Approach to initial systemic therapy in patients with metastatic and recurrent squamous cell carcinoma of the head and neck

Patients with advanced disease who are ineligible for or choose to forego salvage surgery and/or radiation therapy may be eligible for systemic therapy. The goals of treatment are palliative. The listed treatments are the preferred options, although alternative agents that are not listed may also be effective. Clinical trials are encouraged if available.

PD-L1: programmed cell death ligand 1; CPS: combined positive score; ECOG: Eastern Cooperative Oncology Group.

* Systemic therapy may have been given with or without radiation therapy for initial management of locoregional disease.

¶ Progressive or recurrent disease within 6 months of receiving platinum-based chemotherapy with or without cetuximab.

Δ The benefit of pembrolizumab in patients with a CPS of less than 1 is limited. Patients who are not candidates for pembrolizumab may benefit from the addition of cetuximab to platinum-based chemotherapy. Platinum-based doublet chemotherapy alone may be preferred in patients with an impaired performance status.

◊ Options for single-agent therapy include:

Platinum-based chemotherapy (carboplatin preferred)
Taxanes
Cetuximab
Fluorouracil
Methotrexate
Gemcitabine

§ Eligibility for combination chemotherapy and/or immunotherapy is influenced by patient performance status, comorbidities, and prognostic factors. Combination chemotherapy is defined as doublet platinum-based chemotherapy.

¥ Alternatively, some UpToDate contributors substitute a taxane (paclitaxel or docetaxel) for the fluorouracil, based on better tolerability in other platinum-based combinations.

‡ We prefer pembrolizumab with chemotherapy for patients with a good performance status (eg, ECOG performance status ≤2). For others, we prefer single-agent pembrolizumab.

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خرید پکیج

Approach to initial systemic therapy in patients with metastatic and recurrent squamous cell carcinoma of the head and neck