Lisa Licitra

Presentation
The field of immunotherapy in head and neck squamous cell carcinoma has rapidly evolved over the last decade, reshaping the therapeutic landscape and opening new opportunities for integration across disease stages. The three presentations in this session – focused on advances in immunotherapy, perioperative strategies, and optimal combination with radiotherapy – highlight both the promise and the complexity of this rapidly expanding field. From a medical oncologist’s perspective, several key considerations emerge.
First, the consolidation of immune checkpoint inhibitors (ICIs) as the standard of care in recurrent/metastatic disease provides the foundation for their exploration in earlier settings. Durable responses in a subset of patients confirm the long-term benefit potential, yet the limited proportion of responders underscores the urgent need for predictive biomarkers and rational treatment sequencing. Advances in understanding tumor microenvironment heterogeneity, and immune escape are central to tailoring immunotherapy strategies.
Second, the perioperative setting is particularly compelling. Neoadjuvant immunotherapy offers the possibility of early eradication of micrometastatic disease, immune priming, and potentially improved long-term survival. Conversely, adjuvant immunotherapy may consolidate surgical outcomes and reduce recurrence risk. Recent studies have shown feasibility, immune activation, and encouraging pathological responses, but optimal design – choice of agent, treatment duration, and integration with standard surgery and postoperative radiotherapy – remains under investigation. Medical oncologists must weigh these approaches in terms of efficacy, safety, patient selection, and impact on multidisciplinary care pathways.
Third, the interplay between radiotherapy and immunotherapy is a central issue. Radiation may act as an in situ vaccine, enhancing antigen presentation and immune infiltration, while immunotherapy may potentiate systemic control. However, the success of this combination hinges on timing, sequencing, and dosing. Data suggest that concurrent approaches may maximize synergy, but the risk of toxicity and the heterogeneity of patient populations demand careful evaluation in clinical trials.
Multidisciplinary collaboration is essential. The perspectives of surgeons, radiation oncologists, and medical oncologists converge on the shared goal of maximizing cure while minimizing morbidity. For medical oncologists, the challenge is to integrate systemic immunotherapy into multimodal treatment strategies in a way that is biologically rational, clinically effective, and sustainable for patients and healthcare systems.
In conclusion, immunotherapy represents one of the most promising advances in HNSCC, but its optimal use – whether in metastatic, perioperative, or combined-modality contexts – remains to be fully defined. The medical oncologist’s role is to critically appraise emerging evidence, refine patient selection, and ensure that immunotherapy is implemented within a multidisciplinary framework that prioritizes both survival and patient-centered outcomes.

Bio
Lisa Licitra is specialized in Medical Oncology, with experience in the treatment of Head and Neck tumors. She is an Associate Professor at the Università degli Studi di Milano, since November 2016, where she teaches Oncology in the Faculty of Medicine and in the Masters of Biotechnology, Psycho-oncology, Pharmacology, International Medical School, Ear-Nose-Throat Specialty.