SITC - HNSCC Pocket Guide

Immunotherapy for Head and Neck SCC *Locoregional recurrence without salvage surgical or radia on op on or declines local therapies. **Refer to Figure 2. Ini al Therapy Treatment Recommenda ons: Immune Checkpoint Inhibitor monotherapy (nivolumab or pembrolizumab) This treatment strategy takes into account recent data from the Keynote-048 trial and would be reasonable if pembrolizumab is available. All treatment op ons shown may be appropriate. The final selec on of therapy should be individualized based on pa ent eligibility and therapy availability based on the trea ng physician's discre on. The goal of these algorithms are to provide advice as the consensus recommenda ons of the Subcommi ee. 1) Trea ng physician will determine if pa ent is fit to undergo pembrolizumab monotherapy or pembrolizumab/cispla n/5-FU combina on therapy as first-line therapy for R/M HNSCC. 2) If pa ent experiences disease progression on or a er pembrolizumab monotherapy, pa ent should receive pla num based chemotherapy or be enrolled in an appropriate clinical trial. 3) If pa ent experiences disease progression on or a er pembrolizumab/cispla n/5-FU combina on therapy, pa ent may receive second-line non-pla num based chemotherapy/ cetuximab or be enrolled in an appropriate clinical trial. In addi on, pa ents are eligible for nivolumab or pembrolizumab regardless of PD-L1 expression, according to the 2016 FDA approvals of nivolumab and pembrolizumab for second-line treatment of pa ents with HNSCC. Clinical trials, including those that are immunotherapy-based, should be considered in all HNSCC pa ents, in all lines of therapy. • Pa ent evaluated by mul disciplinary team • Disease status/stage confirmed including histology/cytology and radiographic imaging • Disease Status: Locoregional recurrence* and/or metasta c disease • Pa ent is considered eligible for immunotherapy by trea ng physician Diagnos c Workup Pa ent Selec on Ini al Therapy Treatment Recommenda ons Clinical trial, or Pla num based chemotherapy Clinical trial, **Immune Checkpoint Inhibitor monotherapy, or Non-pla num based chemotherapy R/M HNSCC Systemic Therapy Naïve Pa ents 2 3 Disease Progression on or a er Pembrolizumab monotherapy Figure 1. First-line Treatment Algorithm for R/M HNSCC Pa ents Pembrolizumab monotherapy for PD-L1 expressing, or Pembrolizumab/Cispla n/5-FU 1 Disease Progression on or a er Pembrolizumab/ Cispla n/5-FU Refractory Pa ents

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