Head and Neck SACT Regimens

The information contained in these regimens is a statement of consensus of NCCP and ISMO or IHS professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The treatment regimen to be used should take into account factors such as histology, molecular pathology, age, performance status, co-morbidities and the patient’s preference. Each treatment regimen has advantages and disadvantages, and there may be more than one good option. In addition, treatment choices can change over time as more evidence becomes available.The use of these documents is the responsibility of the prescribing clinician and is subject to the HSE.ie terms of use.

Please email any comments or feedback on these regimens to oncologydrugs@cancercontrol.ie

For information on open clinical trials please refer to the Cancer Trials Ireland website here and also to basket trials here.

Head and Neck Chemotherapy protocols


Regimen Name	Indication
CARBOplatin AUC (1.5) Chemoradiation Therapy-7 days Regimen	00332a* Chemoradiation commencing 3 to 8 weeks after the completion of induction chemotherapy with TPF in patients with Stage III or IV locally advanced squamous cell carcinoma (SCC) of the head and neck.
CARBOplatin (AUC2) Weekly with Radiotherapy (RT) Regimen	00419a Chemoradiation treatment of stage III and IV locally advanced nasopharyngeal carcinoma in patients where CISplatin is contraindicated or not tolerated.
CARBOplatin AUC 4 and 5-Fluorouracil 600mg/m2 with Radiotherapy Regimen	00591a Locally Advanced Squamous Cell Carcinoma of the Head and Neck
CARBOplatin (AUC 5) and 5-Fluorouracil 1000mg/m²/day Therapy – 28 day cycle* Regimen	00552a Adjuvant chemotherapy following chemoradiation treatment in patients with locally advanced stage III or IV nasopharyngeal carcinoma where CISplatin is contraindicated or not tolerated
CARBOplatin 70mg/m2 and 5-Fluorouracil 600mg/m2 with Radiotherapy Regimen	00589a Locally Advanced Squamous Cell Carcinoma of the Head and Neck.
CARBOplatin (AUC4-6) Monotherapy-21 days Regimen	00261 Chemoradiation treatment for locally advanced (stage III to IV) squamous cell carcinoma (SCC) of the head and neck, where treatment with CISplatin is not appropriate (AUC 5)
Cetuximab Therapy- 7 days Regimen	00207b Treatment of patients with squamous cell cancer of the head and neck: In combination with radiation therapy for locally advanced disease.
Cetuximab (weekly), Carboplatin AUC 5 and 5-FU 1000mg/m²/day Therapy - 21 day cycle Regimen	00418a Locally advanced or metastatic squamous cell head and neck cancer where CISplatin is contraindicated or not tolerated
Cetuximab (weekly), CISplatin 100mg/m² and 5-Fluorouracil 1000mg/m²/day Therapy-21 day cycle Regimen	00417a Locally advanced or metastatic squamous cell carcinoma of the head and neck
CISplatin 40mg/m² Weekly with Radiotherapy (RT) Regimen	00385c Chemoradiation treatment for locally advanced nasopharyngeal carcinoma. 00385d Chemoradiation treatment for locally advanced unresectable head and neck squamous carcinoma (SCC) in patients who cannot tolerate three weekly CISplatin regimens.
CISplatin 100mg/m²with Radiotherapy (RT) Regimen	00387a Chemoradiation treatment for locally advanced (stage III to IV) squamous cell carcinoma (SCC) of the head and neck.
CISplatin and 5-Fluorouracil Therapy-28 day cycle Regimen	00314a Locally advanced or metastatic head and neck cancer.
CYCLOPHOSPHamide, DOXOrubicin and CISplatin Therapy – 21 Day Regimen	00615a Treatment of advanced salivary gland cancer.
DOCEtaxel CISplatin 5-Fluorouracil and Chemoradiation and Surgery –Neoadjuvant (TCF) Regimen	00315a Induction treatment of patients with Stage III or IV non-metastatic squamous cell carcinoma of the head and neck.
DOCEtaxel,CISplatin ,5-Fluorouracil and Chemoradiation Therapy Regimen	00323a Induction treatment of patients with locally advanced Stage III or IV non-metastatic squamous cell carcinoma of the head and neck.
DOCEtaxel CISplatin 5-Fluorouracil and Radiotherapy Regimen	00324a Induction treatment followed by radiotherapy of patients with Stage III or IV non-metastatic squamous cell carcinoma of the head and neck.
Gemcitabine (1250mg/m²) Monotherapy -21 day Regimen	00514a Loco-regionally recurrent/metastatic nasopharyngeal cancer not amenable for local curative therapy.
Gemcitabine (1250mg/m²) and CISplatin (80mg/m2) Therapy-21 day Regimen	00517a Treatment of locally advanced nasopharyngeal cancer
Lenvatinib (Lenvima)_DTC Therapy Regimen	00295a Treatment of adult patients with progressive, locally advanced or metastatic, differentiated (papillary/follicular/Hürthle cell) thyroid carcinoma (DTC), refractory to radioactive iodine.
Nivolumab 240mg Monotherapy - 14 Day Regimen	00483d As monotherapy for the treatment of squamous cell cancer of the head and neck in adults progressing on or after platinum-based therapy.
Nivolumab 480mg Monotherapy - 28 Day Regimen	00484e As monotherapy for the treatment of squamous cell cancer of the head and neck in adults progressing on or after platinum-based therapy.
Pembrolizumab 200mg Monotherapy Regimen	00455h As monotherapy for the first-line treatment of metastatic or unresectable recurrent head and neck squamous cell carcinoma (HNSCC) in adults whose tumours express PD-L1 with a CPS ≥ 1.
Pembrolizumab 400mg Monotherapy Regimen	00558h As monotherapy for the first-line treatment of metastatic or unresectable recurrent head and neck squamous cell carcinoma (HNSCC) in adults whose tumours express PD-L1 with a CPS ≥ 1
Pembrolizumab, CARBOplatin (AUC5) and 5-Fluorouracil Therapy Regimen	00705a Pembrolizumab is indicated, in combination with CARBOplatin and 5-fluorouracil, for the first-line treatment of metastatic or unresectable recurrent head and neck squamous cell carcinoma (HNSCC) in adults whose tumours express PD-L1 with a CPS ≥ 1.
Pembrolizumab, CISplatin and 5-Fluorouracil Therapy Regimen	00706a Pembrolizumab is indicated, in combination with CISplatin and 5-fluorouracil, for the first-line treatment of metastatic or unresectable recurrent head and neck squamous cell carcinoma (HNSCC) in adults whose tumours express PD-L1 with a CPS ≥ 1.
SORAfenib Therapy Regimen	00294c Treatment of patients with progressive, locally advanced or metastatic differentiated (papillary/follicular/Hürthle cell) thyroid carcinoma, refractory to radioactive iodine.
Vandetanib Monotherapy Regimen	00242a Treatment of aggressive and symptomatic MTC in patients with unresectable locally advanced or metastatic disease

* Unlicensed indication. See protocol for more details.