EXTREME (cetuximab + cisplatin/carboplatin + 5-FU; HNSCC R/M, 1L)
Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.
Knowledge-base record for audit. Provisional clinical content: this is not a prescription. An oncologist must verify original sources, applicability and review status. Full rules and constraints are in the YAML.
| Components | DRUG-CETUXIMAB DRUG-CISPLATIN DRUG-CARBOPLATIN DRUG-5-FLUOROURACIL |
|---|
| ID | REG-EXTREME-HNSCC |
|---|---|
| Type | Regimen |
| Status | reviewed 2026-04-30 | pending_clinical_signoff |
| Diseases | None declared |
| Sources | SRC-ESMO-HNSCC-2020 SRC-EXTREME-VERMORKEN-2008 SRC-NCCN-HNSCC-2025 |
Notes
EXTREME (Vermorken NEJM 2008): cetuximab + platinum + 5-FU vs platinum + 5-FU alone in 1L R/M SCCHN. Median OS 10.1 vs 7.4 mo (HR 0.80); ORR 36% vs 20%. Standard 1L for R/M SCCHN before KEYNOTE-048 (2019). Now positioned as preferred 1L for: (1) PD-L1 CPS <1 (where pembro-chemo benefit is attenuated — KEYNOTE-048 CPS<1 subgroup HR for OS crossed 1.0); (2) IO-contraindicated patients (autoimmune disease, prior SOT, severe interstitial lung disease). Also serves as IO-fallback after IO failure or rapid progression. Cisplatin preferred over carboplatin when feasible. 5-FU CIVI is resource-intensive (PICC line, ambulatory pump); modified TPF and cisplatin + cetuximab + paclitaxel are alternatives in some centers.
Used By
Algorithms
ALGO-LARYNGEAL-1L- ALGO-LARYNGEAL-1L
Indication
IND-HNSCC-RM-1L-EXTREME- IND-HNSCC-RM-1L-EXTREMEIND-LARYNGEAL-RM-1L-EXTREME- IND-LARYNGEAL-RM-1L-EXTREME