What is your approach in deciding on definitive therapy for locally advanced, HPV-negative head and neck cancer unsuitable for standard cisplatin based chemo?

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, ...

Agree with @Dr. First Last. 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...

Hyperfractionation and carboplatin

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 cetuximab...