{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:46:06Z","timestamp":1787161566823,"version":"build-2736575974"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T00:00:00Z","timestamp":1758240000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004334","name":"Merck","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004334","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2009\u2265\u200920 tumours, while 41% would consider it for CPS 1\u201319 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0332413","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T17:23:03Z","timestamp":1758302583000},"page":"e0332413","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["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"],"prefix":"10.1371","volume":"20","author":[{"given":"Florian","family":"Clatot","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Even","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amaury","family":"Daste","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Borel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00f4me","family":"Fayette","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7507-4386","authenticated-orcid":true,"given":"Myriam","family":"Chebbah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solenn","family":"Le Clanche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esma","family":"Saada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,9,19]]},"reference":[{"issue":"1","key":"pone.0332413.ref001","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1038\/s41572-020-00224-3","article-title":"Head and neck squamous cell carcinoma","volume":"6","author":"DE Johnson","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"pone.0332413.ref002","unstructured":"Global Center Observatory. 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