The introduction of immune checkpoint inhibitors (ICIs) to oncological care has transformed the management of various malignancies, including head and neck squamous cell carcinoma (HNSCC), offering improved outcomes. The first-line treatment of recurrent and malignant HNSCC for many years was combined platinum, 5-fluorouracil, and cetuximab. Recently, the ICI pembrolizumab was approved as a first-line treatment, with or without chemotherapy, based on tumor and immune cell percentage of programmed-death ligand 1 (PD-L1). Multiple head and neck (HN) cancer trials have subsequently explored immunotherapies in combination with surgery, chemotherapy, and/or radiation. Immunotherapy regimens may be personalized by tumor biomarker, including PD-L1 content, tumor mutational burden, and microsatellite instability. However, further clinical trials are needed to refine biomarker-driven protocols and standardize pathological methods to guide combined regimen timing, sequencing, and deescalation. Gaps remain for protocols using immunotherapy to reverse oral premalignant lesions, particularly high-risk leukoplakias. A phase II nonrandomized controlled trial, using the ICI nivolumab, showed a 2-y cancer-free survival of 73%, although larger trials are needed. Guidelines are also needed to standardize the role of dental evaluation and care before, during, and after immunotherapy, specifically in regard to oral immune-related adverse events and their impact on cancer recurrence. Standardized diagnostic and oral care coordination strategies to close these gaps are needed to ensure continued success of HN cancer immunotherapy.

中文翻译：

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头颈癌免疫治疗综述


免疫检查点抑制剂 （ICI） 引入肿瘤护理改变了各种恶性肿瘤的管理，包括头颈部鳞状细胞癌 （HNSCC），从而改善了结果。多年来复发性和恶性 HNSCC 的一线治疗是铂类、5-氟尿嘧啶和西妥昔单抗联合治疗。最近，ICI pembrolizumab 被批准作为一线治疗，联合或不联合化疗，基于肿瘤和程序性死亡配体 1 （PD-L1） 的免疫细胞百分比。随后，多项头颈 （HN） 癌症试验探索了免疫疗法与手术、化疗和/或放疗的联合治疗。免疫治疗方案可以通过肿瘤生物标志物进行个性化设置，包括 PD-L1 含量、肿瘤突变负荷和微卫星不稳定性。然而，需要进一步的临床试验来完善生物标志物驱动的方案并标准化病理方法，以指导联合方案的时机、测序和降级。使用免疫疗法逆转口腔癌前病变的方案仍然存在差距，尤其是高危黏膜白斑。一项使用 ICI nivolumab 的 II 期非随机对照试验显示，2 年无癌生存率为 73%，尽管需要更大规模的试验。还需要指南来标准化免疫治疗之前、期间和之后的牙科评估和护理的作用，特别是关于口服免疫相关不良事件及其对癌症复发的影响。需要标准化的诊断和口腔护理协调策略来缩小这些差距，以确保 HN 癌症免疫治疗的持续成功。