Treating Head and Neck Cancer in the Age of Immunotherapy: A 2023 Update

• Published in: Drugs (New York, N.Y.) N.Y.), 2023-02, Vol.83 (3), p.217-248
• Main Authors: Bhatia, Aarti, Burtness, Barbara
• Format: Article
• Language: English
• Subjects: Alcohol; Apoptosis; Cancer; Cancer therapies; Carcinogens; Cell cycle; Cell growth; Chemotherapy; Clinical trials; DNA methylation; Epidermal growth factor receptors; Epstein-Barr virus; ErbB Receptors; Gene expression; Genomes; Growth factors; Head & neck cancer; Head and neck carcinoma; Head and Neck Neoplasms - drug therapy; Head and Neck Neoplasms - etiology; Human papillomavirus; Humans; Immune Checkpoint Inhibitors; Immune system; Immunosuppressive agents; Immunotherapy; Infections; Internal Medicine; Medical prognosis; Medicine; Medicine & Public Health; Metastases; Metastasis; Monoclonal antibodies; Mutation; Nivolumab - therapeutic use; Pathogenesis; PD-1 protein; PD-L1 protein; Pembrolizumab; Pharmacology/Toxicology; Pharmacotherapy; Platinum; Proteins; Review Article; Risk factors; Squamous cell carcinoma; Squamous Cell Carcinoma of Head and Neck - drug therapy; Squamous Cell Carcinoma of Head and Neck - etiology; Tobacco; Tumors; Viral infections
• ISSN: 0012-6667; 1179-1950
• DOI: 10.1007/s40265-023-01835-2

Most patients diagnosed with head and neck squamous cell carcinoma (HNSCC) will present with locally advanced disease, requiring multimodality therapy. While this approach has a curative intent, a significant subset of these patients will develop locoregional failure and/or distant metastases. The prognosis of these patients is poor, and therapeutic options other than palliative chemotherapy are urgently needed. Epidermal growth factor receptor (EGFR) overexpression is an important factor in the pathogenesis of HNSCC, and a decade ago, the EGFR targeting monoclonal antibody cetuximab was approved for the treatment of late-stage HNSCC in different settings. In 2016, the anti-programmed death-1 (PD-1) immune checkpoint inhibitors nivolumab and pembrolizumab were both approved for the treatment of patients with recurrent or metastatic HNSCC with disease progression on or after platinum-containing chemotherapy, and in 2019, pembrolizumab was approved for first-line treatment (either as monotherapy in PD-L1 expressing tumors, or in combination with chemotherapy). Currently, trials are ongoing to include immune checkpoint inhibition in the (neo)adjuvant treatment of HNSCC as well as in novel combinations with other drugs in the recurrent/metastatic setting to improve response rates and survival and help overcome resistance mechanisms to immune checkpoint blockade. This article provides a comprehensive review of the management of head and neck cancers in the current era of immunotherapy.