Recurrent or Metastatic Oral Cavity Carcinoma with CPS<1: What to Do After Platinum–Cetuximab First-Line Failure
This protocol applies to patients with incurable, recurrent or metastatic oral cavity carcinoma whose tumour pathologically lacks PD-L1-expressing cells — defined as a combined positive score below 1 — and who remain in good general condition after first-line therapy has failed.
Clinical Scenario
The disease is incurable, recurrent or metastatic. Pathological assessment has confirmed the absence of PD-L1 expression in tumour and immune cells (combined positive score <1). The patient maintains good performance status and is no longer a candidate for local therapy.
Previous Line — Failure Condition
First-line platinum-containing therapy in combination with cetuximab has been given and has failed. This protocol defines the treatment step indicated after that failure.
Treatment Approach (Partial Overview)
Second-line therapy in this setting involves a checkpoint inhibitor administered according to current approval status. The specific agent selection, eligibility criteria, and full treatment algorithm are available in the complete protocol.
References
In patients pathologically lacking PD-L1 expressing tumor or immune cells (CPS<1), the EGRF receptor targeting antibody cetuximab should be used as first line therapy in combination with platinum (preferably cisplatin) and 5-fluorouracil (EXTREME regimen) in the palliative setting in patients in good general condition who no longer qualify for local therapy.
After failure of platinum-containing first-line therapy with cetuximab, second-line therapy shall be given with a checkpoint inhibitor according to the approval status.
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