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Established treatment concepts for recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSSC)

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Summary

Background

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.

Results

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.

Conclusion

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.

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Abbreviations

ASCO:

American Society of Clinical Oncology

CI:

Confidence interval

CPS:

Combined positive score

CT:

Chemotherapy

G‑CSF:

Granulocyte-colony stimulating factor

HNSCC:

Head and neck squamous cell carcinoma

HR:

Hazard ratio

ICI:

Immune checkpoint inhibitor

ORR:

Objective response rate

OS:

Overall survival

PD-L1:

Programmed cell death 1 ligand

PFS:

Progression-free survival

R/M:

Recurrent and/or metastatic

TPS:

Tumor proportion score

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Authors and Affiliations

  1. Departement for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria

    Marcel Kloppenburg MD & Daniel Dejaco

  2. Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria

    Finn Mildner, Maria Theresia Kasseroler & Arno Amann

Authors
  1. Marcel Kloppenburg MD
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  2. Finn Mildner
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  3. Maria Theresia Kasseroler
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  4. Daniel Dejaco
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  5. Arno Amann
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Corresponding author

Correspondence to Marcel Kloppenburg MD.

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Conflict of interest

M. Kloppenburg, F. Mildner, M.T. Kasseroler, D. Dejaco, and A. Amann declare that they have no competing interests.

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Kloppenburg, M., Mildner, F., Kasseroler, M.T. et al. Established treatment concepts for recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSSC). memo 13, 395–399 (2020). https://doi.org/10.1007/s12254-020-00645-6

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  • DOI: https://doi.org/10.1007/s12254-020-00645-6

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