Refractory
Pa
ents
*Locoregional recurrence without salvage surgical or radia on op on or declines local therapies.
**Disease Progression on or a er Pla num-Based Therapy: Disease progression on or a er
pla num-based therapy including within 6 months of pla num-based CRT given in the locally
advanced se ng. Pa ents that receive but cannot tolerate pla num-based chemotherapy
would also be included in this category.
Immunotherapy treatment algorithm for pla num-refractory recurrent/metasta c HNSCC
based on current FDA approvals for pembrolizumab and nivolumab as second-line therapies.
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 is to provide advice as the consensus
recommenda ons of the Subcommi ee. 1) Nivolumab and pembrolizumab have been
FDA approved only in pa ents with R/M HNSCC and who are refractory to pla num-based
chemotherapy. If pa ent experiences disease progression on or a er prior pla num-based
chemotherapy, pa ent should receive ICI monotherapy or be enrolled in an appropriate clinic
trial. 2) 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 and is eligible for
immunotherapy
• 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
**Disease progression on or a er
prior pla num-based chemotherapy
without receipt of immunotherapy?
Immune Checkpoint
Inhibitor
monotherapy
(Nivolumab or
Pembrolizumab)
Clinical Trial
Clinical trial
Non-Pla num based chemotherapy
Pallia ve care
Pla num-based
chemotherapy
(e.g. EXTREME regimen,
Doublet chemotherapy or
single agent chemotherapy)
Disease Progression on
or a er Pla num-based
chemotherapy?
1
2
Figure 2. Second-line Treatment Algorithm for R/M HNSCC
Pa ents
NO
YES
YES
