How do you approach patients with metastatic SCC of the larynx, PD-L1 <1, unable to tolerate 5-FU based chemotherapy due to grade 4 esophagitis/mucositis?

For patients with PD-L1 zero metastatic head and neck squamous cell cancers, standard of care is platinum/5-FU/Pembrolizumab for first-line management. The mucositis from 5-FU can be very difficult for patients to tolerate, so if dose reductions do not meaningfully allow for tolerability, I switch t...

Carbo-Taxol, Pembrolizumab (I tend to use even if PDL-1 <1%).

Can also use carbo-Taxol-Cetuximab.