Recurrent or metastatic head and neck squamous cell carcinoma
When head and neck cancer comes back where it cannot be removed, or spreads elsewhere, it is treated to extend life rather than cure: pembrolizumab, alone or with chemotherapy, is the first choice, cetuximab-based regimens and cheap oral chemotherapy are alternatives, and antibodies that hit two targets at once are in late-stage trials.
Overview
Recurrent or metastatic head and neck squamous cell carcinoma covers disease that returns in the head and neck after radiotherapy or surgery and cannot be salvaged, and disease that has spread to the lungs, bone or liver. A minority with locoregional recurrence are cured by salvage surgery or re-irradiation, and a few with a single metastasis are treated with stereotactic radiotherapy; for the rest treatment is systemic and palliative. Work-up includes biopsy, PD-L1 combined positive score, HPV status of oropharyngeal primaries and the interval since platinum, since progression within six months of platinum defines platinum-refractory disease.
First-line treatment was defined for a decade by EXTREME (2008), in which cetuximab with platinum and fluorouracil gave median overall survival of 10.1 against 7.4 months. CheckMate 141 (2016) then showed that nivolumab extended survival after platinum failure (7.5 against 5.1 months), and KEYNOTE-048 (2019) moved immunotherapy to the front: pembrolizumab alone gave median survival of 14.9 against 10.7 months in tumours with a combined positive score of 20 or more, and pembrolizumab with chemotherapy gave 13.0 against 10.7 months in the whole population, with a durable tail at five years. Pembrolizumab-based treatment is now the standard, EXTREME or its docetaxel variant TPExtreme the option for rapidly progressing disease or after immunotherapy, and cetuximab sarotalocan photoimmunotherapy is approved in Japan for locoregional recurrence.
The frontier is combinations that lift response rates above the roughly one in five seen with pembrolizumab alone. Petosemtamab, a bispecific antibody against EGFR and LGR5, produced responses in about six in ten untreated patients with pembrolizumab in phase 2 and is in the phase 3 LiGeR-HN1 and LiGeR-HN2 trials; ficerafusp alfa, which blocks EGFR and traps TGF-beta, is in FORTIFI-HN01 for HPV-negative disease; HB-200, an arenavirus-based vaccine against HPV16 E6 and E7, has been tested with pembrolizumab in HPV16-positive disease; and the EGFR antibody-drug conjugate MRG003 is in phase 3 against cetuximab or methotrexate. In India, Tata Memorial trials showed that oral methotrexate with celecoxib beat intravenous cisplatin (median survival 7.5 against 6.1 months), that adding one-twentieth of the usual nivolumab dose raised one-year survival from 16.3 to 43.4 percent, and, in METRO PLUS, that adding metronomic tablets to paclitaxel-carboplatin doubled median survival from 5 to 10 months.
State of the art
- Response rates to immunotherapy alone remain low, so the field is racing to add a second antibody, an antibody-drug conjugate or a vaccine.
- India has shown that cheap oral chemotherapy and fractional immunotherapy doses extend life at a small fraction of Western cost.
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- Pembrolizumab-based first-line treatment gives a minority of patients survival measured in years, something no chemotherapy regimen did.
Red cards
From the labels and guidelines behind the standard of care. Your team's thresholds win.- Emergency services nowBleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
- Emergency services nowHypophysitis or adrenal crisis
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
- Emergency services nowBlood clot (lenalidomide, pomalidomide, thalidomide)
A swollen painful calf, or sudden breathlessness with chest pain; venous and arterial thromboembolism is a boxed warning and blood-thinning prophylaxis is recommended.
- Check before combiningFood and drink: Fluorouracil (5-FU)
Capecitabine: take within 30 minutes after a meal. DPD deficiency (DPYD variants) causes severe toxicity: pre-treatment genotyping is recommended in Europe.
- Check before combiningFood and drink: Pembrolizumab
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
- Check before combiningKidneys: Carboplatin
Dose by Calvert formula using GFR (see the calculators).
