The landscape of head and neck squamous cell carcinoma (HNSCC) treatment is evolving with the introduction of immune checkpoint inhibitors (ICIs), offering improved outcomes for patients. For years, the standard first-line treatment for recurrent and metastatic HNSCC involved a combination of platinum-based chemotherapy, 5-fluorouracil, and cetuximab. However, the recent approval of pembrolizumab, an ICI, marks a significant advancement.
Pembrolizumab's Impact on HNSCC Treatment
Pembrolizumab has been approved as a first-line treatment, both as a monotherapy and in combination with chemotherapy, contingent on the tumor and immune cell percentage of programmed death-ligand 1 (PD-L1). This approval signifies a shift towards personalized immunotherapy regimens guided by tumor biomarkers.
Biomarker-Driven Protocols and Future Trials
While immunotherapy regimens can now be tailored based on tumor biomarkers, further clinical trials are essential. These trials aim to refine biomarker-driven protocols, standardize pathological methods, and optimize the timing, sequencing, and de-escalation strategies for combined regimens. The goal is to enhance the efficacy and safety of immunotherapy in HNSCC.
Nivolumab Shows Promise in Oral Premalignant Lesions
Gaps remain in protocols utilizing immunotherapy to reverse oral premalignant lesions, particularly high-risk leukoplakias. A phase II non-randomized controlled trial, employing the ICI nivolumab, demonstrated a two-year cancer-free survival rate of 73%. These results are encouraging, but larger trials are needed to validate these findings and establish nivolumab's role in preventing cancer development in premalignant oral lesions.
The Importance of Standardized Dental Care
Guidelines are crucial to standardize dental care, especially concerning oral immune-related adverse events and their potential impact on cancer recurrence. Managing these adverse events is vital for maintaining patients' quality of life and ensuring the continuity of cancer treatment. Standardized protocols will help healthcare professionals address and mitigate these challenges effectively.
