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12 standard-of-care settings across 7 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Line | All comers | HPV |
|---|---|---|
| Screening, prevention and diagnosis | 1 | · |
| Early / localised | 2 | 1 |
| Locally advanced | 2 | · |
| Advanced, first line | 3 | · |
| Second line | 1 | · |
| Special situations | 1 | · |
| Other settings | 1 | · |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Prevention | HPV vaccination (also prevents oropharyngeal cancer in men), tobacco and alcohol cessation; no validated screening. | NCCN · Prevention guideline | 90 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Resectable | Neoadjuvant + adjuvant pembrolizumab with surgery; or chemoradiation. | NCCN Guidelines: Head and Neck Cancers | 98 | |
| All comers | Early stage (I-II) oral cavity and larynx | Single-modality surgery or radiation; sentinel node or elective neck dissection for oral cavity; larynx preservation with radiation for T1-T2 glottic cancer. | NCCN · 2A | 93 | |
| HPV | Early HPV-positive oropharynx | TORS with pathology-guided adjuvant therapy or definitive (chemo)radiation; standard 70 Gy dose because de-escalation trials failed. | NCCN · 2A | 74 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Locally advanced, resectable (stage III-IVA) | Neoadjuvant pembrolizumab, surgery, adjuvant pembrolizumab with (chemo)radiation for PD-L1 CPS ≥1 (KEYNOTE-689); otherwise surgery then risk-adapted (chemo)radiation. | NCCN · 1 (CPS ≥1)ESMO-MCBS · A | 98 | |
| All comers | Locally advanced, unresectable or organ preservation | Cisplatin (100 mg/m² q3w or weekly) with 70 Gy IMRT; cetuximab-radiation only if cisplatin-ineligible; concurrent immunotherapy is not indicated (JAVELIN Head and Neck 100, KEYNOTE-412) and adding xevinapant to chemoradiation gave no benefit (TrilynX). | NCCN · 1 | 93 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Recurrent/metastatic | Pembrolizumab ± platinum/5-FU; cetuximab-based; photoimmunotherapy (Japan). | ESMO-MCBS · 2 (cetuximab sarotalocan, Japan, single-arm) | 98 | |
| All comers | Recurrent or metastatic, first line | Pembrolizumab alone (CPS ≥20, or ≥1) or with platinum/5-FU (any CPS); EXTREME if immunotherapy contraindicated. | NCCN · 1ESMO-MCBS · 4 | 98 | |
| All comers | Recurrent or metastatic, after platinum | Nivolumab or pembrolizumab if immunotherapy-naive; otherwise cetuximab, taxane, or methotrexate; clinical trials (bispecifics, ADCs). | NCCN · 1 (IO-naive) | 98 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Locally recurrent, unresectable (Japan) | Cetuximab sarotalocan photoimmunotherapy; re-irradiation (proton or IMRT) in selected patients elsewhere. | 77 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Survivorship | Swallowing and speech therapy, dental care after radiation, thyroid monitoring, lymphoedema management, smoking cessation; second primary surveillance. | - |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Nasopharyngeal carcinoma | Induction gemcitabine-cisplatin then chemoradiation for locoregional disease; toripalimab (or other PD-1) + gemcitabine-cisplatin for recurrent/metastatic; plasma EBV DNA for surveillance. | NCCN · 1 | 93 |
In head and neck cancer, immunotherapy works when given before surgery but not when given alongside chemoradiation.
Being HPV-positive is not enough to justify less radiation; trials that tried it saw more relapses.
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.