ESMO E-Learning: Multimodular Treatment in Head and Neck Squamous Cell Carcinoma (HNSCC)

In this comprehensive E-Learning module, the author provides an excellent overview of data on the epidemiology of head and neck squamous cell carcinoma (HNSCC), oropharyngeal cancer, staging according AJCC 8th edition, the role of chemotherapy in locally advanced disease, indications for postoperative chemoradiation,  deintensification strategies for Human Papillomavirus (HPV)-positive oropharyngeal cancer, current status of immune checkpoint inhibitors in the management of HNSCC, and surgical management of the neck.

This E-learning module represents an update of the previous module by the same author who elaborates the clinical developments in the field in the past few years and provides practical considerations for the management of HNSCC.

Tobacco and alcohol use account for the majority of HNSCC cases. A growing proportion of oropharyngeal squamous cell carcinomas is caused by high-risk HPV, especially HPV16. Upon a general introduction, the author details the epidemiology data related to HNSCC. The next part of the module is dedicated to oropharyngeal cancer disease variants. In the next part, the author summarises the major changes in head and neck cancer staging.

In terms of the role of chemotherapy in locally advanced disease, the author underlines that cisplatin chemoradiotherapy remains the standard of care for locally advanced HNSCC. TPF is the preferred induction chemotherapy regimen. Sequential therapy is not superior to chemoradiotherapy alone.

Patients with HPV-positive oropharyngeal cancer constitute a separate prognostic and therapeutic cohort and are staged differently from HPV-negative ones. Cetuximab/radiotherapy is inferior to cisplatin/radiotherapy in terms of overall survival and progression-free survival in HPV-associated locally advanced oropharyngeal cancer. The new staging system for oropharyngeal cancer does not affect treatment decisions.

In the last part of the module, the author underlines that data support pembrolizumab plus/minus platinum-based chemotherapy as a new first-line standard-of-care for recurrent/metastatic HNSCC in patients with PD-L1 CPS≥1. However, moving to immunotherapy in the curative setting may increase cure rates. Several clinical studies are currently testing the incorporation of PD1 checkpoint inhibitors in cisplatin chemoradiotherapy regimens given as definitive or postoperative therapy. PD1 checkpoint inhibitors are being tested as a substitute to cisplatin in cisplatin unfit patients or good prognosis HPV-positive patients. The results from ongoing randomised clinical trials with PD1 checkpoint inhibitors are eagerly awaited.