Do you always use platinum/5-FU as the chemo backbone with pembrolizumab for recurrent/metastatic H&N cancer?

I prefer to use carbo/taxol with pembrolizumab as well but there is no data to support this and I am having a hard time getting insurance providers to approve. It would be amazing if we can use Mednet platform to create guidelines that might help this cause.

Also, I tend to do chemo+pembro for all patients with heavy disease, irrespective of PD-L1, as long as good PS. For those with minimal disease and high CPS score, I tend to do pembro alone more often.

I prefer carbo-paclitaxel-pembrolizumab not only because I believe it is better tolerated but also is easier for the patient (all given on day 1); however, I have encountered some payor issues with it

I generally use chemotherapy plus pembrolizumab when patients have a significant burden of disease and who may derive greater symptom benefit from a greater response rate. KEYNOTE-048 used platinum/5-FU as the backbone, though I have found anecdotally that the 5-FU can be hard to tolerate and logistically and psychologically difficult for patients to deal with a pump for several days.

It is interesting to note that pembrolizumab alone has an overall survival benefit compared to EXTREME for patie...