PD-L1: programmed cell death ligand 1; CPS: combined positive score; ECOG: Eastern Cooperative Oncology Group.
* Systemic therapy may have been given with or without radiation therapy for initial management of locoregional disease.
¶ Progressive or recurrent disease within 6 months of receiving platinum-based chemotherapy with or without cetuximab.
Δ The benefit of pembrolizumab in patients with a CPS of less than 1 is limited. Patients who are not candidates for pembrolizumab may benefit from the addition of cetuximab to platinum-based chemotherapy. Platinum-based doublet chemotherapy alone may be preferred in patients with an impaired performance status.
◊ Options for single-agent therapy include:§ Eligibility for combination chemotherapy and/or immunotherapy is influenced by patient performance status, comorbidities, and prognostic factors. Combination chemotherapy is defined as doublet platinum-based chemotherapy.
¥ Alternatively, some UpToDate contributors substitute a taxane (paclitaxel or docetaxel) for the fluorouracil, based on better tolerability in other platinum-based combinations.
‡ We prefer pembrolizumab with chemotherapy for patients with a good performance status (eg, ECOG performance status ≤2). For others, we prefer single-agent pembrolizumab.