SEOM clinical guidelines for the treatment of head and neck cancer (2020)

Abstract

Head and neck cancers (HNC) are defined as malignant tumours located in the upper aerodigestive tract and represents 5% of oncologic cases in adults in Spain. More than 90% of these tumours have squamous histology. In an effort to incorporate evidence obtained since 2017 publication, the Spanish Society of Medical Oncology (SEOM) presents an update of the squamous cell HNC diagnosis and treatment guideline. Most relevant diagnostic and therapeutic changes from the last guideline have been updated: introduction of sentinel node biopsy in early oral/oropharyngeal cancer treated with surgery, concomitant radiotherapy with weekly cisplatin 40 mg/m2 in the adjuvant setting, new approaches for HPV-related oropharyngeal cancer and new treatments with immune-checkpoint inhibitors in recurrent/metastatic disease.

Ibero-American Expert Consensus on Squamous Cell Carcinoma of the Head and Neck Treatment in Patients Unable to Receive Cisplatin: Recommendations for Clinical Practice

“…47 According to the Spanish Society of Medical Oncology (SEOM), radiotherapy alone should be considered in patients with locally advanced disease who are not candidate for platinum-based chemotherapy (Quality of evidence I, strength of recommendation A). 48 …”

“…In patients with recurrent, unresectable, or metastatic disease with no surgery or radiotherapy option, the preferred alternative regimen to cisplatin according to NCCN is pembrolizumab as first-line therapy (for tumors that express PD-L1 with a combined positivity score [CPS] ≥ 1; category 1 if CPS ≥ 20), 47 and according to SEOM the combination of paclitaxel plus cetuximab (ERBITAX) should be considered (IIB). 48 …”

“…47 According to the Spanish Society of Medical Oncology (SEOM), radiotherapy alone should be considered in patients with locally advanced disease who are not candidate for platinum-based chemotherapy (Quality of evidence I, strength of recommendation A). 48 The combination of carboplatin and 5-fluorouracil administration with radiotherapy was supported by a phase III study that demonstrated its superiority in both OS and locoregional control compared with radiotherapy alone in patients with advanced oropharyngeal carcinoma. 49 Although there are no direct comparisons, a subsequent retrospective analysis showed median OS was prolonged in patients treated with cisplatin compared with those receiving carboplatin + 5-fluorouracil.…”

“…In patients with recurrent, unresectable, or metastatic disease with no surgery or radiotherapy option, the preferred alternative regimen to cisplatin according to NCCN is pembrolizumab as first-line therapy (for tumors that express PD-L1 with a combined positivity score [CPS] ≥ 1; category 1 if CPS ≥ 20), 47 and according to SEOM the combination of paclitaxel plus cetuximab (ERBITAX) should be considered (IIB). 48 The efficacy of pembrolizumab was demonstrated in the KEYNOTE-048 trial, an open-label, phase III study in which patients were randomized to pembrolizumab alone, pembrolizumab plus a platinum and 5-fluorouracil, or cetuximab plus a platinum and 5-fluorouracil. 5 Pembrolizumab monotherapy improved OS versus cetuximab plus platinum and 5-fluorouracil in the combined positivity score (CPS) ≥ 20 (median 14.9 vs 10.7 months, p = 0.0007) and CPS ≥ 1 (12.3 vs 10.3 months, p = 0.0086) patient populations, and was non-inferior in the total population (11.6 vs 10.7 months).…”

Current Therapeutic Strategies in Patients with Oropharyngeal Squamous Cell Carcinoma: Impact of the Tumor HPV Status

“…American and European guidelines on the management of OPSCC patients do not differ according to the HPV status of the tumor [8,43,44]. Indeed, two therapeutic options can be considered: one based on upfront surgery with or without adjuvant (C)RT, the other on definitive (C)RT.…”