Recurrent and metastatic squamous cell carcinomas of the head and neck are still difficult to treat. The EXTREME regimen has been the standard of care for the last decade, but recent studies initiated a change. In this work we provide an overview of the established treatment concepts for recurrent and metastatic squamous cell carcinomas of the head and neck with palliative intent.
Material and methods
We performed a literature search using the key words: recurrent, metastatic, cancer, head and neck, HNSCC, treatment, chemotherapy, immunotherapy, salvage, and surgery. Furthermore, the presentations of the ASCO highlights of head and neck cancer from 2019 and 2020 were included.
The KEYNOTE-048 and the TPEx randomized trial are the most relevant trials in the first line setting. The CheckMate 141 and KEYNOTE-040 have the greatest impact for the second line regimen.
The expression of PD-L1, prior treatment, performance status, local symptoms and tumor burden are the most important factors regarding choice of treatment. Pembrolizumab alone or in combination with chemotherapy can be recommend as the 1st line standard in patients with combined positive score (CPS) ≥20. The choice of therapy in patients with CPS 1-19 and CPS <1 has to be individually evaluated for each patient. Furthermore, TPEx is an encouraging alternative to the EXTREME regimen with less toxicity and improved quality of life.