Preoperative Immunotherapy in the Multidisciplinary Management of Oral Cavity Cancer
Ramez Philips1, Chihun Han1, Brian Swendseid1
1Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, United States.
Abstract:
Despite advances in multimodal treatment for oral cavity squamous cell carcinoma, recurrence rates remain high, providing an opportunity for new therapeutic modalities that may improve oncologic outcomes. Much recent attention has been paid to the molecular interactions between the tumor cells with the adjacent peritumoral microenvironment, in which immunosuppressive molecular changes create a landscape that promotes tumor progression. The rationale for the introduction of immunotherapy is to reverse the balance of these immune interactions in a way that utilizes the host immune system to attack tumor cells. In the preoperative setting, immunotherapy has the advantage of priming the unresected tumor and the associated native immune infiltration, supercharging the adaptive anti-tumor immune response. It also provides the basis for scientific discovery where the molecular profile of responders can be interrogated to elucidate prognostic markers to aid in future patient selection. Preoperative immunotherapy is not without limitations. The risk of surgical delay due to immune adverse events must be carefully discussed by members of a multidisciplinary treatment team and patient selection will be critical. One day, the discovery of predictive biomarkers may allow for algorithms where pre-surgical immunotherapy decreases the size of surgical defect and impacts the intensity of adjuvant therapy leading to improved patient survival and decreased morbidity. With further study, immunotherapy could become a key component of future treatment algorithm.
Insights
Preoperative immunotherapy shows promise for oral cavity squamous cell carcinoma by harnessing the immune system to fight tumors. Further research may refine patient selection and integrate this approach into future treatment strategies.
Area of Science:
- Oncology
- Immunology
- Cancer Research
Background:
- Oral cavity squamous cell carcinoma (OCSCC) has high recurrence rates despite multimodal treatments.
- The tumor microenvironment in OCSCC often exhibits immunosuppressive characteristics that promote cancer progression.
- Immunotherapy offers a strategy to rebalance immune interactions, enabling the host immune system to target tumor cells.
Purpose of the Study:
- To explore the potential of preoperative immunotherapy in OCSCC.
- To investigate how immunotherapy can prime the tumor and immune system before surgery.
- To identify molecular profiles of responders for prognostic markers and improved patient selection.
Main Methods:
- Review of current research on immunotherapy in the preoperative setting for OCSCC.
- Analysis of the immunological and molecular interactions within the tumor microenvironment.
- Discussion of potential benefits and limitations of preoperative immunotherapy.
Main Results:
- Preoperative immunotherapy can enhance the anti-tumor immune response by priming the tumor and associated immune cells.
- Responder molecular profiles can yield prognostic markers for future patient stratification.
- Potential for reducing surgical defect size and adjuvant therapy intensity.
Conclusions:
- Preoperative immunotherapy presents a promising therapeutic avenue for OCSCC, potentially improving oncologic outcomes.
- Careful patient selection and multidisciplinary discussion are crucial due to potential risks like surgical delay.
- Further biomarker discovery could lead to optimized treatment algorithms incorporating pre-surgical immunotherapy for better survival and reduced morbidity.
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