See all on the product pages:CarboplatinCisplatinDocetaxelFluorouracil (5-FU)MethotrexateNivolumabPaclitaxel / nab-paclitaxelPembrolizumab·Printable cards in the navigator
Anatomy and lymph node drainage
- Oral cavity and tongue
- Oropharynx: tonsil, base of tongue (HPV)
- Nasopharynx (EBV)
- Larynx and hypopharynx
- Parotid and other salivary glands
- Thyroid
- Nodes: level I (submandibular)
- Nodes: level II (upper jugular)
- Nodes: level III-IV (jugular)
- Nodes: level V (posterior)
- Nodes: level VI (central, thyroid)
- Nodes: retropharyngeal (nasopharynx)
Site decides cause and behaviour: HPV drives oropharyngeal cancer, EBV drives nasopharyngeal cancer, tobacco drives oral and laryngeal cancer; all drain into the neck node levels that surgeons and radiotherapists map.
- Oral cavity and tongueHPV-positive versus HPV-negative recurrent disease
- Oropharynx: tonsil, base of tongue (HPV)HPV-positive versus HPV-negative recurrent disease
- Nasopharynx (EBV)
- Larynx and hypopharynx
- Parotid and other salivary glands
- Thyroid
- level I (submandibular)
- level II (upper jugular)
- level III-IV (jugular)
- level V (posterior)
- level VI (central, thyroid)
- retropharyngeal (nasopharynx)
Same organ: Oropharyngeal cancer (tonsil and base of tongue), Laryngeal and hypopharyngeal cancer, Oral cavity cancer (mouth and tongue), Head and neck squamous cell carcinoma, Nasopharyngeal carcinoma, Salivary gland cancers, Papillary thyroid cancer, Follicular thyroid cancer, Medullary thyroid cancer, Anaplastic thyroid cancer, Thyroid cancer, Nasal cavity and paranasal sinus cancers (including esthesioneuroblastoma), NUT carcinoma (midline carcinoma with NUTM1 rearrangement), Parathyroid carcinoma, Multiple endocrine neoplasia syndromes (MEN1, MEN2, MEN4), HPV-positive oropharyngeal cancer, HPV-negative head and neck squamous cell carcinoma (including HPV-negative oropharyngeal cancer), Hypopharyngeal cancer, Adenoid cystic carcinoma, Salivary duct carcinoma, Mucoepidermoid carcinoma, Oral tongue and floor of mouth cancer, Buccal mucosa and gingivobuccal cancer (oral cancer in India), Lip cancer, Locoregionally advanced nasopharyngeal carcinoma (stage III to IVA), Recurrent and metastatic nasopharyngeal carcinoma, Esthesioneuroblastoma (olfactory neuroblastoma), Sinonasal undifferentiated carcinoma (SNUC) and SWI/SNF-deficient sinonasal carcinoma
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- A large share of patients treated for locally advanced head and neck cancer relapse, most within two years; median survival was 7.4 months on platinum-fluorouracil in the EXTREME control arm and 13.0 months with pembrolizumab and chemotherapy in KEYNOTE-048.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Pembrolizumab alone for indolent disease, especially with a score of 20 or more; pembrolizumab with platinum and fluorouracil for bulky or symptomatic disease (KEYNOTE-048).
Pembrolizumab with platinum-fluorouracil, or cetuximab with platinum-fluorouracil (EXTREME) or with docetaxel and platinum (TPExtreme).
Cetuximab, docetaxel, paclitaxel or methotrexate as single agents; nivolumab or pembrolizumab if not given before (CheckMate 141); clinical trials.
Salvage surgery where resectable; re-irradiation with intensity-modulated or stereotactic techniques in selected patients; cetuximab sarotalocan photoimmunotherapy in Japan.
Oral metronomic methotrexate with celecoxib; low-dose nivolumab added where affordable; metronomic tablets with paclitaxel-carboplatin (METRO PLUS).
Palliative radiotherapy for bleeding, pain or airway compromise; early involvement of palliative care, nutrition and speech and swallowing teams.
