Immunotherapy Reshapes First-Line Recurrent Head and Neck Cancer

Kevin Harrington, MBBS, PhD, FRCP, FRCR, opens a discussion on how checkpoint inhibitors changed first-line treatment for recurrent or metastatic head and neck squamous cell carcinoma. Will Ince, MRCP, FRCR, recalls an era of cytotoxic chemotherapy when few patients lived beyond months. He cites KEYNOTE-048 response rates of approximately 30% with chemotherapy plus immunotherapy and 19% with immunotherapy alone, median overall survival of 12 to 13 months, and durable responses in a subset of patients, and he now seeks a way to give every patient immunotherapy. Ross Merkin, MD, reserves cetuximab-based regimens for patients with relative or absolute contraindications to immunotherapy, noting that these regimens lack the deep, durable remissions seen with programmed cell death protein 1 antibodies. He also cites nonrandomized phase 2 data for pembrolizumab plus cetuximab, with a response rate of about 44%. Dr. Harrington expects human papillomavirus (HPV)-positive and HPV-negative disease to require distinct strategies, with HPV-negative disease an area of unmet need.