OBJECTIVES: Taiwan's National Health Insurance has covered targeted therapy, namely cetuximab, for locally advanced head and neck cancers (LAHNC) since July 2009. This study aimed to estimate the trends of first-course treatment modalities before and after cetuximab was reimbursed in Taiwan and examine factors associated with targeted therapy among patients with LAHNC.

METHODS: A population-based retrospective study was conducted using Taiwan's National Health Insurance Research Database. Patients over 20 years old who were newly diagnosed with LAHNC during 2008-2016 and received treatments within six months were included. They were divided into three groups: 1) being diagnosed during 2008-2010; 2) targeted therapy group since 2011; 3) non-targeted therapy group since 2011. The treatment trends were estimated using the Cochran-Armitage trend test. Multiple logistic regression was performed to evaluate odds ratio (OR) and 95% confidence interval (95% CI) for treatment selection effects after 2011. A p-value less than 0.05 was considered statistically significant.

RESULTS: 23,448 patients were included in the study (group 1: 6,661 patients; group 2: 15,422 patients; group 3: 1,365 patients). Around 230 (8.2%) patients received targeted therapy each year, increasing annually from 2011 to 2016 (p-value= 0.02). Most (91.1%) patients also received radiotherapy while few (24.9%) of them were given surgery within six months, showing significant differences from non-targeted therapy group (surgery: 62.3%; radiotherapy: 73.8%; p-value < 0.001). It was shown that older patients with more comorbidities would receive targeted therapy than those who did not (p-value < 0.001). Patients with hypopharynx and oropharynx cancers were more likely to receive targeted therapy compared to oral cavity cancer (OR[95% CI]: 2.76 [2.40-3.18]; p-value < 0.001).

CONCLUSIONS: The treatment patterns between targeted and non-targeted therapy groups differed significantly. Most patients did not receive targeted therapy even after cetuximab was reimbursed. Further studies evaluating the effectiveness of targeted therapy were needed.