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A new study has provided critical insights into the treatment options for head and neck cancer patients who are unable to tolerate cisplatin, establishing cetuximab as the preferred alternative in this population.
Head and neck cancers are the seventh most common cancer type globally, often treated with a combination of radiation therapy and cisplatin chemotherapy. However, over 30% of patients—such as older adults and those with pre-existing kidney disease or hearing loss—cannot tolerate cisplatin due to its severe side effects.
Cetuximab, a monoclonal antibody, has historically been used as an alternative to cisplatin, but its comparative effectiveness against newer therapies was previously unclear. A recent study published in The Lancet Oncology compared the effectiveness of cetuximab and durvalumab, which has shown promise for treating various cancers.
Key Findings: Cetuximab Outperforms Durvalumab
In the multicenter NRG-HN004 trial, researchers evaluated 186 patients with advanced squamous cell carcinoma of the head or neck who were ineligible for cisplatin. The patients were randomized to receive either cetuximab or durvalumab, both in combination with radiation therapy. The study found that cetuximab outperformed durvalumab, with two-year survival and disease-free rates of 64% versus 51%, respectively. Adverse event rates were similar between the two therapies.
Dr. Loren Mell from the University of California San Diego, explained, "We had a lot of reasons to be optimistic about durvalumab, but it turned out to be potentially worse than the standard."
The trial was discontinued early due to these findings. The study also confirmed that cetuximab demonstrated similar efficacy regardless of whether the patient’s cancer was associated with HPV.
A New Standard for an Underserved Population
These findings are significant for a patient population that has historically been underserved in clinical research. Patients ineligible for cisplatin often skew older and have complex health profiles that frequently exclude them from trials. This study highlights the efficacy of cetuximab and provides much-needed evidence to guide treatment in this subset of patients.
"Our study helps reinforce that radiation with cetuximab is a very good alternative for patients who cannot get standard cisplatin," said Dr. Mell. He added that this group has faced challenges in treatment due to competing health problems that have often excluded them from clinical trials.
Looking Forward
The study represents one of the first large-scale North American trials focused on this patient group and solidifies radiation therapy with cetuximab as an effective alternative to cisplatin-based treatment. According to Dr. Mell, research is ongoing to compare cetuximab with other potential alternatives, such as carboplatin and paclitaxel combinations. Additional trials are also underway to evaluate novel therapeutic agents in conjunction with radiation therapy.