Response-Adapted Surgery after Neoadjuvant Immunochemotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma (REMATCH): A Single-Arm Phase II Trial
In brief
Reduced-volume surgery after immunochemotherapy yields 90% two-year disease-free survival
In 50 HPV-negative head and neck cancer patients, 94% responded to three cycles of penpulimab-nab-paclitaxel-cisplatin, and those with at least 50% tumor shrinkage (42 patients) underwent reduced-volume surgery achieving a 90% two-year disease-free rate and 100% laryngeal preservation. Severe adverse events were uncommon, but the small standard-volume surgery group had much poorer outcomes, prompting need for larger trials.
- Journal
- Clinical cancer research : an official journal of the American Association for Cancer Research (Q1)
- Published
- 10 September 2026
- Study design
- Non-randomized / quasi-experimental trial
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Xiaomeng Zhang, Yan Zhou, Jing Huang, Gang Peng, Zhanjie Zhang, Lu Wen, et al.
- PMID
- 42717678
- DOI
- 10.1158/1078-0432.CCR-26-1337
Why clinicians should know about it
- Picked for Otorhinolaryngology (paper of the day, 13 September 2026): Response‑adapted surgery after immunochemotherapy yields high laryngeal preservation
Abstract
PURPOSE: We assessed the feasibility and efficacy of a response-adapted surgical strategy in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) achieving major tumor regression after neoadjuvant immunochemotherapy (NAICT). PATIENTS AND METHODS: This phase II, single-arm, prospective trial enrolled patients with resectable, human papillomavirus-negative stage III to IVA LA-HNSCC. All received three cycles of NAICT (penpulimab, nab-paclitaxel, and cisplatin). Pre-cycle 3 imaging and laryngoscopy guided surgery: Patients with ≥50% primary tumor regression underwent reduced-volume surgery (RVS); those with <50% regression received standard-volume surgery (SVS). All received risk-adapted adjuvant radiotherapy. The primary endpoint was 2-year disease-free survival (DFS). RESULTS: Fifty patients completed NAICT, with an objective response rate of 94% [95% confidence interval (CI), 84%-99%]. At a median follow-up of 34.0 months (IQR, 30.1-39.5), the 2-year DFS for the per-protocol cohort was 83% (95% CI, 69%-91%). The RVS group (n = 42) achieved a 2-year DFS of 90% (95% CI, 77%-96%) with 100% laryngeal preservation in laryngeal/hypopharyngeal cancers, whereas the SVS group (n = 5) had a 2-year DFS of 20% (95% CI, 0.8%-58%). Grade 3 adverse events (AE) occurred in 16% of patients related to NAICT and in 15% related to surgery; there were no grade 4 or 5 AEs. At 9 months after radiotherapy, most quality-of-life scores improved or stabilized compared with baseline. CONCLUSIONS: The REMATCH trial provides the first prospective evidence that a response-adapted surgical strategy after NAICT is feasible. Patients achieving ≥50% primary tumor regression derived promising survival and universal laryngeal preservation. These findings support the initiation of phase III randomized trials to validate this de-escalation strategy.
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.