With the current cisplatin and carboplatin shortages, for HPV+ H&N patients with indications for concurrent chemoRT, which agent do you recommend next?

The question of 2nd line therapy is difficult due to the dearth of data.

This leaves essentially 3 choices - immunotherapy, cetuximab, or other cytotoxic agents.

Regarding immunotherapy, recent trials for concurrent IO have been mixed, tending to compare IO vs Cetux. The main take-home though, is the lack of superiority of IO for survival.

We know that while cetux is an option, it is inferior to cis (1016). OTOH, there is an RCT that shows cetux + RT is better than RT alone. In that CRT, altered fx was an option, and in an analysis that did not have a lot of strength, it was suggested that patients did better with the altered fx. As such, even though RTOG 0129 was negative for 6 vs 7 weeks with cis, the 6-week arm was chosen for 1016. While I...

Altered fractionation, preferably hyper fractionation, and a taxane. If hyper fractionation is not an option, 6-week SIB.

I assume the question is what to use for first line where platinum (cisplatin or carbo/taxol) is indicated for concurrent therapy but unable to access cisplatin or carboplatin due to the national shortage. Unfortunately, this is a real and increasing problem.

If that is the case, I would consider docetaxel 15 mg/m2 weekly with concurrent radiotherapy (Patil et al., PMID 36706347) for first line use.