Cristina Valero

Presentation
Head and neck squamous cell carcinoma (HNSCC) remains a challenging disease due to its aggressive nature and relatively poor prognosis. Surgery is often the primary treatment for resectable tumors, frequently combined with radiotherapy and chemotherapy. However, despite advances in multimodal therapies, recurrence rates remain high. Recently, immunotherapy, particularly immune checkpoint inhibitors, has emerged as a promising treatment strategy for head and neck cancers.

The goal of neoadjuvant immunotherapy is to enhance the anti-tumor immune response early, potentially reducing tumor burden, improving surgical outcomes, and eliminating micrometastatic disease. Early-phase clinical trials investigating neoadjuvant immune checkpoint inhibitors such as anti-PD-1 or anti-PD-L1 antibodies have shown encouraging results in resectable HNSCC. These studies demonstrate increased immune cell infiltration in the tumor microenvironment, evidence of tumor regression, and in some cases, improved pathological response rates. Neoadjuvant immunotherapy may also help identify patients who are more likely to benefit from immunotherapy in the adjuvant setting.

Adjuvant immunotherapy is given often combined with radiotherapy or chemotherapy, to eradicate residual microscopic disease and prevent recurrence. For high-risk patients, this approach aims to improve long-term survival. Clinical trials are ongoing to evaluate the safety and efficacy of adjuvant checkpoint blockade in resected HNSCC. Preliminary data suggest that adjuvant immunotherapy is generally well tolerated and may improve disease-free survival, though definitive results from large randomized studies are awaited.

Despite promising advances, challenges remain in integrating immunotherapy into standard care for resectable head and neck cancer. Biomarkers to predict response, optimal timing and sequencing of immunotherapy with surgery and radiation, and management of immune-related adverse events require further investigation. Combining immunotherapy with other agents, such as targeted therapies or novel immune modulators, also represents a future direction to enhance therapeutic efficacy.

In conclusion, neoadjuvant and adjuvant immunotherapy offer new avenues to improve outcomes in patients with resectable head and neck cancer. Ongoing clinical trials and translational research will clarify their role and help optimize treatment strategies in this complex disease.

Bio
Cristina Valero Mayor, MD, PhD, MSc
Attending Physician and Associate Professor in Otorhinolaryngology and Head and Neck Surgery at Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona. PhD in Surgery and Master’s degree in Statistics in Health Sciences from Universitat Autònoma de Barcelona. Fellowship in Head and Neck Oncologic Surgery at Memorial Sloan Kettering Cancer Center, New York, NY, USA.