Subtypes & biomarkers
top- Locoregional recurrence after radiotherapy (candidates for salvage surgery or re-irradiation)
- Distant metastatic disease (lung, bone, liver)
- Platinum-sensitive versus platinum-refractory disease (progression within six months of platinum)
- PD-L1 combined positive score 20 or more, 1 to 19, and under 1
- HPV-positive versus HPV-negative recurrent disease
- Oligometastatic disease treated with stereotactic radiotherapy
- PD-L1 combined positive score (22C3 assay)
- HPV and p16 status of oropharyngeal primaries
- Platinum-free interval
- EGFR expression (near universal, not predictive)
- Circulating tumour DNA and HPV DNA (emerging)
- Tumour mutational burden (pembrolizumab for 10 or more mutations per megabase)
How often this target appears
- 2006Cetuximab approved for head and neck cancer
- 2008EXTREME: first survival gain in recurrent disease
- 2016CheckMate 141: nivolumab after platinum
- 2019KEYNOTE-048: pembrolizumab first line
- 2020Tata Memorial: oral metronomic chemotherapy beats cisplatin
- 2023Tata Memorial: low-dose nivolumab nearly triples one-year survival
- 2025Petosemtamab with pembrolizumab: phase 2 responses in about six in ten; phase 3 under way
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 16 changes by month →- 2026-09-17This recordRecurrent or metastatic head and neck squamous cell carcinomaFacts on this page last checked
When this page itself was last checked or edited.
- 2026Trial resultMETRO PLUS (Tata Memorial Centre, Varanasi)METRO PLUS (Tata Memorial Centre, Varanasi) reported
Median OS 10 vs 5 months, HR 0.
- 2025MilestonePetosemtamabPetosemtamab with pembrolizumab: phase 2 responses in about six in ten; phase 3 under way
A milestone in how this cancer is treated.
- 2023Trial resultLow-dose nivolumab plus metronomic chemotherapy (Tata Memorial)Low-dose nivolumab plus metronomic chemotherapy (Tata Memorial) reported
1-year OS 43.
- 2023MilestoneLow-dose nivolumab plus metronomic chemotherapy (Tata Memorial)Tata Memorial: low-dose nivolumab nearly triples one-year survival
A milestone in how this cancer is treated.
- 2021Trial resultTPExtreme (GORTEC 2014-01)TPExtreme (GORTEC 2014-01) reported
TPEx did not improve overall survival over EXTREME, but gave similar survival with a shorter schedule and less toxicity.
What is in development for Recurrent or metastatic head and neck squamous cell carcinoma, drawn from the whole corpus: 45 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Drugs in phase 3 · 5
Drugs in phase 2 · 1
Trials under way · 32
- LiGeR-HN1 · phase 3 · Merus (Genmab)
- A Phase 3 Study to Evaluate Petosemtamab Compared With Investigator's Choice Monotherapy in Previously Treated Head and Neck Squamous Cell Carcinoma P · phase 3 · Merus B.V.
- FORTIFI-HN01 · phase 2/3 · Bicara Therapeutics
- A Study Evaluating Ficerafusp Alfa (BCA101) QW in Combination With Pembrolizumab vs Alternative Ficerafusp Alfa Dosing in 1L R or M HNSCC · phase 2 · Bicara Therapeutics
- A Study to Evaluate MRG003 vs Cetuximab/Methotrexate in in the Treatment of Patients With RM-SCCHN · phase 3 · Lepu Biopharma
- A Phase 3 Study of AK112 Plus AK117 Versus Pembrolizumab in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma (R/M HNSCC) · phase 3 · Akeso
- A Study of Amivantamab in Addition to Standard of Care Agents (SOC) Compared With SOC Alone in Participants With Recurrent/Metastatic Head and Neck Cancer · phase 3 · Janssen Research & Development, LLC
- A Study of ASP-1929 Photoimmunotherapy in Combination With Pembrolizumab in First-line Treatment of Locoregional Recurrent Squamous Cell Carcinoma of · phase 3 · Rakuten Medical, Inc.
- A Clinical Study of SI-B001 in Combination With Paclitaxel/Docetaxel in the Treatment of Recurrent and Metastatic HNSCC · phase 2 · Sichuan Baili Pharmaceutical Co., Ltd.
