Immunotherapies in the treatment sequence of head and neck cancer

Drug therapy of head and neck cancer has changed dramatically during the past 5 years due to the approval of immunotherapy in the palliative setting. With nivolumab and pembrolizumab firmly established in second- and first-line recurrent or metastatic situations, various completed or ongoing clinical trials focus on the adjuvant or neoadjuvant setting. Currently available results show that addition of a checkpoint inhibitor to definitive radiochemotherapy fails to elicit an advantage. The currently running ADRISK trial assessing pembrolizumab in the context of adjuvant radiochemotherapy is still recruiting and results cannot be expected in the near future. Currently available early data on the use of a checkpoint inhibitor after salvage surgery appear promising, although clear treatment recommendations cannot be derived at present. It is, however, in principle possible for clinicians to submit a proposal for off-label use to the provider on the basis of these trials in high-risk situations. In the authors' opinion, the field of neoadjuvant immunotherapy is by far the most interesting. On the one hand, large phase III studies that challenge the established treatment standard are currently open. On the other, in the case of positive results, a large number of patients will be affected by changes in the treatment sequence. The mentioned trials address locally advanced stages, as suffered by the majority of patients at initial diagnosis. Application of immunotherapy with subsequent biopsy continues to be an excellent tool to guide patient-specific neoadjuvant or maintenance therapy.