Squamous cell carcinoma of the head and neck (HNSCC) arises from the mucosal epithelium of the nose, mouth, and throat. Approximately 90% of all head and neck cancers are HNSCC. Risk factors for the development of HNSCC include smoking, alcohol use, and history of infection with human papillomavirus (HPV) and Epstein Barr Virus (EBV).
Immunotherapies have been approved to treat patients with recurrent or metastatic HNSCC since 2016. These therapies work by enhancing the activity of the immune system to eliminate cancerous cells. Initially immune-checkpoint inhibitors (ICIs), nivolumab and pembrolizumab, were approved for the treatment of patients with platinum-refractory recurrent or metastatic HNSCC. More recently, these therapies may be used for first-line treatment in patients with recurrent or metastatic HNSCC.
The National Comprehensive Cancer Network (NCCN), recently updated their guidelines for head and neck cancers. In this Guidelines Side-by-Side, we have compared the NCCN’s updated guidelines on immunotherapy treatment for HNSCC with guidelines from the Society for Immunotherapy of Cancer (SITC) and the American Society of Clinical Oncology (ASCO). The recommendations made are meant to guide clinical practice, taking into consideration the unique desires and needs of individual patients. These guidelines are extensive and this article is not inclusive of all recommendations made. We encourage you to review the full clinical practice guidelines at the links below for more useful information on the treatment of HNSCC.
Guidelines for Comparison
| Authoring Organization | National Comprehensive Cancer Network (NCCN) | Society for Immunotherapy of Cancer (SITC) | American Society of Clinical Oncology (ASCO) |
| Publication Date | January 2025 | December 2019, updated November 2024 | February 2023 |
| Graded Recommendations | Yes | Yes | Yes |
| Includes GRADE | No | No | No |
| Links | Full Text | Overview Full Text | Summary Pocket Guide Full Text |
- Although GRADE was not used, all three societies used a similar system to rate the strength of recommendation and level of evidence.
Key Takeaways
- NCCN offers the most up-to-date and specific treatment recommendations for head and neck cancers. Many treatment algorithms are available to help guide practice. This Guidelines Side-by-Side only represents a small portion of the information available in the full guideline, focusing on recent updates to immunotherapy treatment for recurrent or metastatic nasopharyngeal HNSCC.
- Across all three guidelines it is recommended that immunotherapy be offered as either monotherapy or combination therapy for the treatment of recurrent or metastatic nasopharyngeal HNSCC. The immunotherapy recommendations from the NCCN reviewed in this article go a step further specifying that these therapies are for patients with no surgery and no radiation therapy options.
- Choice of immunotherapy agent depends on the location of the HNSCC, any previous treatments the patient has received, specific factors like PD-L1 (programmed death-ligand 1) expression, stage of disease, and the individual’s goals and preferences.
- There are some differences between these guidelines in the recommendations for first-line immunotherapy in patients with recurrent or metastatic nasopharyngeal cancers.
- NCCN:
- Pembrolizumab, nivolumab, tislelizumab-jsgr, and toripalimab-tpzi may be considered for first-line or subsequent-line treatment.
- ASCO:
- Tislelizumab-jsgr, toripalimab-tpzi, and camrelizumab may be considered for first-line treatment and pembrolizumab and nivolumab may be used if these three drugs are unavailable.
- SITC:
- Pembrolizumab and nivolumab are recommended as a first-line treatment or as monotherapy after progression on platinum therapy and toripalimab-tpzi as a first line treatment for some patients.
- An important note from the NCCN is that nivolumab and hyaluronidase-nvhy subcutaneous injection may be substituted for IV nivolumab, but nivolumab and hyaluronidase-nvhy has different dosing and administration instructions compared to IV nivolumab.
| Recurrent or Metastatic Nasopharyngeal HNSCC | |||
|---|---|---|---|
| Therapy | NCCN (for patients with no surgery and no radiation therapy option) | SITC | ASCO |
| Pembrolizumab | First-Line combination therapy | FDA approved for recurrent or metastatic cutaneous SCC | First-Line as monotherapy or combination therapy if tislelizumab-jsgr, toripalimab, and camrelizumab are unavailable |
| Subsequent-Line therapy for previously treated, PD-L1-positive, recurrent or metastatic disease | First-Line or Monotherapy after progression on platinum therapy | Offered to patients with platinum-refractory recurrent or metastatic disease | |
| Nivolumab | First-Line combination therapy | First-Line or Monotherapy after progression on platinum therapy | First-Line as monotherapy or combination therapy if tislelizumab-jsgr, toripalimab, and camrelizumab are unavailable |
| Subsequent-Line therapy for previously treated recurrent or metastatic non-keratinizing disease. | Offered to patients with platinum-refractory recurrent or metastatic disease | ||
| Nivolumab and hyaluronidase-nvhy subcutaneous injection may be substituted for IV nivolumab. Nivolumab and hyaluronidase-nvhyhas different dosing and administration instructions compared to IV nivolumab. | |||
| Tislelizumab-jsgr | First-Line combination therapy | Not Addressed | First-Line |
| Subsequent-Line therapy | |||
| Toripalimab-tpzi | Preferred First-Line or Preferred Subsequent-Line therapy | First-Line or Monotherapy for certain patients | First-Line |
| Camrelizumab | Not Addressed | Not Addressed | First-Line |
This concludes our Guidelines Side-by-Side on Immunotherapy treatment of squamous cell carcinoma of the head and neck. Don’t forget to sign up for alerts to stay informed on the latest published guidelines and articles.
Copyright © 2024 Guideline Central, All Rights Reserved.