Management of oral cancer
- surgical management of the neck to should be offered all people with early oral cavity cancer (T1-T2, N0)
- sentinel lymph node biopsy instead of elective neck dissection should be offered to people with early oral cavity cancer (T1-T2, N0), unless they need cervical access at the same time (for example, free-flap reconstruction).
Patients with distant metastases should be treated with targeted therapy if amenable, and chemotherapy if not amenable to targeted therapy.
Consideration should be given to combination therapy of immunotherapy plus platinum-based chemotherapy in the setting of metastatic head and neck cancer, as this has been shown to provide a survival benefit. (2)
Cetuximab - an epidermal growth factor receptor inhibitor - in combination with platinum-based chemotherapy is recommended as an option for treating recurrent or metastatic squamous cell cancer of the head and neck in adult, and may be combined with radiotherapy. (3)
Additionally, monoclonal antibodies such as pembrolizumab target specific genetic receptors on tumour cells.
NICE recommends nivolumab as an option for treating recurrent or metastatic squamous cell carcinoma of the head and neck in patients in whom disease has progressed within 6 months of receiving platinum‑based chemotherapy. (4)
Reference
- NICE. Cancer of the upper aerodigestive tract: assessment and management in people aged 16 or over. NICE guideline NG36. Published February 2016, last updated June 2018
- Xu Q, Huang S, Yang K. Combination immunochemotherapy for recurrent or metastatic head and neck squamous cell carcinoma: a systematic review and meta-analysis. BMJ Open. 2023 Jun 13;13(6):e069047.
- National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: head and neck cancers [internet publication].
- National Institute for Health and Care Excellence. Nivolumab for treating recurrent or metastatic squamous cell carcinoma of the head and neck after platinum-based chemotherapy. Oct 2021 [internet publication].
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