- A Clinical Study to Evaluate the Efficacy and Safety of SI-B001 in the Treatment of Recurrent and Metastatic HNSCC · phase 2 · Sichuan Baili Pharmaceutical Co., Ltd.
- A Clinical Trial Investigating the Safety, Tolerability, and Therapeutic Effects of BNT113 in Combination With Pembrolizumab Versus Pembrolizumab Alone for Patients With a Form of Head and Neck Cancer Positive for Human Papilloma Virus 16 and Expressing the Protein PD-L1 · phase 2/3 · BioNTech SE
- A Platform Study of Novel Immunotherapy Combinations as First-Line Treatment in Participants With PD-L1 Positive Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck- GALAXIES H&N-202 · phase 2 · GlaxoSmithKline
- A Study of BL-B01D1, SI-B003 and BL-B01D1+SI-B003 in Patients With Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma and Other Solid Tumor · phase 2 · Sichuan Baili Pharmaceutical Co., Ltd.
- A Study of BL-B01D1+PD-1 Monoclonal Antibody in Patients With Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma and Other Solid Tumors · phase 2 · Sichuan Baili Pharmaceutical Co., Ltd.
- A Study of Ficlatuzumab in Combination With Cetuximab in Participants With Recurrent or Metastatic (R/M) HPV Negative Head and Neck Squamous Cell Carcinoma · phase 3 · AVEO Pharmaceuticals
- A Study of LVGN6051 Combination Therapy in Patient With Head and Neck Squamous Cell Carcinoma (HNSCC) · phase 2 · Lyvgen Biopharma Holdings Limited
- A Study of SI-B001+SI-B003 Combined With Platinum-based Chemotherapy as First-line Treatment in Patients With Recurrent or Metastatic Head and Neck Sq · phase 2 · Sichuan Baili Pharmaceutical Co., Ltd.
- A Study to See if Giving Fianlimab and Cemiplimab Together is Better Than Cemiplimab Alone at Treating Recurrent or Metastatic Head and Neck Squamous · phase 2 · Regeneron Pharmaceuticals
- A Trial of SHR-A2102 With Adebrelimab With or Without Other Anti-tumor Therapies in Recurrent/MetastaticHead and Neck Squamous Cell Carcinoma Cancer · phase 1/2 · Suzhou Suncadia Biopharmaceuticals Co., Ltd.
- ASP-1929 Photoimmunotherapy (PIT) Study in Recurrent Head/Neck Cancer for Patients Who Have Failed at Least Two Lines of Therapy · phase 3 · Rakuten Medical, Inc.
- Assessment of Efficacy and Safety of Monalizumab Plus Cetuximab Compared to Placebo Plus Cetuximab in Recurrent or Metastatic Head and Neck Cancer · phase 3 · AstraZeneca
- Clinical Trial of SIBP-03 in Patients With Head and Neck Squamous Cell Carcinoma · phase 2 · Shanghai Institute Of Biological Products
- EGFR/HER2 Dual-Target CAR-NK Cells for Recurrent or Metastatic HNSCC · phase 1/2 · Beijing Biotech
- INBRX-106 in Combination With Pembrolizumab in First-line PD-L1 CPS≥20 HNSCC · phase 2/3 · Inhibrx Biosciences
- Safety and Efficacy of VB10.16 and Pembrolizumab in Patients With Head-Neck Squamous Cell Carcinoma · phase 1/2 · Nykode Therapeutics ASA
- Study of Novel Treatment Combination Therapies in Participants With Head and Neck Squamous Cell Carcinoma Regardless of PD-L1 Expression Status; Subst · phase 2 · Gilead Sciences
- Study of Retinfanlimab in Combination With INCAGN02385 and INCAGN02390 as First-Line Treatment in Participants With PD-L1-Positive (CPS ≥ 1) Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck · phase 2 · Incyte Biosciences International Sàrl
- Study of TL117 in Patients With Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma · phase 1/2 · Suzhou Junde Biotechnology Co., Ltd
- Study of Zanzalintinib (XL092) + Pembrolizumab vs Pembrolizumab in Subjects With PD-L1 Positive Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma · phase 2/3 · Exelixis
- Study to Evaluate the Safety and Efficacy of Oral NRC-2694-A in Combination With Paclitaxel in Patients With Recurrent and/or Metastatic Head and Neck · phase 2 · NATCO Pharma Ltd.
