OBJECTIVES

IO therapy has been listed in the National Cancer Center Network Guidelines as a category 1 treatment option for patients with SCCHN. The study objectives were to understand the SCCHN patient journey, patterns of treatment, timing of relapse and to evaluate changes in clinical practice that may have resulted from the increasing role of HPV in carcinogenesis and the availability of IO.

METHODS

A Delphi panel consisting of 10 US community medical oncologists representing broad geographic and practice settings with ≥5 SCCHN patients under active treatment was consulted to understand the SCCHN patient journey, disease etiology, treatment modalities, and diagnostics pre- and post-approval of IO.

RESULTS

Most SCCHN patients are referred to community medical oncologists by primary care physicians or surgeons; it was estimated that two-thirds of presenting patients are newly diagnosed and that one-third have relapsed. None of the participants routinely test, document, or alter treatment for suspected HPV etiology. HPV positivity is clinically suspected based on a limited smoking and alcohol consumption history, younger age, good performance status, and locally advanced disease. Concurrent platinum-based chemoradiotherapy is standard of care for most patients with <10% undergoing subsequent surgery. Ancillary services (dental work, central line placement, triple endoscopy, percutaneous endoscopic gastrostomy) do not impede chemotherapy initiation. Positron emission tomography (PET) is the standard for staging with restaging PET performed 3 months after last radiation dose. IO availability appears to have resulted in eliminating the need for a repeat PET at 6-months if a 3-month PET is positive allowing patients to initiate treatment earlier.

CONCLUSIONS

The increasing role of HPV in SCCHN has had minimal impact on treatment paradigms, whereas the availability of new treatment options, such as IO, has significantly altered the course of the SCCHN patient journey.