Neoadjuvant Therapy for Head and Neck Squamous Cell Carcinoma: Where Are We Now?

PROGRAM DESCRIPTION: While neoadjuvant chemotherapy for head and squamous cell carcinoma (HNSCC) dates to the earliest multidisciplinary approaches, the introduction of immune checkpoint inhibitors has renewed enthusiasm and research into its use. Although neoadjuvant therapy has remained mostly investigative through single-institutional clinical trials for HNSCC, new data, including clinical trial Keynote 689, have emerged to support its use. This panel will address current literature, evolving research, and gaps in knowledge surrounding neoadjuvant therapy.

We will provide updates on the current science ushering in a new era of induction approaches. Neoadjuvant immune checkpoint inhibitors, most notably agents targeting anti-programmed cell death protein 1, bolster antitumor immunity prior to ablating local structures. Potential benefits include de-escalation of subsequent treatment, but neoadjuvant therapy for curable disease also carries a small but real risk of progression and compromise of curative options. Measures of response include pathologic, clinical, and radiographic, but there are rapidly expanding capabilities in new diagnostics, such as circulating tumor DNA, with the emerging potential to provide objective quantification of disease burden. Further neoadjuvant strategies include response adaptive therapy, such as treatment/bio-selection or modification of surgery, adjuvant therapy, or definitive treatment. Neoadjuvant ICI trials will be summarized in this session.

With neoadjuvant therapy on the brink of entering the standard of care for HNSCC, understanding the pros and cons of this approach are increasingly important for surgical oncologists and general otolaryngologists alike.

OUTCOME OBJECTIVE 1: Describe the risks and benefits of neoadjuvant therapy, including immunotherapy, chemotherapy, and radiation.

OUTCOME OBJECTIVE 2: Understand the surgeon's role and tools for assessing treatment response and adapting treatment.

OUTCOME OBJECTIVE 3: Learn the current data and clinical trial landscape surrounding different approaches to neoadjuvant immunotherapy.

BACKGROUND STATEMENT: With Keynote 689 (mucosal) being presented and the NRG HN014 (cutaneous) opening just prior to the Annual Meeting, there is increasing adoption of neoadjuvant therapy for HNSCC. While this is an exciting option for precision oncology, it is also an immense risk if not used responsibly.

Comprehensive Otolaryngology Track Statement :