A systematic review of neoadjuvant and definitive immunotherapy in locally advanced head and neck squamous cell carcinoma
Abstract Background Patients with locally advanced head and neck squamous cell carcinoma (HNSCC) require multi‐modality treatment. Immune checkpoint inhibitors (ICIs) are now standard of care in management of recurrent/metastatic HNSCC. However, its role in the definitive and neoadjuvant setting rem...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-05-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.5815 |
| _version_ | 1797810414477639680 |
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| author | Udit Nindra Joshua Hurwitz Dion Forstner Venessa Chin Richard Gallagher Jia Liu |
| author_facet | Udit Nindra Joshua Hurwitz Dion Forstner Venessa Chin Richard Gallagher Jia Liu |
| author_sort | Udit Nindra |
| collection | DOAJ |
| description | Abstract Background Patients with locally advanced head and neck squamous cell carcinoma (HNSCC) require multi‐modality treatment. Immune checkpoint inhibitors (ICIs) are now standard of care in management of recurrent/metastatic HNSCC. However, its role in the definitive and neoadjuvant setting remains unclear. Methods A literature search was conducted that included all articles investigating ICI in untreated locally advanced (LA) HNSCC. Data was extracted and summarised and rated for quality using the Cochrane risk of bias tool. Results Of 1086 records, 29 met the final inclusion criteria. In both concurrent and neoadjuvant settings, the addition of ICI was safe and did not delay surgery or reduce chemoradiotherapy completion. In the concurrent setting, although ICI use demonstrates objective responses in all published trials, there has not yet been published data to with PFS or OS benefit. In the neoadjuvant setting, combination ICI resulted in superior major pathological response rates compared to ICI monotherapy without a significant increase adverse event profiles, but its value in improving survival is not clear. ICI efficacy appears to be affected by tumour characteristics, in particular PD‐L1 combined positive score, HPV status and the tumour microenvironment. Conclusions There is significant heterogeneity of ICI use in untreated LA HNSCC with multiple definitive concurrent and neoadjuvant protocols used. Resultantly, conclusions regarding the survival benefits of adding ICI to standard‐of‐care regimens cannot be made. Further trials and translational studies are required to elucidate optimal ICI sequencing in the definitive setting as well as better define populations more suited for neoadjuvant protocols. |
| first_indexed | 2024-03-13T07:07:25Z |
| format | Article |
| id | doaj.art-3d266d38ea8d48ad995b88f61c670e77 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-03-13T07:07:25Z |
| publishDate | 2023-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-3d266d38ea8d48ad995b88f61c670e772023-06-06T07:30:47ZengWileyCancer Medicine2045-76342023-05-011210112341124710.1002/cam4.5815A systematic review of neoadjuvant and definitive immunotherapy in locally advanced head and neck squamous cell carcinomaUdit Nindra0Joshua Hurwitz1Dion Forstner2Venessa Chin3Richard Gallagher4Jia Liu5Department of Medical Oncology Liverpool Hospital Sydney New South Wales AustraliaThe Kinghorn Cancer Centre St Vincent's Hospital Darlinghurst New South Wales AustraliaThe Kinghorn Cancer Centre St Vincent's Hospital Darlinghurst New South Wales AustraliaThe Kinghorn Cancer Centre St Vincent's Hospital Darlinghurst New South Wales AustraliaThe Kinghorn Cancer Centre St Vincent's Hospital Darlinghurst New South Wales AustraliaThe Kinghorn Cancer Centre St Vincent's Hospital Darlinghurst New South Wales AustraliaAbstract Background Patients with locally advanced head and neck squamous cell carcinoma (HNSCC) require multi‐modality treatment. Immune checkpoint inhibitors (ICIs) are now standard of care in management of recurrent/metastatic HNSCC. However, its role in the definitive and neoadjuvant setting remains unclear. Methods A literature search was conducted that included all articles investigating ICI in untreated locally advanced (LA) HNSCC. Data was extracted and summarised and rated for quality using the Cochrane risk of bias tool. Results Of 1086 records, 29 met the final inclusion criteria. In both concurrent and neoadjuvant settings, the addition of ICI was safe and did not delay surgery or reduce chemoradiotherapy completion. In the concurrent setting, although ICI use demonstrates objective responses in all published trials, there has not yet been published data to with PFS or OS benefit. In the neoadjuvant setting, combination ICI resulted in superior major pathological response rates compared to ICI monotherapy without a significant increase adverse event profiles, but its value in improving survival is not clear. ICI efficacy appears to be affected by tumour characteristics, in particular PD‐L1 combined positive score, HPV status and the tumour microenvironment. Conclusions There is significant heterogeneity of ICI use in untreated LA HNSCC with multiple definitive concurrent and neoadjuvant protocols used. Resultantly, conclusions regarding the survival benefits of adding ICI to standard‐of‐care regimens cannot be made. Further trials and translational studies are required to elucidate optimal ICI sequencing in the definitive setting as well as better define populations more suited for neoadjuvant protocols.https://doi.org/10.1002/cam4.5815curativedefinitive immunoradiotherapyhead and neck cancerimmunotherapyneoadjuvant chemoimmunotherapy |
| spellingShingle | Udit Nindra Joshua Hurwitz Dion Forstner Venessa Chin Richard Gallagher Jia Liu A systematic review of neoadjuvant and definitive immunotherapy in locally advanced head and neck squamous cell carcinoma Cancer Medicine curative definitive immunoradiotherapy head and neck cancer immunotherapy neoadjuvant chemoimmunotherapy |
| title | A systematic review of neoadjuvant and definitive immunotherapy in locally advanced head and neck squamous cell carcinoma |
| title_full | A systematic review of neoadjuvant and definitive immunotherapy in locally advanced head and neck squamous cell carcinoma |
| title_fullStr | A systematic review of neoadjuvant and definitive immunotherapy in locally advanced head and neck squamous cell carcinoma |
| title_full_unstemmed | A systematic review of neoadjuvant and definitive immunotherapy in locally advanced head and neck squamous cell carcinoma |
| title_short | A systematic review of neoadjuvant and definitive immunotherapy in locally advanced head and neck squamous cell carcinoma |
| title_sort | systematic review of neoadjuvant and definitive immunotherapy in locally advanced head and neck squamous cell carcinoma |
| topic | curative definitive immunoradiotherapy head and neck cancer immunotherapy neoadjuvant chemoimmunotherapy |
| url | https://doi.org/10.1002/cam4.5815 |
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