RTP On Demand — Head & Neck/Thyroid | Research To PracticeTreatment algorithm for recurrent head and neck cancer
2:25 minutes.
TRANSCRIPTION:
DR COHEN: For a patient with recurrent metastatic disease, the first thing that we want to think about is, does that patient have a curative option? And we have to realize that squamous cell carcinoma of the head and neck, the majority of recurrences are going to be locoregional. They’re going to be either at the primary site or in the neck. And there’s a fraction of patients, albeit a small fraction, who still have curative options. So that’s the first question: Can we cure this patient? If the answer to that is yes, then we explore surgery. We explore reirradiation, et cetera. If the answer to that is no, then we’re talking about systemic palliative chemotherapy. And then I begin to assess the patient’s performance status. That’s probably the next most important feature. Because we do have a triplet regimen of platinum/5-FU and cetuximab that’s approved in the first line that we know extends median overall survival and is very effective — response rates of 35%, 40%. So if I think a patient can tolerate that, then I would go to that regimen. It’s widely known as the EXTREME regimen, because that was the study that garnered approved for it. And I would go to the EXTREME regimen. If I’ve any doubts about the ability of the patient to tolerate that, then I will go to a platinum and a taxane or some other doublet, but usually, for instance, carboplatin/paclitaxel, very well tolerated. Easy to administer. And that would be my first-line choice in most patients. If for some reason I couldn’t use one of those agents because of comorbidities or fear of toxicity, sometimes I’ll use a platinum and cetuximab. Again, data around that are very strong. Sometimes I’ll use a taxane and cetuximab, with good Phase II data supporting that. So some sort of doublet in that first line. When they progress on first-line therapy, usually I will only go to a single agent and that will depend on what they had in the first line. So a taxane, methotrexate, cetuximab — those are all options. And it really comes down to what they did not have in the first line and using that in second line. |