What is your approach in deciding on definitive therapy for locally advanced, HPV-negative head and neck cancer unsuitable for standard cisplatin based chemo?
How do you decide on other chemo regimen? (Dosing, frequency, carboplatin based, non-platinum based etc.)
Would you use Cetuximab?
Altered fractionation RT with or without chemo?
Answer from: Radiation Oncologist at Academic Institution
The real answer is it depends on the medical oncologist as (s)he typically administers the therapy.It also depends on why cisplatin is contraindicated. Is it an otherwise healthy patient who has renal or hearing issues, or is it an elderly patient with a marginal PS for whom cytotoxics, in general, ...
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Answer from: Radiation Oncologist at Academic Institution
Agree with @Francis Worden. The choice, in this case, is between altered fractionation, a sensitizer that differs from cisplatin (assuming the pt cannot tolerate weekly low dose cisplatin), or a combination of both. For concurrent cetuximab, there is one randomized study demonstrating its benefit co...
Answer from: Radiation Oncologist at Academic Institution
Hyperfractionation and carboplatin
Answer from: Medical Oncologist at Academic Institution
I always try to give platinum, meaning that I would give Carboplatin (AUC 5-6) every 21 days during RT as long as the CrCl is > 30 cc/min. I think that alternatives with cetuximab and RT and altered fraction RT are also useful. In the adjuvant setting, I would consider weekly docetaxel and cetuxi...