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Objectives: Given a lack of universally-accepted standard-of-care treatment for patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC), study objectives were to assess treatment utilization and survival outcomes for R/M HNSCC in the real-world setting., Materials and Methods: A multi-site retrospective chart review was conducted in Europe (Germany, United Kingdom, Italy, Spain), Asia Pacific (Australia, South Korea, Taiwan), and Latin/North America (Brazil and Canada) to identify patients who initiated first-line systemic therapy for R/M HNSCC between January 2011 and December 2013. Patients were followed through December 2015 to collect clinical characteristics, treatment and survival data., Results: Among 733 R/M HNSCC patients across 71 sites, median age was 60 years (inter-quartile range 54-67), 84% male, and 70% Eastern Cooperative Oncology Group performance status 0-1; 32% had oral cavity and 30% oropharyngeal cancers. The most common first-line regimen across all countries consisted of platinum-based combinations (73%), including platinum + 5-fluorouracil (5-FU) (26%), cetuximab + platinum ± 5-FU (22%), or taxane + platinum ± 5-FU (16%). However, use of different platinum-based combinations varied substantially; administration of cetuximab + platinum ± 5-FU was frequent in Italy (81%), Germany (46%) and Spain (38%), whereas use in other countries was limited. Median follow-up was 22.6 months (95% confidence interval [CI]: 21.5-24.6 months). Median real-world overall survival was only 8.0 months (95% CI: 7.0-8.0), with one-year survival reaching only 30.9% (95% CI: 27.5-34.3)., Conclusion: Systemic therapies used in clinical practice for patients with R/M HNSCC vary substantially across countries. Prognosis remains poor in this patient population, highlighting the need for newer, more efficacious treatments., Competing Interests: Declaration of Competing Interest Funding for this study was provided by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Diana Chirovsky, Seongjung Joo and Roshani Shah are employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA; Diana Chirovsky and Seongjung Joo additionally own stock options from Merck & Co., Inc., Kenilworth, NJ, USA. Hélène Kuyas, Valérie Auclair and Xavier Guillaume are employees of Kantar Health Division, which received funding to conduct and oversee the study. Viktor Grünwald reports honoraria from AstraZeneca, Bristol-Myers Squibb, Eisai, Ipsen, MSD, Merck Serono, Novartis, Pfizer and Roche, fees for advisory roles from AstraZeneca, Bristol-Myers Squibb, Ipsen, MSD, Merck Serono, Novartis, Pfizer and Roche, and research funding from AstraZeneca, Bristol-Myers Squibb, MSD, Novartis and Pfizer. Myung-Ju Ahn reports honoraria from Astra-Zeneca, MSD, Roche, BMS, Merck and Alphas Pharmaceutical. Gilberto Castro reports honoraria from MSD. Alfonso Berrocal reports honoraria from BMS, MSD, Roche, Novartis, Pierre Fabre, Merck-Pfizer, Sanofi and Incyte, fees for consultant or advisory roles from BMS, MSD, Roche, Novartis, Pierre Fabre, Merck-Pfizer, Sanofi and Incyte, and travel funding from BMS, MSD, Roche, Novartis, Pierre Fabre, Merck-Pfizer and Sanofi. Katrin Sjoquist reports honoraria from Pfizer, Merck and Amgen, and travel funding from Amgen and Ipsen. Kevin Harrington reports honoraria from AstraZeneca/MedImmune, Bristol-Myers Squibb, Merck- Serono, and Merck Sharp Dohme, fees for advisory roles from AstraZeneca/MedImmune, Boehringer-Ingelheim, Bristol-Myers Squibb, Merck- Serono, Merck Sharp Dohme and Pfizer, and research funding from AstraZeneca/MedImmune and Merck Sharp Dohme. The other authors declare no conflict of interest., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)