Patient and Disease Factors Guide First-Line Selection

Ross Merkin, MD, explains that the goal of first-line therapy for recurrent or metastatic head and neck squamous cell carcinoma is to help the patient, which usually means treating the cancer. He weighs patient preferences, frailty, performance status, and prior systemic therapy alongside tumor burden, disease location, and the threat posed by further growth. Dr. Merkin notes that adding chemotherapy to pembrolizumab improved the objective response rate in KEYNOTE-048, and he describes offering a modified chemotherapy regimen with pembrolizumab to a frail patient whose disease presses on a critical area and causes significant pain. Will Ince, MRCP, FRCR, focuses on quality of life after prior chemoradiation and tells patients they will live with its effects every day. He avoids rechallenging with chemotherapy within 6 months of chemoradiation and notes that swallowing difficulty and pain can reflect either treatment toxicity or recurrent disease, which makes the two difficult to disentangle.