- SYS6010 Combined With Enlonstobart In Recurrent Or Metastatic Head And Neck Squamous Cell Carcinoma · phase 2 · CSPC Megalith Biopharmaceutical Co.,Ltd.
- To Evaluate the Efficacy and Safety of Accelerator-Based Boron Neutron Capture Therapy (AB-BNCT) Combined With NBB-001 and NBB-002 for Patients With Recurrent Head and Neck Malignancies · phase 2 · Neuboron Bio-SciTech Co., Ltd.
Trials reported · 7
- CheckMate 141 · phase 3 · 2016 · positive
- EXTREME · phase 3 · 2008 · positive
- KEYNOTE-048 · phase 3 · 2019 · positive
- Low-dose nivolumab plus metronomic chemotherapy (Tata Memorial) · phase 3 · 2023 · positive
- METRO PLUS (Tata Memorial Centre, Varanasi) · phase 3 · 2026 · positive
- Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial) · phase 3 · 2020 · positive
- TPExtreme (GORTEC 2014-01) · phase 2 · 2021 · mixed
Open problems and what is being done
Most patients still die within two years.
No test yet identifies the minority who gain years from immunotherapy.
Salvage surgery and re-irradiation carry high complication rates.
Access to pembrolizumab and cetuximab in the countries with the most cases.
and how the field plans to fix it →What is being done about thisCost and accessAvailable now- Palliative radiotherapyStandard of care
In trialsIdeas and roadmapsNothing recorded yet.
Also on OnCo: Financial help · Coverage by country · HTA decisions.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials
Expert centres
topExpert centres
Baltimore · cancer center | United States | 0 | 2,955 | 41,449 | #10 | ||
Stanford · university | United States | 0 | 3,000 | 50,162 | #30 | ||
Mumbai · cancer center | India | none recorded | 3 | 665 | 4,926 | none recorded | #80 |
Varanasi · cancer center | India | none recorded | 1 | 0 | 0 | - | |
Dallas, TX · cancer center | United States | 0 | 1,744 | 19,757 | - | ||
Utrecht · cancer center | Netherlands | none recorded | 0 | 1,422 | 20,323 | - | |
Tianjin · cancer center | China | none recorded | 0 | 1,219 | 11,455 | - | |
Hangzhou · cancer center | China | none recorded | 0 | 1,219 | 17,635 | - | |
Buffalo, NY · cancer center | United States | 0 | 1,172 | 15,786 | - | ||
Pittsburgh, PA · cancer center | United States | 0 | 1,078 | 21,539 | - | ||
Rozzano (Milan) · hospital | Italy | none recorded | 0 | 1,031 | 10,720 | - | |
Naples · cancer center | Italy | none recorded | 0 | 961 | 15,028 | - | |
Changsha · cancer center | China | none recorded | 0 | 930 | 14,477 | - | |
Jinan · cancer center | China | none recorded | 0 | 920 | 7,804 | - | |
Dresden · cancer center | Germany | none recorded | 0 | 728 | 7,984 | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Recurrent or metastatic head and neck squamous cell carcinoma but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Recurrent or metastatic head and neck squamous cell carcinoma
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example PD-L1 combined positive score, HPV and p16 status of oropharyngeal primaries, Platinum-free interval, EGFR expression, Circulating tumour DNA and HPV DNA), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Locoregional recurrence after radiotherapy, Distant metastatic disease, Platinum-sensitive versus platinum-refractory disease.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
First line, combined positive score 1 or more
- For my situation (first line, combined positive score 1 or more), which of the standard options do you recommend and why?Why: Guideline options include: Pembrolizumab alone for indolent disease, especially with a score of 20 or more; pembrolizumab with platinum and fluorouracil for bulky or symptomatic disease (KEYNOTE-048).
