Table 1. Key clinical immunotherapy recommenda ons for
treatment of pa ents with HNC
Subject Summary Recommenda ons
Level of
Evidence*
Immune-
related
Adverse
Events
For further detail into toxicity management strategies
please refer to the NCCN Clinical Prac ce Guidelines
in Oncology: Management of Immunotherapy-Related
Toxici es (2019) [h ps://jnccn.org/view/journals/
jnccn/17/3/ar cle-p255.xml]
Toxici es were graded using the NCI CTCAE version
4.0. [h ps://ctep.cancer.gov/protocolDevelopment/
electronic_applica ons/docs/CTCAE_4.03.xlsx]
• For an irAE < grade 3: Con nue ICIs for grade 1 events
with the excep on of some neurologic, hematologic or
cardiac toxici es. For grade 2 events, stop IO therapy
and provide closely monitored outpa ent treatment,
including considera on of oral steroids.
• For irAE development ≥ grade 3, halt treatment, admit
the pa ent to the hospital and administer steroids.
• Rou nely monitor thyroid func on, neck and airway
with imaging and AST/ALT levels.
• In pa ents that develop hypothyroidism, con nue
immunotherapy, providing levothyroxine for
management and evalua ng thyroid func on at two-
month intervals.
• In the event of bulky disease leading to func onal or
organ compromise: Halt immunotherapy.
• Pneumoni s is not a greater concern in immunotherapy
pa ents with HNSCC compared to other cancers.
Consensus
Quality of life
and Pa ent
Engagement
• Provide face-to-face counseling with pa ents and
up-to-date literature to educate pa ents on how
immunotherapy works and its associated toxici es.
• Meet with pa ents and their respec ve families during
office visits to aid in informa on reten on.
• Treat depression in HNSCC pa ents with counseling
and selec ve serotonin reuptake inhibitors (SSRIs).
• Doctors should pay close a en on to depression in
general appointments and should be sure to inquire
into and monitor pa ents' emo onal well-being.
• Clinical trials should be a standard part of a doctor's
discussion with the pa ent about their treatment
op ons, especially for pa ents whose disease has
recurred a er first-line therapy.
Consensus
*Consensus: >50%.
(cont'd)
