Current State and Future of Systemic Treatment for Elderly Patients With Head and Neck Cancer Undergoing Radiotherapy

BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) affects many older individuals, with over half diagnosed at 65 or older. This group is often underrepresented in trials, leading to limited treatment guidelines. This review assesses systemic treatment options, including chemotherapy, targeted therapy, and immune checkpoint inhibitors (ICIs) in elderly HNSCC patients undergoing radiotherapy. METHODS: We reviewed studies from major databases using keywords like elderly, HNSCC, systemic therapy, chemotherapy, ICI, and targeted therapy. We included studies of patients 65+ with HNSCC receiving definitive or adjuvant radiotherapy with systemic treatment. RESULTS: The review included 35 studies. In definitive treatment, concurrent chemoradiation (CRT) improved survival in fit elderly patients, with cisplatin-based CRT being most effective and tolerable. For unfit patients, alternatives like cetuximab and carboplatin have been explored, but results have varied. In the adjuvant setting, evidence is limited. Adding ICIs appears to be feasible and safe; however, it needs further research to evaluate efficacy and identify potential biomarkers. CONCLUSION: Systemic treatment decisions in HNSCC should rely on a comprehensive geriatric assessment, not age alone. For fit elderly patients, cisplatin-based CRT remains key in treatment, but its use should be cautiously considered due to study heterogeneity.