Indian clinical practice consensus guidelines for the management of very advanced head-and-neck squamous cell carcinoma: Update 2022

Abstract

The management of recurrent or metastatic head-and-neck cancers is evolving. Promising novel immunotherapies and targeted therapies have led to a paradigm shift in the management of very advanced disease. Single-agent systemic therapy including cisplatin/carboplatin/paclitaxel/docetaxel/5-florouracil/methotrexate/cetuximab/gemcitabine/capecitabine or combination chemotherapy may be considered. Immunotherapy alone or in combination with chemotherapy has improved survival and should be considered. Oral metronomic chemotherapy with or without immunotherapy also improves oncologic outcomes. The challenges associated with the disease may be resolved by using an integrated approach of combining locoregional and systemic therapies. Salvage treatments like re-radiation or surgery are useful for the management of locoregional recurrences.