Treatment of Recurrent or Metastatic Hypopharyngeal Squamous Cell Carcinoma with PD-L1-Positive Tumour
Clinical Scenario
This protocol addresses patients with recurrent or metastatic hypopharyngeal squamous cell carcinoma that is not amenable to curative radiotherapy or surgery. The protocol applies when the patient has not received platinum-based chemotherapy within the preceding six months.
Key Eligibility Factor
PD-L1 Combined Positive Score ≥ 1
A confirmed PD-L1-positive tumour (combined positive score ≥ 1) is a defining criterion for this treatment pathway. The approach differs based on the clinical urgency and the presence of any contraindications to specific therapies.
Treatment Approach (Partial Overview)
The standard first-line approach centres on immunotherapy, either as monotherapy or in combination — with the combination particularly favoured when rapid tumour shrinkage is a clinical priority. Alternative chemotherapy-based regimens exist for patients with contraindications to immunotherapy, with the choice further guided by fitness for platinum-based therapy.
Full regimen details, sequencing, and supporting evidence are available in the structured protocol below.
References
DOI: 10.1016/j.annonc.2020.07.011
- No platinum-based ChT during the last 6 months and PD-L1-positive tumour
- A 'chemo-free' approach with pembrolizumab monotherapy in patients with CPS 1 SCCHN should be considered, especially when a rapid tumour shrinkage is not needed [I, A].
- Pembrolizumab monotherapy [I, A; MCBS 4]
- Pembrolizumab plus platinum/5-FU [I, A; MCBS 4]
- Platinum/5-FU/cetuximab if contraindication to immunotherapy and fit for platinum-based therapy [I, A; MCBS 3]
- Methotrexate or taxane or cetuximab and/or BSC if contraindication to immunotherapy and unfit for platinum-based therapy [III, C]
- A second option, independent of PD-L1 status, is the combination of pembrolizumab and ChT (cisplatin or carboplatin plus 5-FU), particularly in symptomatic patients or when a rapid tumour shrinkage is needed [I, A].
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