HPV-negative head and neck squamous cell carcinoma (including HPV-negative oropharyngeal cancer): lines of therapy
7 standard-of-care settings across 5 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 | Risk group |
|---|---|---|
| Screening, prevention and diagnosis | 2 | · |
| Early / localised | · | 1 |
| Locally advanced | 1 | · |
| Advanced, first line | 2 | · |
| Other settings | 1 | · |
Screening, prevention and diagnosis
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Diagnosis and staging | Biopsy with p16 (and HPV testing for oropharyngeal primaries), PD-L1 combined positive score, panendoscopy for second primaries, CT or MRI and PET-CT for stage III to IV. | NCCN Guidelines: Head and Neck Cancers | 92 | |
| All comers | Prevention | Smoking cessation, alcohol reduction and betel quid cessation; second primaries make cessation after diagnosis worthwhile. | 32 |
Early / localised
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| Risk group | After surgery, high risk | Postoperative cisplatin chemoradiation for extranodal extension or positive margins; nivolumab added on the basis of NIVOPOSTOP. | NCCN · Category 1 (chemoradiation) | 93 |
Locally advanced
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Resectable stage III to IVA | Surgery with neck dissection; perioperative pembrolizumab for tumours with a combined positive score of 1 or more (KEYNOTE-689), then radiotherapy or chemoradiation by pathology. | NCCN · Category 1 | 98 |
Advanced, first line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Unresectable or organ-preserving | Definitive cisplatin chemoradiation to 70 Gy; cetuximab with radiotherapy for patients who cannot have cisplatin (Bonner). | NCCN · Category 1 | 93 | |
| All comers | Recurrent or metastatic | Pembrolizumab alone (combined positive score 1 or more) or with platinum-fluorouracil (KEYNOTE-048); cetuximab-based EXTREME for rapid disease or PD-1 failure. | NCCN · Category 1 | 98 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Resource-limited settings | Oral metronomic methotrexate with celecoxib, with or without low-dose nivolumab (Tata Memorial trials). | 83 |
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.