H&N Cancer

Question 1

Squamous Cell Cancers Lip, Oral Cavity, Oropharynx, Hypopharynx, Glottic Larynx, Supraglottic Larynx, Ethmoid Sinus, Maxillary Sinus, Occult Primary:

Answer 1

• Primary systemic therapy + concurrent RT High-dose cisplatin(preferred) (category 1) Cetuximab (category 1) 
Carboplatin/infusional 5-FU (category 1)
5-FU/hydroxyurea
Cisplatin/paclitaxel
Cisplatin/infusional 5-FU
Carboplatin/paclitaxel(category 2B) 
Weekly cisplatin 40 mg/m2 (category 2B)

• Postoperative chemoradiation
Cisplatin(category 1 for high-risk non oropharyngeal cancers)

Question 2

Nasopharynx:

• Chemoradiation followed by adjuvant chemotherapy

Answer 2

Cisplatin + RT followed by cisplatin/5-FU
or
carboplatin/5-FU (category 2B for carboplatin/5-FU)
• Cisplatin + RT without adjuvant chemotherapy (category 2B)

Question 3

Lip, Oral Cavity, Oropharynx, Hypopharynx, Glottic Larynx, Supraglottic Larynx, Ethmoid Sinus, Maxillary Sinus, Occult Primary:

Answer 3

• Induction/Sequential chemotherapy Docetaxel/cisplatin/5-FU (category 1 if induction is chosen)
Paclitaxel/cisplatin/infusional 5-FU

Following induction, agents to be used with concurrent chemoradiation typically include weekly carboplatin or cetuximab.

Question 4

Nasopharynx:

• Induction (category 3)/Sequential chemotherapy

Answer 4

Docetaxel/cisplatin/5-FU
Docetaxel/cisplatin (category 2B)
Cisplatin/5-FU
Cisplatin/epirubicin/paclitaxel

Following induction, agents to be used with concurrent chemoradiation typically include weekly cisplatin or carboplatin

Question 5

Recurrent, Unresectable, or Metastatic (with no surgery or RT option)
• Combination therapy

Answer 5

Cisplatin or carboplatin + 5-FU + cetuximab (non-nasopharyngeal) (category 1)
Cisplatin or carboplatin + docetaxel or paclitaxel
Cisplatin/cetuximab (non-nasopharyngeal) Cisplatin/5-FU
Cisplatin/docetaxel/cetuximab (non-nasopharyngeal)
Cisplatin/paclitaxel/cetuximab (non-nasopharyngeal)
Carboplatin/cetuximab (nasopharyngeal) Cisplatin/gemcitabine (nasopharyngeal) Gemcitabine/vinorelbine (nasopharyngeal)

Question 6

Recurrent, Unresectable, or Metastatic (with no surgery or RT option)
• Single agents

Answer 6

Cisplatin
Carboplatin
Paclitaxel
Docetaxel
5-FU
Methotrexate
Cetuximab (non-nasopharyngeal) 
Gemcitabine (nasopharyngeal) 
Capecitabine
Vinorelbine(non-nasopharyngeal) 
Afatinib(non-nasopharyngeal, second line) (category 2B) 
Pembrolizumab (if disease progression on or after platinum-containing chemotherapy) 
Nivolumab (if disease progression on or after platinum-containing chemotherapy) (category 1)