Preparing Practices and Treatment at Progression

Will Ince, MRCP, FRCR, advises community oncologists to prepare for patients with recurrent or metastatic head and neck squamous cell carcinoma to live longer, which will increase clinic volume and affect service organization. Frequent dosing will strain infusion units and burden patients who travel long distances, and he suggests subcutaneous options, including subcutaneous pembrolizumab, may appeal to these patients. Dr. Ince encourages colleagues to learn the data for all regimens, though he expects some to master one. Ross Merkin, MD, says moving epidermal growth factor receptor blockade from the second-line to the first-line setting creates a void at progression. He supports sequencing bispecific antibodies if approved and highlights antibody-drug conjugates, citing a National Comprehensive Cancer Network recommendation for enfortumab vedotin, a Nectin-4-directed agent, and earlier-phase agents without data yet. He cautions that patients at progression may not tolerate aggressive chemotherapy, which makes novel targets the likely direction of the field.