Since 2020, Pembrolizumab has been approved by NICE as an option for untreated metastatic or unresectable recurrent head and neck squamous cell carcinoma (HNSCC) in adults whose tumours express PD‑L1 with a combined positive score (CPS) of 1 or more.

Now, evidence has emerged from a large international clinical trial about the effectiveness of this immunotherapy when given before and after surgery to treat advanced cancer. The Keynote study involved around 700 head and neck patients in 24 countries, involving 192 hospitals. It was led by the Washington University Medical School in St Louis and funded by the drug company MSD.

The experimental treatment arm showed significant benefit over standard care. It doubled the length of time patients were cancer free from, on average, from 2.5 years to 5 years. After 3 years patients receiving pembrolizumab had a 10% lower risk of the cancer returning elsewhere in the body.

Kevin Harrington is the Professor in Biological Cancer Therapies at The Institute of Cancer Research (ICR) and a Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust and led the trial in the UK. He said the therapy could “change the world” for this group of patients. Researchers explained that giving patients the drug before surgery trains the body to hunt down and kill the cancer if it ever comes back.

Hopefully the NICE guidelines may soon be amended to include the use of pembrolizumab in this way.