Treatment Considerations for Patients with Locoregionally Advanced Head and Neck Cancer with a Contraindication to Cisplatin

Opinion statementSignificant advancements have been made in the treatment of locally advanced head and neck cancer, predominantly driven by the integration of concurrent chemotherapy with radiation therapy as a standard of care for many patients. The most heavily investigated chemotherapeutic is cisplatin, yet many patients are ineligible for cisplatin due to the presence of pre-existing medical comorbidities. Moreover, given the toxicity profile of cisplatin, identifying which patients stand to benefit from cisplatin is challenging, which is particularly evident in older patients. Efforts to better risk-stratify patients based on age, performance status, and the degree of pre-existing comorbidities are ongoing and have been increasingly utilized in national clinical trials. In parallel, exploration into alternative systemic agents, including novel targeted therapies and immunotherapies, in cisplatin-ineligible patients are rapidly expanding. Cumulatively, identifying appropriate treatment paradigms in patients who harbor contraindications to cisplatin can not only improve clinical outcomes but also critically mitigate detrimental adverse effects.

Automated summary

Significant advancements have been made in the treatment of locally advanced head and neck cancer, particularly with the integration of concurrent chemotherapy and radiation therapy. Cisplatin, the most studied chemotherapeutic, may not be suitable due to pre-existing medical comorbidities and its toxicity. Efforts are being made to identify high-risk patients and explore alternative systemic agents such as targeted therapies and immunotherapies for cisplatin-ineligible patients, with the aim of improving outcomes and reducing adverse effects.