Improving the multidisciplinary therapeutic management of head and neck squamous cell carcinoma: Consensus statements from an Italian expert panel

Objective: The management of recurrent and/or metastatic (RM) head and neck squamous cell carcinoma (HNSCC) poses significant clinical challenges. This study aimed to develop expert consensus statements to improve the multidisciplinary management of RM HNSCC. Methods: A multidisciplinary team of 39 Italian experts, including medical oncologists, surgeons, radiation oncologists, radiologists, and pathologists, employed the Delphi method to achieve consensus on critical aspects of RM HNSCC management. Two rounds of surveys were conducted, focusing on five key areas: PD-L1 testing, treatment selection, treatment refinement, patient care, and special clinical scenarios. Results: Consensus was reached on 43 out of 45 statements (96 %). Key recommendations included mandatory PD-L1 testing for guiding treatment selection, the use of immunotherapy in patients with a combined positive score ≥ 1, and the importance of considering patient fitness, disease characteristics, and potential treatment toxicities in decision-making. The panel emphasized integrating supportive care early in the treatment pathway and highlighted the need for multidisciplinary decision-making in cases of oligometastatic disease. Treatment strategies should prioritize both locoregional control and systemic therapy based on tumor biology and patient-specific factors. Conclusions: These consensus statements provide guidance for optimizing the multidisciplinary management of RM HNSCC, emphasizing personalized treatment strategies, early supportive care, and the importance of clinical trials to address existing uncertainties.