Head and neck squamous cell carcinoma: lines of therapy
12 standard-of-care settings across 7 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Line | All comers | HPV |
|---|---|---|
| Screening, prevention and diagnosis | 1 | · |
| Early / localised | 2 | 1 |
| Locally advanced | 2 | · |
| Advanced, first line | 3 | · |
| Second line | 1 | · |
| Special situations | 1 | · |
| Other settings | 1 | · |
Screening, prevention and diagnosis
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Prevention | HPV vaccination (also prevents oropharyngeal cancer in men), tobacco and alcohol cessation; no validated screening. | NCCN · Prevention guideline | 89 |
Early / localised
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Resectable | Neoadjuvant + adjuvant pembrolizumab with surgery; or chemoradiation. | NCCN Guidelines: Head and Neck Cancers | 98 | |
| All comers | Early stage (I-II) oral cavity and larynx | Single-modality surgery or radiation; sentinel node or elective neck dissection for oral cavity; larynx preservation with radiation for T1-T2 glottic cancer. | NCCN · 2A | 91 | |
| HPV | Early HPV-positive oropharynx | TORS with pathology-guided adjuvant therapy or definitive (chemo)radiation; standard 70 Gy dose because de-escalation trials failed. | NCCN · 2A | 74 |
Locally advanced
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Locally advanced, resectable (stage III-IVA) | Neoadjuvant pembrolizumab, surgery, adjuvant pembrolizumab with (chemo)radiation for PD-L1 CPS ≥1 (KEYNOTE-689); otherwise surgery then risk-adapted (chemo)radiation. | NCCN · 1 (CPS ≥1)ESMO-MCBS · A | 98 | |
| All comers | Locally advanced, unresectable or organ preservation | Cisplatin (100 mg/m² q3w or weekly) with 70 Gy IMRT; cetuximab-radiation only if cisplatin-ineligible; concurrent immunotherapy is not indicated (JAVELIN, KEYNOTE-412). | NCCN · 1 | 91 |
Advanced, first line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Recurrent/metastatic | Pembrolizumab ± platinum/5-FU; cetuximab-based; photoimmunotherapy (Japan). | ESMO-MCBS · 2 (cetuximab sarotalocan, Japan, single-arm) | 98 | |
| All comers | Recurrent or metastatic, first line | Pembrolizumab alone (CPS ≥20, or ≥1) or with platinum/5-FU (any CPS); EXTREME if immunotherapy contraindicated. | NCCN · 1ESMO-MCBS · 4 | 98 | |
| All comers | Recurrent or metastatic, after platinum | Nivolumab or pembrolizumab if immunotherapy-naive; otherwise cetuximab, taxane, or methotrexate; clinical trials (bispecifics, ADCs). | NCCN · 1 (IO-naive) | 93 |
Second line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Locally recurrent, unresectable (Japan) | Cetuximab sarotalocan photoimmunotherapy; re-irradiation (proton or IMRT) in selected patients elsewhere. | 63 |
Special situations
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Survivorship | Swallowing and speech therapy, dental care after radiation, thyroid monitoring, lymphoedema management, smoking cessation; second primary surveillance. | — |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Nasopharyngeal carcinoma | Induction gemcitabine-cisplatin then chemoradiation for locoregional disease; toripalimab (or other PD-1) + gemcitabine-cisplatin for recurrent/metastatic; plasma EBV DNA for surveillance. | NCCN · 1 | 91 |
Sequence and caution pairings
SequenceStandard of care
Immunotherapy before surgery rather than with chemoradiation (HNSCC)
In head and neck cancer, immunotherapy works when given before surgery but not when given alongside chemoradiation.
Caution
Caution: de-escalating radiation on HPV status alone
Being HPV-positive is not enough to justify less radiation; trials that tried it saw more relapses.
Regimens in the library
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.