What is the recommended approach for systemic therapy for patients with locally recurrent p16-positive SCC of the oral cavity who are not candidates for resection or re-irradiation?

The recommended regimen would depend on the PD-L1 (CPS) score and would be guided by recent clinical trials, particularly KEYNOTE-048 and KEYNOTE-B10.

The KEYNOTE-048 trial has established pembrolizumab as a preferred first-line treatment option. While monotherapy for CPS-positive patients could be considered, the addition of platinum and 5-fluorouracil should be used if the patient is very symptomatic and is generally added if CPS is <20 (although this latter practice admittedly varies across in...

I agree. Checking the patient's tumor CPS is foremost. If >1% and with limited symptoms, treatment with single-agent pembrolizumab from the KEYNOTE-048 data is recommended. If however, the patient has symptoms, chemotherapy (platinum and a taxane) in combination with pembrolizumab, is warranted. Once maximal response is achieved, the chemotherapy should be dropped and the patient treated with maintenance pembrolizumab. Patients with a CPS >20% can attain very nice responses with single-agent pem...