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. 2025 Sep 19;20(9):e0332413.
doi: 10.1371/journal.pone.0332413. eCollection 2025.

Defining a need for rapid response and practical guidance for recurrent and metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) management in France: A Delphi consensus

Florian Clatot  1 , Caroline Even  2 , Amaury Daste  3 , Christian Borel  4 , Jérôme Fayette  5 , Myriam Chebbah  6 , Solenn Le Clanche  6 , Esma Saada  7   8
Affiliations

Defining a need for rapid response and practical guidance for recurrent and metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) management in France: A Delphi consensus

Florian Clatot et al. PLoS One. .

Erratum in

Abstract

Background: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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Conflict of interest statement

Florian CLATOT has received payments or honoraria for lectures, presentations, speaker bureau activities, manuscript writing, or educational events, as well as support for attending meetings and/or travel from Merck and MSD. Caroline EVEN has received support for attending meetings and/or travel from Merck Serrono and MSD. Amaury DASTE has received consulting fees from Merck, MSD, BMS, Merus and has received support for attending meetings and/or travel from Merck and MSD. Christian BOREL has received consulting fees from PHE, MSD, Merck KGaA, has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from MSD and Merck KGaA and received support for attending meetings and/or travel from MSD and Merck KGaA. Jérôme FAYETTE has received consulting fees from AstraZeneca, Hookipa, Innate pharma, Merck Serrono, MSD, Pfizer, Roche. Esma SAADA received grants from Merck Serrono and Astrazeneca, consulting fees from MSD, BMS, Lilly, Merck Serrono, payments or honoraria for lectures, presentations, speaker bureau activities, manuscript writing, or educational events from Merck Serrono and has received support for attending meetings and/or travel from Merck Serrono, MSD and Novartis. Myriam CHEBBAH and Solenn LE CLANCHE have no conflicts of interests to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Respondent characteristics.
A. Sample size including targeted experts and respondents in the first and second rounds. B. Geographic distribution of respondents.
Fig 2
Fig 2. Systematic discussion of the use of a combination of cetuximab with mono- or polychemotherapy as a first-line treatment for patients requiring a rapid response according to the tumour CPS.
A. Tumours with a CPS between 1 and 19; B. Tumours with a CPS ≥ 20. “For a patient with R/M HNSCC requiring a rapid response, the combination of cetuximab with mono- or polychemotherapy is a therapeutic option that should be systematically considered as a first-line treatment for a CPS score between 1 and 19 for A/ ≥20 for B. Do you: Fully agree/Rather agree/Stay Neutral/Rather disagree/Fully disagree with this statement?”.
Fig 3
Fig 3. Use of immunotherapy in the first line (alone or in combination with chemotherapy) according to the tumour’s CPS.
A. Tumours with a CPS ≥ 20; B. Tumours with a CPS between 1 and 19. “A CPS score ≥ 20 for A/ CPS score between 1 and 19 for B in a given patient’s tumor systematically leads to the prescription of immunotherapy (alone or in combination with chemotherapy) as a first-line treatment, regardless of the patient’s clinical situation (except in cases of contraindication to immunotherapy). Do you: Fully agree/Rather agree/Stay Neutral/Rather disagree/Fully disagree with this statement?”.
Fig 4
Fig 4. Use of immunotherapy alone for elderly persons (>75 years old).
“First-line immunotherapy alone should be preferred for elderly patients. Do you: Fully agree/Rather agree/Stay Neutral/Rather disagree/Fully disagree with this statement?”.
Fig 5
Fig 5. Consensus on the therapeutic sequence in managing R/M SCCHN.
A. First-line treatment choice should not hinder second-line options; B. Therapeutic management should follow the best therapeutic sequence; C. Patients should receive immunotherapy, cetuximab, taxanes, and platinum salts within the first two treatment lines; D. Cetuximab and taxanes should be considered as second-line treatment after progression with immunotherapy and chemotherapy; E. The combination of cetuximab and chemotherapy should be considered after progression with immunotherapy alone; F. Immunotherapy should be considered after progression with cetuximab and chemotherapy, even if CPS < 1. “Do you: Fully agree/Rather agree/Stay Neutral/Rather disagree/Fully disagree with A, B, C, D, E, F statements?”.
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