- Am I a candidate for Pembrolizumab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEYNOTE-048 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
First line, combined positive score under 1 or immunotherapy unsuitable
- For my situation (first line, combined positive score under 1 or immunotherapy unsuitable), which of the standard options do you recommend and why?Why: Guideline options include: Pembrolizumab with platinum-fluorouracil, or cetuximab with platinum-fluorouracil (EXTREME) or with docetaxel and platinum (TPExtreme).
- Am I a candidate for Pembrolizumab, Cisplatin, Carboplatin or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of EXTREME and KEYNOTE-048 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
After platinum and immunotherapy
- For my situation (after platinum and immunotherapy), which of the standard options do you recommend and why?Why: Guideline options include: Cetuximab, docetaxel, paclitaxel or methotrexate as single agents; nivolumab or pembrolizumab if not given before (CheckMate 141); clinical trials.
- Am I a candidate for Nivolumab, Cetuximab, Docetaxel or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of CheckMate 141 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Locoregional recurrence
- For my situation (locoregional recurrence), which of the standard options do you recommend and why?Why: Guideline options include: Salvage surgery where resectable; re-irradiation with intensity-modulated or stereotactic techniques in selected patients; cetuximab sarotalocan photoimmunotherapy in Japan.
- Am I a candidate for Cetuximab sarotalocan, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Resource-limited settings
- For my situation (resource-limited settings), which of the standard options do you recommend and why?Why: Guideline options include: Oral metronomic methotrexate with celecoxib; low-dose nivolumab added where affordable; metronomic tablets with paclitaxel-carboplatin (METRO PLUS).
- Am I a candidate for Methotrexate, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial) and Low-dose nivolumab plus metronomic chemotherapy (Tata Memorial) apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Symptom control
- For my situation (symptom control), which of the standard options do you recommend and why?Why: Guideline options include: Palliative radiotherapy for bleeding, pain or airway compromise; early involvement of palliative care, nutrition and speech and swallowing teams.
Any stage
- Are there clinical trials I could join, for example of Petosemtamab, LiGeR-HN1, A Phase 3 Study to Evaluate Petosemtamab Compared With Investigator's Choice Monotherapy in Previously Treated Head and Neck Squamous Cell Carcinoma P, Ficerafusp alfa?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Most patients still die within two years”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “No test yet identifies the minority who gain years from immunotherapy”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Recurrent or metastatic head and neck squamous cell carcinoma, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
10targets
3drugs
17companies
15terms
3trials
40people
2key papers
5For the majority of the world's head and neck cancer patients who cannot afford full-dose checkpoint inhibitors, a low dose added to oral metronomic chemotherapy is a tested alternative that improves survival. It also challenges the assumption that approved doses are the necessary doses: pharmacology had long suggested receptor saturation at far lower exposures.
TPEx is a less toxic, more convenient chemotherapy backbone for patients who need cetuximab-based first-line therapy, for instance when immunotherapy is unsuitable.
Patients with head and neck squamous cell cancer that has recurred or spread should be treated first with pembrolizumab: alone if their tumour is strongly PD-L1 positive and they can wait for a slower response, or with chemotherapy if the tumour is bulky or PD-L1 low. Cetuximab-based chemotherapy is no longer the default. Long-term follow-up shows a small but real group of patients alive at four to five years, which was almost unheard of before.
PD-1 blockade after platinum became standard, and the trial opened the way for first-line pembrolizumab in KEYNOTE-048.
EXTREME was the first-line standard for a decade and remains the option for patients unsuitable for pembrolizumab; it was the comparator that KEYNOTE-048 improved upon.
Latest papers
topQuery for this cancer: (TITLE:"Recurrent or metastatic head and neck squamous cell carcinoma" OR ABSTRACT:"Recurrent or metastatic head and neck squamous cell carcinoma" OR TITLE:"R/M HNSCC" OR ABSTRACT:"R/M HNSCC" OR TITLE:"Advanced head and neck cancer" OR ABSTRACT:"Advanced head and neck cancer" OR TITLE:"Platinum-refractory head and neck cancer" OR ABSTRACT:"Platinum-refractory head and neck cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Recurrent or metastatic head and neck squamous cell carcinoma, not a curated reading list.
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