Pathologic Response After Neoadjuvant Chemoimmunotherapy in Head and Neck Squamous Cell Carcinoma
In brief
Neoadjuvant chemoimmunotherapy yields deep pathologic response in 67% of resectable head-neck cancers
In a single-center retrospective cohort of 86 patients, 67% of those receiving two cycles of neoadjuvant chemoimmunotherapy achieved a complete or major pathologic response, versus only 3.6% with immunotherapy alone. The regimen was well tolerated, but prospective trials are required to confirm survival benefit.
- Journal
- JAMA otolaryngology-- head & neck surgery (Q1)
- Published
- 13 August 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Ethan A Gomez, Daniel O Kraft, Yehia Elkersh, Peter V Cooke, Ryan M Sicard, Thomas F Barrett, et al.
- PMID
- 42593779
- DOI
- 10.1001/jamaoto.2026.2259
Why clinicians should know about it
- Picked for Otorhinolaryngology (top studies of the week, 16 August 2026): Neoadjuvant chemoimmunotherapy pathologic response in HNSCC
Abstract
IMPORTANCE: Treatment outcomes for locally advanced head and neck squamous cell carcinoma (HNSCC) remain suboptimal, and strategies to improve response to therapy are needed. Neoadjuvant immunotherapy has shown promise, but pathologic response rates remain modest with single-agent regimens. OBJECTIVE: To compare rates of pathologic response between neoadjuvant immunotherapy (NAI) and neoadjuvant chemoimmunotherapy (NACI) in patients with resectable HNSCC treated in an off-trial setting. DESIGN, SETTING, AND PARTICIPANTS: This was a single-center retrospective cohort study of adult patients with pathologically confirmed HNSCC of the aerodigestive tract who received at least 1 cycle of NAI or NACI followed by definitive surgery at a large, urban tertiary academic referral center from July 19, 2024, to March 4, 2026. Patients with locoregional recurrence were included if treated with curative intent. Propensity score-adjusted analyses were performed to account for baseline differences between treatment groups. Data were analyzed from March 5 to June 17, 2026. EXPOSURE: NAI and NACI, typically administered over 2 cycles, before surgery. MAIN OUTCOMES AND MEASURES: Pathologic response in the surgical specimen, categorized as pathologic complete response (pCR), major pathologic response (MPR; ≤10% viable tumor), or partial response. Deep pathologic response was defined as pCR or MPR. RESULTS: Among 86 participants (mean [SD] age, 63 [12] years; 27 female [31%] and 59 male [69%]), 25 (29%; 95% CI, 21%-39%) achieved pCR and 15 (17%; 95% CI, 11%-27%) achieved MPR. pCR or MPR occurred in 39 of 58 NACI recipients (67%; 95% CI, 54%-78%) compared with 1 of 28 NAI recipients (3.6%; 95% CI, 0.6%-17.7%). In propensity score-adjusted analysis, NACI was associated with higher odds of pCR or MPR (odds ratio [OR], 29.1; 95% CI, 6.7-274.7). Treatment was generally well tolerated, with few adverse event-related delays to surgery. CONCLUSIONS AND RELEVANCE: In this cohort study, neoadjuvant chemoimmunotherapy was associated with substantially higher rates of pCR and MPR compared with immunotherapy alone in resectable HNSCC. These findings support the potential role of combination regimens in improving tumor response, although prospective trials are needed to determine effects on survival.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.