HPV Status and Curative-Intent Future Directions

Closing reflections on recurrent or metastatic head and neck squamous cell carcinoma center on human papillomavirus (HPV) status and curative-intent strategies. Will Ince, MRCP, FRCR, calls HPV status the most important biomarker in this setting and expects it to guide drug decisions more than the programmed death-ligand 1 combined positive score. He sees treatment diverging, with bispecific antibodies plus pembrolizumab for HPV-negative disease and antibody-drug conjugates and vaccines potentially showing more activity in HPV-positive disease. Ross Merkin, MD, notes that efficacy in recurrent or metastatic disease has long served as a springboard to curative-intent use, as with KEYNOTE-689 and postoperative nivolumab, and expects epidermal growth factor receptor bispecific antibodies to move into curative-intent settings to prevent recurrence. Kevin Harrington, MBBS, PhD, FRCP, FRCR, highlights a paradox: clinicians tell newly diagnosed patients that HPV-positive disease is potentially readily curable, yet 7 of 10 patients in his recurrent or metastatic clinic have HPV-positive disease. He sees a major opportunity for new therapies in this group.