This consensus document is not a rigid constraint on clinical practice, but a concept of good practice against which the needs of the individual patient should be considered. It therefore remains the responsibility of the individual clinician to interpret the application of the Clinical Management Pathway (CMP), taking into account local service constraints and the needs and wishes of the patient. It is not intended that these consensus documents are applied as rigid clinical protocols.
SACT regimens for sinonasal undifferentiated carcinoma (SNUC), small cell, high grade olfactory estherioneuroblastoma or sinonasal neuroendocrine carcinoma (SNEC)
For squamous cell carcinoma (SCC) related head and neck cancer, refer to HNSCC SACT options
Cisplatin (or carboplatin) and Etoposide
Cisplatin 80mg/m2 IV Day 1 or Carboplatin AUC5 IV Day 1
Etoposide 100mg/m2/day IV Days 1-3
If oral administration assessed to be suitable: option to switch day 2 and 3 IV etoposide to PO etoposide 200mg/m2/day
Every 3 weeks, for 2-4 cycles
Refer to regional or local protocols for carboplatin prescribing advice
Cisplatin (or carboplatin) and Etoposide
Cisplatin 80mg/m2 IV Day 1 or Carboplatin AUC5 IV Day 1
Etoposide 100mg/m2/day IV Days 1-3
If oral administration assessed to be suitable: option to switch day 2 and 3 IV etoposide to PO etoposide 200mg/m2/day
Every 3 weeks, for 2-4 cycles
Refer to regional or local protocols for carboplatin prescribing advice
Cisplatin (or carboplatin) and Etoposide
Cisplatin 80mg/m2 IV Day 1 or Carboplatin AUC5 IV Day 1
Etoposide 100mg/m2/day IV Days 1-3
If oral administration assessed to be suitable: option to switch day 2 and 3 IV etoposide to PO etoposide 200mg/m2/day
Every 3 weeks, for 2-3cycles
Refer to regional or local protocols for carboplatin prescribing advice
Cisplatin
Cisplatin 100mg/m2 IV Week 1 and week 4 of Radiotherapy
For 2-3 cycles
(maximum dose of surface area (SA)=2.00/m2)
For patients receiving 7 weeks of radiotherapy, a third cycle can also be considered on week 7 (day 43)
Alternative regimen
Cisplatin 40mg/m2 IV Week 1 of radiotherapy then weekly during radiotherapy for 6-7 cycles
In cases of concern over renal/cardiac function or patient factors, switch Cisplatin to Carboplatin AUC5
Cisplatin (or carboplatin) and Etoposide
Cisplatin 80mg/m2 IV Day 1 or Carboplatin AUC5 IV Day 1
Etoposide 100mg/m2/day IV Days 1-3
If oral administration assessed to be suitable: option to switch day 2 and 3 IV etoposide to PO etoposide 200mg/m2/day
Every 3 weeks, for 4-8 cycles
Refer to regional or local protocols for carboplatin prescribing advice
For small cell pathology head and neck consider the suitability of treatment options from the lung clinic management pathway -extensive SCLC
Consider on an individual patient basis on whether it may be appropriate to make an unlicensed medicines.
Potential option: Atezolizumab in combination with carboplatin and etoposide followed by atezolizumab monotherapy
Atezolizumab 1875mg SC or 1200mg IV, Cisplatin 80mg/m2 IV Day 1 or Carboplatin AUC 5 IV Day 1
Etoposide 100mg/m2/day IV Days 1-3
If oral administration assessed to be suitable: option to switch day 2 and 3 IV etoposide to PO etoposide 200mg/m2/day
Every 3 weeks, for 4 cycles
Refer to regional or local protocols for carboplatin prescribing advice
Followed by
Atezolizumab :
1875mg SC every 21 days
or 840mg IV every 14 days
or 1200mg IV every 21 days
or 1680mg IV every 28 days
until progression or unacceptable toxicity
For small cell pathology head and neck consider the suitability of treatment options from the lung clinic management pathway -extensive SCLC
Consideration should be given on an individual patient basis on whether it may be appropriate to make an unlicensed medicines request for a patient
Carboplatin/Paclitaxel
Carboplatin AUC 5 IV D1
Paclitaxel 175mg/m2 IV D1
Every 21 days for 6 cycles
Refer to regional or local protocols for carboplatin prescribing advice
Paclitaxel
Paclitaxel 175mg/m2 IV Day 1
Every 21 days, for 4-6 cycles
Alternative regimen
Paclitaxel 80mg/m2, IV, Day 1
Every 7 days for 12-18 cycles
DocetaxelDocetaxel 75mg/m2 IV every 21 days for 6 cycles
Alternative regimen
Docetaxel 30mg/m2 IV every 7 days for 18 cycles
Links to Regional Guidance/Protocols where available (access to local intranet may be required):
(For Tayside protocols refer to Chemocare)
Scottish Cancer Network: Clinical Management Pathways