Clatot Florian, Even Caroline, Daste Amaury, Borel Christian, Fayette Jérôme, Chebbah Myriam, Le Clanche Solenn, Saada Esma
Centre Henri-Becquerel, Rouen, France.
Gustave Roussy, Villejuif, France.
PLoS One. 2025 Sep 19;20(9):e0332413. doi: 10.1371/journal.pone.0332413. eCollection 2025.
Recurrent and metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) presents substantial treatment challenges due to its aggressive and heterogeneous nature. While evidence-based guidelines provide useful recommendations, they may not offer sufficient support for real-time clinical decision-making.
This Delphi consensus aimed to establish expert agreement on clinical parameters guiding first- and second-line treatment decisions and the management of specific clinical scenarios in R/M SCCHN in France.
A two-round Delphi consensus was conducted between December 2023 and June 2024. A scientific committee of six national experts developed consensus statements based on a literature review and supervised the process. An expert panel of 25 oncologists from across France participated in both rounds.
All respondents agreed that the need for a rapid therapeutic response and the presence of comorbidities were critical factors influencing first-line treatment choice. Seven major indicators of rapid response were identified: rapidly progressive relapse, partial airway obstruction, respiratory compromise, tumour-related bleeding, uncontrolled symptoms, carotid axis lesions, and pain resistant to third-step analgesics. For patients requiring rapid response, 76% supported using cetuximab with chemotherapy as a first-line option in cases with a combined positive score (CPS) between 1 and 19. Furthermore, 84% recommended immunotherapy (alone or combined with chemotherapy) as first-line treatment for CPS ≥ 20 tumours, while 41% would consider it for CPS 1-19 cases. A strong consensus (80%) held that first-line treatment should not restrict second-line options. Notably, 100% of respondents agreed that all patients should receive immunotherapy, cetuximab, taxanes, and platinum salts within the first two treatment lines.
This Delphi consensus offers valuable, expert-based perspectives on the management of R/M SCCHN in France. It highlights a progressive shift from standardized European guideline frameworks toward a more personalized approach that accounts for individual patient profiles and tumour characteristics. The insights generated provide practical guidance for clinical decision-making and lay the groundwork for future research and optimisation of treatment strategies in real-world settings.
头颈部复发性和转移性鳞状细胞癌（R/M SCCHN）因其侵袭性和异质性，在治疗上面临重大挑战。尽管循证指南提供了有用的建议，但可能无法为实时临床决策提供充分支持。
本德尔菲共识旨在就指导法国R/M SCCHN一线和二线治疗决策以及特定临床情况管理的临床参数达成专家共识。
于2023年12月至2024年6月进行了两轮德尔菲共识。一个由六名国家专家组成的科学委员会在文献综述的基础上制定了共识声明，并监督该过程。来自法国各地的25名肿瘤学家组成的专家小组参与了两轮。
所有受访者一致认为，快速治疗反应的需求和合并症的存在是影响一线治疗选择的关键因素。确定了七个快速反应的主要指标：快速进展性复发、部分气道阻塞、呼吸功能不全、肿瘤相关出血、症状控制不佳、颈动脉轴病变以及对第三步镇痛药耐药的疼痛。对于需要快速反应的患者，76%的人支持在综合阳性评分（CPS）为1至19的情况下，将西妥昔单抗联合化疗作为一线选择。此外，84%的人推荐免疫治疗（单独或联合化疗）作为CPS≥20肿瘤的一线治疗，而41%的人会考虑将其用于CPS为1 - 19的病例。强烈共识（80%）认为一线治疗不应限制二线选择。值得注意的是，100%的受访者同意所有患者在前两条治疗线内应接受免疫治疗、西妥昔单抗、紫杉烷类和铂盐。
本德尔菲共识为法国R/M SCCHN的管理提供了基于专家的宝贵观点。它突出了从标准化的欧洲指南框架向更个性化方法的逐步转变，该方法考虑了个体患者概况和肿瘤特征。所产生的见解为临床决策提供了实用指导，并为未来在现实环境中研究和优化治疗策略奠定了基础。
