Evolving Neoadjuvant, Adjuvant, and Concurrent Systemic Therapy Strategies in Head and Neck Squamous Carcinoma

The role of cytotoxic chemotherapy in the neoadjuvant setting has not been well established by older studies, except in the case of larynx preservation. Novel neoadjuvant strategies are being explored, such as the incorporation of immune checkpoint inhibitors into the neoadjuvant/peri-operative setting, novel combinations of chemotherapy with ICI and/or metronomic therapy, and the use of neoadjuvant chemo-immunotherapy for response-adapted de-escalation of radiotherapy. IAP (inhibitor of apoptosis protein) antagonists are novel agents being investigated in HNSCC, but have not shown benefit in the phase III setting.