Head and neck tumors in older adults: Systemic treatments and combination with local strategies

As older patients are very rarely included in clinical trials, and without any dedicated clinical trials in curative or palliative setting, there are at now no standards of treatment for elderly head and neck cancer (HNC) patients. Treatments recommended for younger patients are therefore adapted to older in the daily practice. Combinations of systemic treatments (chemotherapy or cetuximab) with radiotherapy are usually only proposed to “fit” elderly patients, without any support of evidencebased medicine. Systemic treatment is therefore essentially discussed for recurrent and/or metastatic HNC patients. The choice between a monotherapy and a platinum-cetuximab combination is based on the performance status, which is not suitable and/or sufficient for elderly patients. The main difficulty is therefore to evaluate their ability to receive a systemic treatment and 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, vulnerable 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. Therefore, it is necessary to develop and evaluate customized treatments, based on a simple and reproducible geriatric assessment to guide practitioners to conduct the most suitable therapy. It is therefore crucial to enroll patients in dedicated therapeutics trials for elderly HNC, such as the ELAN studies, exploring new approaches such as promising immunotherapies. This review focuses on squamous cell HNC patients.