Neoadjuvant Immunotherapy in Resectable HNSCC: An Updated Systematic Review and Meta-analysis

Area of Science:

• Oncology
• Immunotherapy
• Head and Neck Cancer Research

Background:

• Immunotherapy is an FDA-approved treatment for recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC).
• Investigating neoadjuvant immunotherapy before surgery is crucial for mucosal head and neck cancers.

Purpose of the Study:

• To explore the safety and efficacy of neoadjuvant immunotherapy in mucosal head and neck cancer.
• To compare chemoimmunotherapy with immunotherapy alone in the neoadjuvant setting.

Main Methods:

• Systematic literature search of three databases up to March 2024.
• Extracted demographic and tumor characteristics.
• Analyzed outcomes including disease-free survival (DFS), progression-free survival (PFS), overall survival (OS), complete pathological response (cPR), and major pathological response (MPR).
• Assessed safety outcomes such as grade 3+ adverse events and treatment-related delays or deaths.

Main Results:

• Analysis included 459 patients from 15 studies.
• Chemoimmunotherapy demonstrated a higher pooled complete pathological response (cPR) rate (30.1%) compared to immunotherapy alone (1.4%).
• Disease-free survival (DFS) was higher with chemoimmunotherapy (89.8%) versus immunotherapy alone (80.4%).
• Chemoimmunotherapy was associated with a higher incidence of adverse events (22.9%) than immunotherapy alone (8.5%).
• No treatment-related deaths were reported.

Conclusions:

• Neoadjuvant immunotherapy is generally well-tolerated in head and neck cancers.
• Neoadjuvant chemoimmunotherapy appears more effective for locally advanced head and neck squamous cell carcinoma (LAHNSCC) than immunotherapy alone.
• Higher treatment-related adverse events (TRAEs) are noted with chemoimmunotherapy.