 Pemetrexed 500 mgm2 and gemcitabine 1250 mgm2 will be given together on Days 1 and 15 of a 28 day cycle in patients with recurrent or metastatic head and neck squamous cell carcinoma HNSCC. Patients will not have received more than 2 prior chemotherapy regimens in the recurrentmetastatic disease setting. Vitamin B12 and folate supplementation will be administered per standard guidelines for pemetrexed chemotherapy. 