When it comes to upfront definitive surgery or chemoradiation for locally-advanced head and neck squamous cell carcinoma (HNSCC), more is more. Meaning the bigger volume you have to treat aggressively, the bigger the expected morbidity. Knowing immune checkpoint inhibition (ICI) has shown some activity in platinum-refractory HNSCC, maybe giving some upfront in the first-line setting can be helpful. So far, 344 patients have been treated on 10 early phase studies of ICI as neoadjuvant treatment either alone (n=8) or along with chemo and/or radiation (n=2) prior to definitive resection, and a meta-analysis is here to help us synthesize the available data. Major path response (aka <10% viable tumor cells remaining) was <10% with low variability across studies, but at least so was rate of grade 3-4 toxicities and no surgery was delayed—well, except from when it would have been done without the neoadjuvant ICI. Only time will tell if this strategy can outdo chenmo and pan out to better disease outcomes. | Masarwy, JAMA Otolaryngol Head Neck Surg 2021


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