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Approach to the Patient with Recurrent/Metastatic Disease

  • Joël GuigayEmail author
  • Esma Sâada-Bouzid
  • Frédéric Peyrade
  • Cécile Michel
Head and Neck Cancer (CP Rodriguez, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Head and Neck Cancer

Opinion statement

For most of patients with a recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC), the treatment remains palliative: The main objective is to reduce the symptoms related to the locoregional relapse, prolong life while maintaining quality of life, which is a big challenge. The systemic treatment needs to be adapted to the performance status, comorbidities, and sequelae of patients. For fit patients, the combination of platinum-based chemotherapy and cetuximab (EXTREME) is the standard of care in first-line treatment since 2008, as no other targeted therapy has been approved in this setting until now. The replacement of 5-FU with a taxane (docetaxel) in the EXTREME regimen has been explored in the large randomized international study TPExtreme which results are awaited in a few months. Depending on the study results on survival, response rate, and tolerance, the TPEx regimen may become a treatment option for patients with R/M HNSCC. Unfit patients are usually treated with platinum-free combinations or with the monotherapies which are recommended in second-line setting (methotrexate, taxanes, cetuximab). However, the irruption of new immunotherapies (e.g., checkpoint inhibitors (CPI)) is changing the guidelines. The tolerance of anti-PD-1 CPI is better than that of chemotherapy, and they seem to be a good option for unfit patients. Anti-PD-1 nivolumab and pembrolizumab are now approved for platinum refractory patients, providing prolonged survival in the case of response, and improvement in quality of life. New options arise in first-line setting with pembrolizumab alone or combined with chemotherapy. Patients with a high PD-L1 biomarker level seem to benefit more from immunotherapy. Other situations (e.g., PD-L1–low, PD-L1–negative, high tumor burden) may more likely to benefit from other combinations, such as cetuximab plus chemotherapy, to avoid local failures and life-threatening fast progression. In terms of perspectives, chemo-free and CPI-free approaches, using other immune oncology agents, should be the next steps.

Keywords

Recurrent/metastatic disease Treatment Standards Advances Review 

Notes

Compliance with Ethical Standards

Conflict of Interest

Joel Guigay has served on advisory boards for AstraZeneca, Bristol-Myers Squibb, Innate Pharma, and Merck KGaA, and has received research grants from GlaxoSmithKline, Bristol-Myers Squibb, Chugaï, and Merck KGaA.

Esma Sâada-Bouzid declares that she has no conflict of interest.

Frédéric Peyrade declares that he has no conflict of interest.

Cécile Michel declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Joël Guigay
    • 1
    Email author
  • Esma Sâada-Bouzid
    • 1
  • Frédéric Peyrade
    • 1
  • Cécile Michel
    • 1
  1. 1.Centre Antoine Lacassagne, Cancer research center, Medical Oncology Department, FHU OncoageUniversity Côte d’AzurNice Cedex 2France

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