Systematic review and meta-analysis on immunotherapy for head and neck squamous cell carcinoma

BackgroundThe treatment of head and neck squamous cell carcinoma (HNSCC) poses significant difficulties because patients with advanced disease experience poor survival rates. The use of immune checkpoint inhibitors as therapy shows potential, yet researchers report inconsistent findings regarding their effectiveness and safety in clinical trials and real-world settings.ObjectiveThe study aimed to assess the effectiveness and safety of immunotherapy for HNSCC, as well as treatment success by biomarker status, through a systematic review and meta-analysis of clinical and real-world evidence.MethodologyThe researchers conducted a comprehensive systematic review and meta-analysis that included all available randomized controlled trials, phase II and III studies, retrospective cohort studies, and real-world evidence. The researchers applied a random-effects model analysis, using inverse-variance weighting and a Freeman–Tukey double arcsine transformation, to pool the data. The I² statistic served as the measure of heterogeneity, while publication bias was assessed using funnel plots and Egger’s test. The GRADE methodology assessed the certainty of the evidence.ResultsThe analysis included 36 studies involving 8880 to 5930 patients, assessed across five main outcome categories. The clinical effectiveness assessment showed a combined rate of 0.16 (95% CI: 0.14–0.18), with considerable heterogeneity (I² = 81%). The effectiveness assessment showed a combined rate of 0.18 (95% CI: 0.16–0.19), which displayed evidence of publication bias. The combination therapies achieved an improvement rate of 0.18 (95% CI: 0.15–0.22), whereas the dual/targeted immunotherapy showed superior performance, with an improvement rate of 0.22 (95% CI: 0.19–0.24), based on highly reliable evidence. The PD-L1-based outcomes showed a pooled proportion of 0.17 (95% CI: 0.16–0.19) with moderate heterogeneity (I² = 66%). The majority of randomized controlled datasets showed no evidence of publication bias.ConclusionImmunotherapy delivers moderate yet dependable medical results for HNSCC, with its greatest effectiveness achieved through dual- or targeted-treatment methods. The randomized research evidence shows strong treatment effects, whereas the actual treatment data reveal different results and suggest possible publication bias. The PD-L1 biomarker is a useful tool for predicting response, yet its performance is inconsistent across applications. The use of immunotherapy represents a major development in HNSCC treatment.