OBJECTIVES: Given a lack of universally-accepted standard of care treatment for patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC), the objectives were to assess treatment utilization and survival outcomes for R/M HNSCC in the real-world setting.

METHODS: A multi-site retrospective chart review study was conducted in Europe (Germany, United Kingdom, Italy, Spain), Asia Pacific (Australia, South Korea, Taiwan), and Latin/North America (Brazil and Canada) to identify patients who initiated first line (1L) systemic therapy for the treatment of R/M HNSCC between January 1, 2011 and December 31, 2013. Patients were followed through December 31, 2015 to collect clinical characteristics, treatment and survival data.

RESULTS: Among 733 R/M HNSCC patients enrolled across 71 sites, median age was 65 years (interquartile range 59-72 years), 84% were male, and 71% had performance status 0-1; 32% had oral cavity cancer and 30% oropharyngeal cancer. The most common 1L regimen consisted of platinum-based combinations (78%) across all countries, including platinum+5-FU (26%), cetuximab+platinum±5-FU (22%), or taxane+platinum±5-FU (16%). However, use of different platinum-based combinations varied substantially across countries; administration of cetuximab+platinum±5-FU was frequent in Italy (81%), Germany (46%) and Spain (38%), whereas use in other countries was limited. Median overall survival was only 8.0 months (95% confidence interval 7-9 months), with one-year survival reaching only 31%. A total of 380 patients (52%) progressed on platinum-based therapy and received additional systemic therapy. Re-treatment with platinum-based combinations (46%) was common, and 38% received monotherapy primarily consisting of taxanes (17%), methotrexate (7%) or cetuximab (6%); utilization of monotherapies and re-treatment with platinum-based combinations differed greatly across countries.

CONCLUSIONS: Systemic therapies for patients with R/M HNSCC vary substantially across countries in routine clinical practice. Furthermore, prognosis in this patient population remains poor with limited therapeutic options, underscoring the need for newer, more efficacious treatments.