OnCo
pairingsPairing

Immunotherapy before surgery rather than with chemoradiation (HNSCC)

In head and neck cancer, immunotherapy works when given before surgery but not when given alongside chemoradiation.

KEYNOTE-689 (neoadjuvant + adjuvant pembrolizumab) doubled event-free survival; JAVELIN H&N 100 and KEYNOTE-412 (concurrent with chemoradiation) failed. Radiation-induced lymphopenia, steroids, and the loss of the antigen-rich primary are proposed explanations.

Rationale
T-cell priming needs an intact tumour and functioning lymphatics; chemoradiation destroys both while the drug is on board.
Evidence
One positive phase 3 versus two negative ones with the alternative sequence.

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