Adjuvant checkpoint inhibitors improve survival in resected head and neck cancer, at a real toxicity cost

The edition in brief

Adjuvant immune checkpoint inhibitors added to chemoradiotherapy in resected locally advanced head and neck squamous cell carcinoma improved disease-free survival with a hazard ratio of 0.75 and overall survival with 0.74 — a 26% reduction in the risk of death. Benefit was larger where PD-L1 CPS was 1 or above, at 0.66. The cost is substantial: 81% had an adverse event of any grade, 43 to 45% had grade 3 or worse, and 12 to 18% stopped treatment because of toxicity. On airway management, a meta-analysis of 25 studies and 5,987 patients found adverse airway events in 10.3% of head and neck reconstructions managed without elective tracheostomy. Floor-of-mouth tumours, oropharyngeal tumours, bilateral neck dissection and higher ASA class raised the odds. But elective tracheostomy itself was associated with more flap complications, more unplanned returns to theatre and nearly six days longer to oral feeding — so this is a selection problem, not a default. A randomised trial in vitamin D-deficient patients with recurrent benign paroxysmal positional vertigo found cholecalciferol halved recurrence out to 24 months, 27.5% against 55.0%, with a number needed to treat of 3.6. And new pharmacogenomic guidance recommends MT-RNR1 genotype testing to prevent aminoglycoside ototoxicity.