Dr. Hanna on the Role of Second-Line Cetuximab in Head and Neck Cancer

Glenn J. Hanna, MD, physician, director, Center for Salivary and Rare Head and Neck Cancers, Dana-Farber Cancer Institute, assistant professor of medicine, Harvard Medical School, discusses the role of second-line cetuximab (Erbitux) in head and neck cancer.

Currently, the first-line standard of care treatment for patients with head and neck cancer is single-agent pembrolizumab (Keytruda) for patients with PD-L1–positive disease (combined positive score ≥1) or chemoimmunotherapy for PD-L1 unselected patients, Hanna explains. However, questions remain regarding second-line therapy.

Ultimately, clinical trials should be considered in the second-line setting; however, single-agent cetuximab could be utilized, Hanna says. Additionally, clinical trials are evaluating combination regimens with cetuximab plus agents like CDK4/6 inhibitors. A phase 2 study (NCT03422536) is evaluating ficlatuzumab with or without cetuximab in cetuximab-resistant patients with recurrent or metastatic head and neck squamous cell carcinoma. The phase 3 INTERLINK-1 trial (NCT04590963) is currently enrolling patients with recurrent or metastatic head and neck cancer who will be randomized to receive monalizumab plus cetuximab vs placebo plus cetuximab.

Additionally, chemotherapy is a second-line treatment option for patients with head and neck cancer who developed primary resistance to immunotherapy and have rapidly progressing disease, Hanna says. Chemotherapy can provide disease control and symptom improvement but adding cetuximab to chemotherapy could provide a more aggressive second-line option for patients, Hanna concludes.