SITC - HNSCC Pocket Guide

Squamous Cell Carcinoma of the Head and Neck Guidelines

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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)

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