A Trial of Nimotuzumab and Pinkiller Efficacy and Pain in Advanced Head and Neck Squamous Cell Carcinoma

Prior treatment

• Participation in another interventional clinical trial within 30 days prior to screening.
• Chronic steroid therapy (\>10 mg/day prednisone equivalent for \>6 months).

Other illness

• Uncontrolled comorbidities (e.g., heart failure, diabetes, hypertension, thyroid disorders, psychiatric diseases).
• Active HIV infection, viral hepatitis, or severe active infections (\>Grade 2 per CTCAE v5.0).
• Known hypersensitivity to any component of the study drugs.
  • ●≥Grade 2 peripheral neuropathy or hearing loss (per NCI CTCAE v5.0).

Lab values

• Received radiotherapy, chemotherapy, monoclonal antibody therapy, oral EGFR-TKI therapy, anti-angiogenic agents, or immunosuppressants within the past 6 months.

Age

• History of other malignancies (except cured cervical carcinoma in situ, basal cell carcinoma of the skin, or malignancies cured ≥5 years prior).

Other

• Presence of distant metastases.
• Pregnancy, lactation, or refusal to use effective contraception (for both male and female participants) until 6 months after the last treatment.
• Investigator judgment of unsuitability for the study.
• Unwillingness or inability to provide informed consent.

• Age 18-75 years, inclusive of 18 years but exclusive of 75 years.
• ECOG Performance Status (PS) score 0-2.
• Histologically or cytologically confirmed Stage III-IVb (according to the 2020 CSCO Guidelines for Diagnosis and Treatment of Head and Neck Tumors) squamous cell carcinoma of the head and neck (including oral, oropharyngeal, hypopharyngeal, and laryngeal cancers; excluding nasopharyngeal carcinoma).
• EGFR-positive expression confirmed by immunohistochemistry.
• Patients deemed ineligible for surgery (due to physical contraindications or refusal of surgery).
• At least one measurable lesion according to RECIST 1.1 criteria:
  • CT scan ≥10 mm (tumors not measurable by calipers should be recorded as non-measurable).
  • Chest X-ray ≥20 mm. Pathologically enlarged lymph nodes: short-axis ≥15 mm on CT scan (slice thickness ≤5 mm).
  • Suitable for comprehensive treatment with curative or palliative intent. ●Baseline pain assessment: Numeric Rating Scale (NRS) score ≥1. Patients not previously treated with opioids who are candidates for opioid therapy.
  • Patients on weak opioids with inadequate pain control requiring escalation to strong opioids.
  • Patients with moderate-to-severe cancer pain on strong opioids with inadequate control.
  • Patients requiring urgent intervention due to poorly controlled pain.
• Expected survival ≥3 months.
• Adequate hematologic function:
  • White blood cell count ≥4×10\^9/L. Absolute neutrophil count ≥1.5×10\^9/L. Platelets ≥100×10\^9/L. Hemoglobin ≥90 g/L.
  • ●Adequate renal function: Serum creatinine ≤1.2 mg/dL or creatinine clearance ≥60 mL/min.
  • ●Adequate hepatic function: Total bilirubin ≤1.5×ULN (≤3.0×ULN if liver metastases present). AST and ALT ≤2.5×ULN (≤5.0×ULN if liver metastases present).
• Negative urine pregnancy test for female patients of childbearing potential (excludes those with bilateral oophorectomy, hysterectomy, or postmenopausal status).
• Signed informed consent.