Inclusion:

        * Histologically or cytologically confirmed diagnosis of recurrent or second primary
        squamous cell carcinoma (SCC) of the head and neck, including any of the following:

          -  Oral cavity

          -  Oropharynx

          -  Hypopharynx

          -  Larynx

          -  Recurrent neck metastases with unknown primary

        Exception from pathology confirmation of tumor recurrence is accepted for patients who
        originally had pathologically confirmed SCC of the Head and Neck, the new tumor is located
        in the head and neck area and it is clinically considered as a recurrence of the original
        tumor, and a tumor biopsy is technically difficult and would expose the patient to
        unjustified risk. The treating physicians should agree and document the clinical definition
        of tumor recurrence and should document the increased risk for biopsy.

          -  Measurable disease by CT scan or MRI OR evaluable disease

          -  No definitive evidence of distant metastasis

          -  Unresectable disease by a preliminary ENT evaluation OR refused surgery

          -  Patients may have received chemotherapy as a component of their primary tumor
             treatment but not for recurrent or metastatic disease. No prior treatment with
             systemic anti-EGFR inhibitors or Pemetrexed is permitted

          -  Has undergone prior head and neck radiotherapy (for SCC of the head and neck) to a
             dose of ≤ 72 Gy that involved most of the recurrent tumor (> 75%) OR has a second
             primary tumor volume in areas previously irradiated to > 45 Gy

          -  The entire tumor volume must be included in a treatment field that limits the total
             spinal cord dose to 54 Gy (prior plus planned dose)

          -  Must have disease recurrence or persistence for ≥ 6 months after completion of prior
             radiotherapy

          -  ECOG performance status 0-1

          -  Age ≥ 18 years

          -  ANC > 1,500/µL

          -  Platelet count > 100,000/µL

          -  Total bilirubin < 1.5 times upper limit of normal (ULN)

          -  AST/ALT < 2 times ULN

          -  Creatinine < 1.5 times ULN

          -  Willing and able to take folic acid and vitamin B12 supplementation

          -  Recovered from prior surgery, chemotherapy, or radiotherapy

          -  At least 6 months since prior radiotherapy

          -  At least 5 days since prior aspirin or other non-steroidal anti-inflammatory agents (8
             days for long acting agents [e.g., piroxicam])

          -  Fertile patients must use effective contraception

        Exclusion:

          -  Nasopharyngeal carcinoma

          -  Concurrent uncontrolled illness, including, but not limited to, any of the following:

               -  Ongoing or active infection

               -  Psychiatric illness or social situation that would limit compliance with study
                  requirements

               -  Significant history of uncontrolled cardiac disease (i.e., uncontrolled
                  hypertension; unstable angina; recent myocardial infarction [within the past 3
                  months]; uncontrolled congestive heart failure; or cardiomyopathy with decreased
                  ejection fraction)

          -  Active interstitial lung disease

          -  Presence of third space fluid that cannot be controlled by drainage

          -  Other concurrent investigational agents

          -  Pregnant or nursing

          -  HIV positive