Prior Platinum Exposure and Patient Treatment Priorities

Ross Merkin, MD, discusses first-line selection for recurrent or metastatic head and neck squamous cell carcinoma after platinum-based chemotherapy during curative-intent chemoradiation. He describes recurrence within 6 months as an indicator of rapid relapse in a heterogeneous population that may include tumors with intrinsic treatment resistance. Dr. Merkin notes that KEYNOTE-048 used a platinum and fluorouracil backbone, the single-arm KEYNOTE-B10 study used platinum and a taxane, and many first-line trials excluded patients with rapid recurrence, which leaves an area of unmet need without clear data. When he adds chemotherapy, he usually offers a platinum plus a taxane for logistic ease, citing data that suggest similar efficacy. Will Ince, MRCP, FRCR, says patients want to live and live well, and many accept toxicity to achieve that goal. Because many patients with head and neck cancer die of local disease, with aspiration and poor nutrition, he favors regimens with high, rapid response rates for patients who need them.