TNM Staging Guide 5th Edition eBook

D. Immunotherapy An emerging new treatment option for select head and neck cancers is immunotherapy. These medications have gained prominence due to the increased knowledge of the mechanisms of immune checkpoints and their impact on cancer behavior. The Programmed cell Death-1 receptor (PD-1) is expressed on activated T-cells and binding of it to PD-L1 results in a downreg- ulation of the T-cell response. PD-L1 is expressed in approximately 50 to 60% of head and neck squamous cell carcinomas and this expression is thought to provide a method for the disease to suppress the local immune reaction. There are two immunotherapy agents currently approved by the FDA for use in head and neck cancer (Pembrolizumab and Nivolumab). Such therapies are primarily employed in the treatment of recurrent/metastatic and/or platin refractory head and neck squamous cell carcinomas that express PD-L1. While response rates are modest for these agents, their side effect profile tends to be less severe than standard cytotoxic chemotherapy agents. Currently, these and other agents are the subject of active research to investigate how they best can be employed in the management of patients with head and neck cancer.

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