Real-World Treatment Patterns Among Patients With Unresected Locally Advanced Squamous Cell Carcinoma of the Head and Neck (LA SCCHN) From Community Practices in the US

OBJECTIVES: This study identifies demographics, clinical characteristics, and treatment patterns among patients with unresected LA SCCHN from community practices in the US.

METHODS: Electronic health record data were manually abstracted for patients (aged ≥18 years) receiving care in The US Oncology Network clinics. Patients were diagnosed with stage III, IVA, or IVB LA SCCHN in the oral cavity, oropharynx, hypopharynx, or larynx between January 2013 and April 2022. Patients who underwent primary resection were excluded. Patients were followed up until death or data cutoff in October 2022.

RESULTS: Overall, 250 patients were included; mean age was 62.6 years, and 80.0% were male. Of patients with known ethnicity (84.8%), 90.1% were White, and 6.1% were Black. Disease was stage III in 33.2% of patients, stage IVA in 63.6%, and stage IVB in 3.2%. Cancer of the oropharynx was the most common (54.4%, of which 60% were HPV positive), followed by larynx (33.6%), hypopharynx (10.8%), and oral cavity (1.2%). Of patients with known smoking status (91.6%), 73.8% were current/former smokers. Of patients with known payer type (88.8%), Medicare (43.2%), commercial (40.1%), and Medicaid coverage (9.9%) were most common.

Median time from diagnosis to first treatment was 1.3 months. Concurrent chemoradiotherapy (CRT) was received by 92.8% of patients; of these, 90.1% received platinum-based chemotherapy agents (cisplatin-CRT, 89.5%; carboplatin-CRT, 4.3%; other, 6.2%). Of patients receiving cisplatin-CRT with known dosing information (98.4%), 42.4% received cisplatin 100 mg/m² every 3 weeks, and 57.1% received cisplatin 40 mg/m² every week. Of patients with known radiotherapy type (63.3%), intensity-modulated radiotherapy was the most common type (84.0%), with a median dose of 70.0 Gy.

CONCLUSIONS: Cisplatin-CRT remains the standard of care for patients with unresected LA SCCHN, highlighting the lack of progress in treatment options over the last 2 decades. Additional studies are needed to identify novel treatments.