Headline: The addition of cetuximab to post-op head and neck radiation improves disease-free but not overall survival across a broad population not meriting concurrent cisplatin.
The Study: We know cetuximab helps when added to radiation alone in the definitive setting so maybe it’s a good compromise for patients receiving post-op radiation for “intermediate risk” disease (read: for any risk factor meriting post-op radiation other than involved margins or extracapsular extension). The phase 3 RTOG 0920 trial (LBA 01) randomized 577 eligible enrollees receiving conventionally-fractionated post-op radiation to +/- the addition of cetuximab. There was a trend towards improvement in the primary endpoint of overall survival at 5 years with the addition of cetuximab (69% → 77%) though it did not reach significance due to there being far fewer deaths than anticipated. There was, however, a significant improvement in disease-free survival (64% → 72%). Acute toxicity was worse with cetuximab (70% v 40%), but there was no difference in late grade 3+ toxicity.
TBL: “It will be critical to identify subgroups achieving benefit from this combined-modality therapy.” | Machtay, ASTRO 2023
The Study: We know cetuximab helps when added to radiation alone in the definitive setting so maybe it’s a good compromise for patients receiving post-op radiation for “intermediate risk” disease (read: for any risk factor meriting post-op radiation other than involved margins or extracapsular extension). The phase 3 RTOG 0920 trial (LBA 01) randomized 577 eligible enrollees receiving conventionally-fractionated post-op radiation to +/- the addition of cetuximab. There was a trend towards improvement in the primary endpoint of overall survival at 5 years with the addition of cetuximab (69% → 77%) though it did not reach significance due to there being far fewer deaths than anticipated. There was, however, a significant improvement in disease-free survival (64% → 72%). Acute toxicity was worse with cetuximab (70% v 40%), but there was no difference in late grade 3+ toxicity.
TBL: “It will be critical to identify subgroups achieving benefit from this combined-modality therapy.” | Machtay, ASTRO 2023