Immune checkpoint inhibitors after surgery cut recurrence in high-risk head and neck cancer

The edition in brief

Adjuvant immunotherapy is earning a place in head and neck cancer. A meta-analysis of phase III trials found that adding immune checkpoint inhibitors to chemoradiotherapy after resection of high-risk locally advanced squamous cell carcinoma improved disease-free survival (hazard ratio 0.75) and overall survival (hazard ratio 0.74), with the clearest benefit where PD-L1 combined positive score was 1 or more (HR 0.66). The cost is toxicity: 43–45% grade 3 or worse adverse events and more immune-related effects, so patient selection and monitoring matter. In otology, a large meta-analysis of 72 studies and 3,783 ears found lateral-wall electrode arrays preserved residual hearing better than perimodiolar designs (45.9% versus 34.2%), with the advantage strengthening in longer-term studies. It supports favouring lateral-wall arrays when hearing preservation is a goal. A phase IIIB trial found intratympanic dexamethasone prevented cisplatin-induced tinnitus almost completely, but at a real cost — permanent tympanic membrane perforation in about a third of treated ears at six months — which tempers enthusiasm. The regulatory highlight is a UK pharmacogenomic guideline on MT-RNR1 genotype testing: mitochondrial variants carried by roughly 1 in 330 people cause irreversible hearing loss after aminoglycosides, sometimes from a single dose, and testing can pre-empt it where treatment is predictable.