January 16, 2023

ASCO Releases New Guidelines for Immunotherapy and Biomarker Testing in Recurrent and Metastatic Head and Neck Cancers

Recommendations focus on selecting the right biomarkers for the right setting

Head and neck cancers

An estimated 66,470 people in the U.S. were diagnosed with head and neck squamous cell carcinoma (HNSCC) last year. These encompass a diverse and complex set of diseases that often are diagnosed at an advanced stage. Many HNSCC treatments can significantly impact a patient’s quality of life, causing issues with speech, taste, swallowing, lymphatic processes and more, making it all the more crucial to hone in on the right targeted therapy from the start. Clinicians often struggle with determining the optimal frontline treatment and choosing between immunotherapy and more systemic therapies in recurrent metastatic disease.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

With the emergence of immune-checkpoint inhibitors for use frontline treatment of head and neck cancers, biomarkers such as programmed death ligand-1 (PD-L1) and tumor mutation burden are increasingly important for treatment selection. To that end, ASCO convened a panel of medical, surgical and radiation oncologists as well as radiology, pathology and patient advocacy experts to create a single source of information for treating recurrent disease in different types of head and neck cancers. A patient representative also played a significant role in developing the recommendations, ensuring that the guidelines were practical and that the language was accessible to patients.

“We wanted to provide clearer guidelines to clinicians and patients for all range of head and neck cancers, including less common cancers such as nasopharyngeal carcinomas and salivary gland tumors,” says Emrullah Yilmaz, MD, PhD, expert panel co-chair and a hematologist/oncologist with Cleveland Clinic’s Taussig Cancer Institute. “Particularly for rare cancers, where there are not large sets of trial data, it can be tough to know which treatment approach to use.”

To produce the guidelines, the panel conducted an extensive review of 28 relevant phase 3 trials published between 2000-2022 to discern outcomes of interest, such as survival and overall response to treatment. “The most important takeaways from the new ASCO guidelines are to check the patient’s PD-L1 to help with the decision about whether to use a single agent or combination immunotherapy, with or without chemotherapy,” says Yilmaz.

Advertisement

Notable updates to the ASCO guidelines include the following recommendations:

  • Conduct PD-L1 immunohistochemistry testing for patients with recurrent or metastatic HNSCC.
  • Interpret PD-L1 combined positive score ≥ 1 as positive, which correlates with a clinical benefit of PD-1 inhibitors.
  • Consider tumor mutation burden testing for patients with recurrent or metastatic disease when CPS is not available the PD-L1 combined positive score is not available or in patients with rare tumors.
  • A tumor mutation burden of ≥ 10 should be interpreted as high, which correlates with a clinical benefit of PD-1 inhibitors.
  • Offer pembrolizumab monotherapy or pembrolizumab, platinum and fluorouracil as first-line treatment for patients with recurrent or metastatic HNSCC with a combined positive score of ≥ 1.
  • Consider pembrolizumab, platinum and fluorouracil as first-line treatment for patients with recurrent or metastatic HNSCC with a combined positive score of < 1.
  • Pembrolizumab or nivolumab should be offered to patients with platinum-refractory recurrent or metastatic HNSCC, regardless of CPS status.
  • Toripalimab, camrelizumab or tislelizumab, with gemcitabine and cisplatin, should be offered as first-line treatment for patients with recurrent or metastatic nasopharyngeal cancer.

The panel hopes that guidance for more specific treatments will result in higher success rates for patients. Dr. Yilmaz noted that there is more work to be done to continue to develop appropriate therapies. “Participation in ongoing clinical trials will help to further improve outcomes. There is much effort being undertaken by the National Cancer Institute to design trials that are easier for patients to participate in.”

Learn more in our recent podcast.

Advertisement

Related Articles

Doctor measuring patient's waist size
February 26, 2024
Impact of Obesity on GVHD & Transplant Outcomes in Hematologic Malignancies

Findings highlight an association between obesity and an increased incidence of moderate-severe disease

Physician with patient
February 21, 2024
Strategies for Improving Clinical Trial Equity

Cleveland Clinic Cancer Institute takes multi-faceted approach to increasing clinical trial access

How antibody drug conjugates work
February 13, 2024
Real-World Use of Trastuzumab Deruxtecan

Key learnings from DESTINY trials

24-CNR-4545611-CQD-Podcast-967&#215;544
February 1, 2024
Possibilities of CRISPR Technology (Podcast)

Gene editing technology offers promise for treating multiple myeloma and other hematologic malignancies, as well as solid tumors

Disparities in multiple myeloma
January 25, 2024
Major Study Identifies Global Disparities in Drug Toxicity for Multiple Myeloma Treatment

Study of 401,576 patients reveals differences in cancer burdens as well as overall survival

Dr. Shilpa Gupta
December 27, 2023
A New Standard Emerges in Advanced Urothelial Carcinoma After Decades of First-Line Chemotherapy

Enfortumab plus pembrolizumab reduced risk of death by 53% compared with platinum-based chemotherapy

23-CNR-4318382-CQD-Hero-650&#215;450 Dr Hill
December 19, 2023
Active Surveillance may be a Feasible Option for a Subset of Patients with Nodular Lymphocyte-Predominant Hodgkin Lymphoma

Large cohort study finds no reduction in survival for patients managed with active surveillance compared to treated patients

Dr. Caimi
December 15, 2023
CAR-T Cell Therapy Effective in Refractory Double-Hit/Triple-Hit Lymphoma

Two thirds of patients responded to CAR T-cell therapy

Ad