Standards for palliative systemic therapy in Germany – A survey of the DGHNO Oncology Working Group

Introduction Medical tumor therapy (MTT) of head and neck tumors (HNT) is gaining increasing importance. Since the last survey on medical tumor therapy (2013/14), new drugs have been approved for palliative systemic therapy of HNT. There is room for interpretation in the selection of systemic therapy. This survey aims to provide an overview of standards in MTT for head and neck tumors.

Methods From 10/22 to 07/23, an online survey (Limesurvey) was conducted by the Oncology Working Group of the German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO), targeting all 172 ENT clinics in Germany.

Results 51 out of 172 clinics participated in the survey. Palliative systemic therapy is offered in 49 of these clinics. The therapy is conducted by 19 ENT clinics, 5 maxillofacial surgery departments, 38 oncology clinics, and 26 oncology practices (multiple responses possible). The analysis of PD-L1 expression in the tumor was considered a standard by 37 participants. Only 8 out of 51 clinics use the Companion Diagnostic antibody for Pembrolizumab (22C3), while the majority use other diagnostic PD-L1 antibodies. For CPS<1, EXTREME (33/51) is mostly considered the standard, followed by TPEx (16/51). For patients with CPS 1-19, 33/51 prefer Pembrolizumab+PF, while 8/51 prefer Pembrolizumab monotherapy. For CPS>=20, the preference is reversed (Pembro Mono: 33/51; Pembro+Chemo: 8/51). The significance of other influencing factors (tumor burden, progression pressure, general condition, PD-L1, platinum pretreatment) is evaluated differently depending on the CPS group.

Conclusion Different antibodies are used to determine the PD-L1 status. There is a high level of homogeneity in the interpretation of standards in first-line therapy.

 

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Publication History

Article published online:
19 April 2024