Immunotherapy and Biomarker Testing in Recurrent and Metastatic Head and Neck Cancers
Publication Date: December 15, 2022
Treatment
Recommendation 1.1
Programmed death-ligand 1 (PD-L1) immunohistochemistry testing should be performed in patients with recurrent HNSCC. (EB, B, H, S)
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Recommendation 1.2
PD-L1 combined positive score (CPS) ≥1 should be interpreted as positive and correlates with a clinical benefit to PD-1 inhibitors. (EB, B, H, S)
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Recommendation 1.3
Tumor mutational burden (TMB) testing may be performed in patients with recurrent or metastatic HNSCC when CPS is not available or in patients with rare tumors. (EB, B, H, S)
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Recommendation 1.4
TMB ≥10 should be interpreted as high and correlates with a clinical benefit to PD-1 inhibitors. (EB, B, H, S)
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Recommendation 2.1
Pembrolizumab monotherapy or pembrolizumab, platinum, and 5-fluorouracil (5-FU) should be offered as first-line treatment for patients with recurrent or metastatic HNSCC with a CPS ≥1. (EB, B, H, S)
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Recommendation 2.2
Pembrolizumab, platinum, and 5-FU may be offered as first-line treatment for patients with recurrent or metastatic HNSCC with a CPS <1. (EB, B, M, S)
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Recommendation 3.1
Pembrolizumab or nivolumab should be offered to patients with platinum-refractory recurrent or metastatic HNSCC, regardless of CPS status. (EB, B, H, S)
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Recommendation 4.1
Toripalimab, camrelizumab or tislelizumab, with gemcitabine and cisplatin, should be offered as first-line treatment for patients with recurrent or metastatic nasopharyngeal cancer. (EB, B, H, S)
Qualifying statement: Pembrolizumab or nivolumab may be offered with gemcitabine and cisplatin if the immune checkpoint inhibitors in Recommendation 4.1 are unavailable.
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Recommendation 4.2
Programmed cell death protein 1 (PD-1) inhibitors may be offered to patients with recurrent or metastatic nasopharyngeal cancer who have progressed following platinum-based therapy. (IC, B, L, W)
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Recommendation 5.1
For patients with oligometastatic HNSCC, radiation therapy is safe to give concurrently with immunotherapy for the purpose of palliation or local control, but should not be given to enhance response to immunotherapy outside of a clinical trial. (EB, , M, W)
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Recommendation 6.1
Pembrolizumab may be offered to patients with TMB-high recurrent or metastatic rare head and neck cancers. (EB, B, M, W)
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Recommendation 6.2
Pembrolizumab may be offered to patients with PD-L1 positive recurrent or metastatic salivary gland cancer. (EB, B, M, W)
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Recommendation Grading
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Overview
Title
Immunotherapy and Biomarker Testing in Recurrent and Metastatic Head and Neck Cancers
Authoring Organization
American Society of Clinical Oncology
Publication Month/Year
December 15, 2022
Supplemental Implementation Tools
Document Type
Guideline
Country of Publication
US
Inclusion Criteria
Male, Female, Adult, Older adult
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Treatment
Diseases/Conditions (MeSH)
D007167 - Immunotherapy, D006258 - Head and Neck Neoplasms, D000082082 - Immune Checkpoint Inhibitors
Keywords
immunotherapy, head and neck cancer, Cancer immunotherapy, PD-L1, biomarker, immune-checkpoint inhibitor
Source Citation
Yilmaz E, Ismaila N, Bauman J, et al. Immunotherapy and Biomarker Testing in Recurrent and Metastatic Head and Neck Cancers: ASCO Guideline. J Clin Oncol. 2022 Dec 15. doi: 10.1200/JCO.22.02328
Supplemental Methodology Resources
Methodology
Number of Source Documents
86
Literature Search Start Date
January 1, 2000
Literature Search End Date
February 1, 2022