck cancer, and most clinical trials that define current standard therapy included few elderly patients. The key point appears to be appropriate