Immunotherapy for Head and Neck SCC
Table 1. Key clinical immunotherapy recommenda ons for
treatment of pa ents with HNC
Subject Summary Recommenda ons
Level of
Evidence*
Rare head
and neck
cancer
subtypes
Cemiplimab should be prescribed for pa ents with
metasta c or locally-advanced cSCC in the head and neck
region who are not candidates for cura ve surgery or
radia on.
1
Pa ents with NPC are dis nct from other HNSCC pa ents.
Clinical trial enrollment is recommended as the primary
treatment op on for recurrent and metasta c disease.
Where clinical trial enrollment is not feasible, pa ents
with pla num-refractory NPC may derive clinical benefit
from single-agent PD-1/PD-L1 check-point blockade.
Consensus
Treatment Response
Evalua on
and
Management
• Allow a 1-month meframe for ini al clinical follow-up
for iden fica on of signs of immune-related symptoms
and AEs.
• For con nued iden fica on of signs of immune-related
symptoms and AEs, pa ents should be evaluated at
least monthly, and some mes more frequently in the
se ng of ac ve AEs.
• In monitoring pa ents for signs of response a er ini al
follow-up, pa ent evalua on (via radiographic imaging)
should occur every three months.
• If CR or near CR a er treatment and six months of
maintenance immunotherapy, con nue treatment for at
least two years or un l disease progression or toxicity.
• For ini al assessment, conduct imaging via CT or PET-CT
scan following a baseline clinical exam of the pa ent.
• It is not acceptable to treat beyond progression
if a pa ent has symptoma c progression/clinical
deteriora on.
• If radiographic progression is observed early in treatment
and the pa ent is clinically stable, con nue treatment
un l progression is confirmed on a second scan.
• If disease progresses on or a er treatment with a PD-1
inhibitor: Enroll in a clinical trial and treat with pallia ve
radiotherapy and/or chemotherapy (a taxane).
• Anatomical site of the tumor is an important
considera on.
Potential for airway obstruction, surgical resection or
radiotherapy to the site may alter the course of treatment.
• The term "pseudoprogression" should be avoided in a
se ng of worsening symptoms.
• Hyperprogression is defined as "a rapid increase in
tumor growth rate (minimum two-fold) compared to the
expected or prior growth rate."
Consensus
(cont'd)