Neoadjuvant immunotherapy in advanced oral cancer: Emerging treatment paradigms

Abstract

Background: Locally advanced borderline resectable oral cancer poses significant treatment challenges due to its infiltrative nature and high relapse rates, leading to poor prognosis. Neoadjuvant immunotherapy may offer a novel therapeutic approach, potentially altering the standard of care for advanced oral cancer. Case report: Two patients with locally advanced tongue cancer, initially deemed inoperable, were treated with neoadjuvant immunotherapy. The first patient received 4 cycles of taxane, cisplatin, and pembrolizumab, while the second received 12 cycles of nivolumab and methotrexate. Both patients exhibited excellent clinical responses at the primary site and in regional lymph nodes. Following treatment, one patient underwent primary closure, and the other had a nasolabial flap with marginal mandibulectomy. Intraoperative frozen sections indicated tumor-free margins in both cases. Conclusion: These two cases underscore the potential of neoadjuvant immunotherapy in managing borderline resectable oral squamous cell carcinoma (OSCC), initially deemed inoperable. The favorable outcomes highlight the need for more research and clinical trials to further assess the efficacy of this approach in head and neck cancers. In this review, we explore the scientific rationale, current clinical evidence, and key debated topics, including the evaluation of pathological and radiological responses.

Keywords

• Neoadjuvant immunotherapy
• Borderline resectable
• Oral squamous cell carcinoma
• Pembrolizumab
• Nivolumab