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In head and neck cancer, immunotherapy works when given before surgery but not when given alongside chemoradiation.
This sequence rule in head and neck squamous cell carcinoma places immune checkpoint inhibitors before surgery rather than concurrently with modern external beam chemoradiation. T-cell priming needs an intact tumour and functioning lymphatics, and chemoradiation destroys both while the drug is on board; radiation-induced lymphopenia, steroids and loss of the antigen-rich primary are the proposed explanations. KEYNOTE-689, which gave pembrolizumab before and after surgery, improved event-free survival, whereas JAVELIN Head and Neck 100 and KEYNOTE-412, which gave it with chemoradiation, both failed. One positive phase 3 against two negative ones makes timing, not the drug, the lesson; the concept sits under neoadjuvant, adjuvant and perioperative therapy.
Shares KEYNOTE-689, Head and neck squamous cell carcinoma, Pembrolizumab, Immune checkpoint inhibitors.
Shares KEYNOTE-689, Pembrolizumab.
Shares KEYNOTE-689, Neoadjuvant / adjuvant / perioperative, Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam).
Shares Neoadjuvant / adjuvant / perioperative, Pembrolizumab, Immune checkpoint inhibitors.
Shares KEYNOTE-689, Head and neck squamous cell carcinoma, Pembrolizumab, Immune checkpoint inhibitors.
Shares Neoadjuvant / adjuvant / perioperative, Pembrolizumab, Immune checkpoint inhibitors.
Shares KEYNOTE-689, Head and neck squamous cell carcinoma, Pembrolizumab, Immune checkpoint inhibitors.
Shares Neoadjuvant / adjuvant / perioperative, Pembrolizumab, Immune checkpoint inhibitors.