Head and Neck Cancer

Regimen Options

Last Updated: 11/05/2024 See Details

NOTE: Best Supportive Care or Clinical Trial

	Evolent Pathways	Febrile Neutropenic Risk	Emetogenic Risk	References
Chemoradiation	cisplatin	Low	High	NCCN Guidelines® for Head and Neck Cancers V.2.2017. Cooper JS, et al. N Engl J Med. 2004;350(19):1937-44. Bernier J, et al. Head Neck. 2005;27(10):843-50. Bernier J, et al. N Engl J Med. 2004;350(19):1945-52.
	cetuximab if contraindications to platinum; e.g. deemed unlikely to tolerate cisplatin	Low	Low	NCCN Guidelines® for Head and Neck Cancers V.2.2017. Vermorken JB. DOI: 10.1200/JCO.2006.06.7447 Journal of Clinical Oncology 25, no. 16 (June 1 2007) 2171-2177.
Adjuvant (Postop or consolidation)	cisplatin	Low	High	NCCN Guidelines® for Head and Neck Cancers V.2.2017. Cooper JS, et al. N Engl J Med. 2004;350(19):1937-44. Bernier J, et al. Head Neck. 2005;27(10):843-50. Bernier J, et al. N Engl J Med. 2004;350(19):1945-52.
Advanced/Metastatic: Initial Therapy	carboplatin or cisplatin and paclitaxel	Low	High	NCCN Guidelines® for Head and Neck Cancers V.2.2017. Ferrari D et al. Anticancer Drugs . 2009 Mar;20(3):185-90.
	pembrolizumab [PD-L1 (Combined Positive Score, CPS) Expression > or = to 1%]	Low	Low	NCCN Guidelines® for Head and Neck Cancers V.2.2017. Burtness B et al. https://doi.org/10.1016/S0140-6736(19)32591-7
	pembrolizumab and cisplatin or carboplatin and 5FU	Low	High	NCCN Guidelines® for Head and Neck Cancers V.2.2017. Burtness B et al. Lancet 2019; 394: 1915–28. Burtness B et al. J Clin Oncol 40:2321-2332.
	pembrolizumab, carboplatin and paclitaxel	Low	High	NCCN Guidelines® for Head and Neck Cancers V.5.2024. Dzienis M et al. J Clin Oncol 42:2989-2999
Advanced/Metastatic: Subsequent Therapy	carboplatin or cisplatin and paclitaxel	Low	High	NCCN Guidelines® for Head and Neck Cancers V.2.2017. Ferrari D et al. Anticancer Drugs . 2009 Mar;20(3):185-90.
	carboplatin	Low	High	NCCN Guidelines® for Head and Neck Cancers V.5.2024. Al-Sarraf, M et al. Cancer Treat Rep . 1987 Jul-Aug;71(7-8):723-6.
	paclitaxel	Low	Low	NCCN Guidelines® for Head and Neck Cancers V.5.2024. Grau JJ, et al. Acta Otolaryngol. 2009;129(11):1294-99.
	cetuximab	Low	Low	NCCN Guidelines® for Head and Neck Cancers V.2.2017. Vermorken JB. DOI: 10.1200/JCO.2006.06.7447 Journal of Clinical Oncology 25, no. 16 (June 1 2007) 2171-2177.
	nivolumab if PD inhibitor naive	Low	Low	NCCN Guidelines® for Head and Neck Cancers V.5.2024. Ferris RL. N Engl J Med 2016; 375:1856-1867
	pembrolizumab if PD inhibitor naive	Low	Low	NCCN Guidelines® for Head and Neck Cancers V.5.2024. Cohen E et al. Lancet . 2019 Jan 12;393(10167):156-167

Chemoradiation

Evolent Pathways

cisplatin

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cetuximab *if contraindications to platinum; e.g. deemed unlikely to tolerate cisplatin*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Adjuvant (Postop or consolidation)

Evolent Pathways

cisplatin

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Advanced/Metastatic: Initial Therapy

Evolent Pathways

carboplatin or cisplatin and paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

pembrolizumab [PD-L1 (Combined Positive Score, CPS) Expression > or = to 1%]

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

pembrolizumab and cisplatin or carboplatin and 5FU

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

pembrolizumab, carboplatin and paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Advanced/Metastatic: Subsequent Therapy

Evolent Pathways

carboplatin or cisplatin and paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

cetuximab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

nivolumab *if PD inhibitor naive*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

pembrolizumab *if PD inhibitor naive*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

	Regimen	Alternative
LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES
	cetuximab and pembrolizumab initial line or subsequent line	Alternative: pembrolizumab, pembrolizumab and platinum (cisplatin or carboplatin) and 5-FU
	nivolumab and ipilimumab CPS ≥20 and initial line	Alternative: pembrolizumab, pembrolizumab and platinum (cisplatin or carboplatin) and 5-FU

LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES

Regimen

cetuximab and pembrolizumab *initial line or subsequent line*

Regimen

nivolumab and ipilimumab *CPS ≥20 and initial line*

Pathways and Low-Value Regimens

Head and Neck Cancer