58 year old female with SCC of supraglottic larynx, initially diagnosed as T2N0M0, received the following 1) Radiation in 2015 2) Local recurrence in 2022 needing salvage total laryngectomy + B/L LND, pT4pN0 3) Local recurrence vs new primary SCC in the pharyngeal wall, received concurrent cisplatin + RT in 2023 4) Local recurrence in the left neck muscle flap in 2024, bx proven SCC, started on pembrolizumab 5) Now with progressive disease on pembrolizumab, s/o 3 cycles What would be your next line of therapy? She has clearly progressed within 3 months of completing cisplatin based RT, so most likely chemo refractory. She has had 3 cycles of pembro, clearly progressing clinically and radiographically. I was thinking cetuximab monotherapy. Not sure of the benefit of adding chemo to cetuximab. Will obtain NGS.