The following is a summary of the paper: “Neoadjuvant immunotherapy is safe before surgery in head and neck squamous cell carcinoma: Is it time to challenge the standard-of-care?” by Gross, N. D., & Seiwert, T. Y. (2024), published in Cancer, explores the safety and potential benefits of using neoadjuvant immunotherapy in patients with resectable head and neck squamous cell carcinoma (HNSCC).

Head and neck squamous cell carcinoma (HNSCC) remains one of the most challenging cancers to treat, with the standard-of-care largely unchanged for decades, particularly for HPV-negative cases. However, a burgeoning field of research into neoadjuvant immunotherapy suggests a promising shift may be on the horizon.

Neoadjuvant immunotherapy, which involves the administration of immune checkpoint inhibitors before surgical intervention, is emerging as a potentially game-changing approach for patients with resectable HNSCC. This method is underpinned by a strong scientific rationale, suggesting that treating the cancer with immunotherapy before surgery could lead to disease downstaging, allowing for less extensive surgery and potentially improving patient outcomes.

A spotlight has recently been cast on this innovative treatment approach by a study conducted by Philips et al., as discussed in an editorial in the journal Cancer. The study compared outcomes between patients receiving neoadjuvant immunotherapy followed by surgery and those undergoing surgery alone. Interestingly, it found no significant increase in medical or surgical complications in patients treated with neoadjuvant immunotherapy, suggesting that this approach is generally well-tolerated.

Despite these encouraging results, the study also revealed some challenges. A small percentage of patients in the immunotherapy group experienced disease progression that precluded surgery or led to delays in surgical treatment. These findings underscore the need for further research to refine the use of neoadjuvant immunotherapy, balancing its potential benefits with the risks of disease progression.

The broader implications of incorporating neoadjuvant immunotherapy into the treatment landscape for HNSCC are profound. Given the stubbornly poor survival rates for HPV-negative HNSCC, the advent of immunotherapy offers a beacon of hope. Coupling immunotherapy with chemotherapy might increase response rates and further enhance patient outcomes, although this may also introduce increased toxicity.

As the field stands at the cusp of a paradigm shift, the call for randomized controlled trials has never been louder. The initiation of such studies will be crucial in determining the efficacy and safety of neoadjuvant immunotherapy, paving the way for it to become a new standard-of-care.

The journey of integrating neoadjuvant immunotherapy into the treatment of HNSCC is just beginning. With ongoing and future trials, there’s a hopeful promise that this approach could significantly improve the survival and quality of life for patients facing this challenging disease. As we move forward, a collective effort from the scientific and medical communities will be essential to harness the full potential of this innovative treatment paradigm, offering new hope to patients and potentially setting a new standard in cancer care.

Source: Gross, N. D., & Seiwert, T. Y. (2024). Neoadjuvant immunotherapy is safe before surgery in head and neck squamous cell carcinoma. Is it time to challenge the standard-of-care? Cancer, 130(6), 846-847. https://doi.org/10.1002/cncr.35198