Therapeutic approach to laryngeal and pharyngeal tumors: from traditional methods to immunotherapy
Lukach E.V., Volobuev M.A., Serezhko Yu.O.
Summary. The article discusses current opportunities for the use of immunotherapy in malignant tumors of the larynx, pharynx, and other sites of head and neck squamous cell carcinoma. Conventional treatment modalities, including surgery, radiotherapy, and chemotherapy, remain the main components of multidisciplinary cancer care. However, their effectiveness is often limited in patients with recurrent, metastatic, or platinum-resistant disease, which supports the need for new systemic therapeutic strategies. Particular attention is paid to immune checkpoint inhibitors, especially agents targeting the PD-1 / PD-L1 axis. The article summarizes data from key clinical trials, including KEYNOTE-048 and CheckMate-141, which demonstrated the clinical benefit of pembrolizumab and nivolumab in patients with recurrent or metastatic head and neck squamous cell carcinoma. The importance of assessing PD-L1 expression using the Combined Positive Score (CPS) is emphasized. CPS is considered one of the leading clinically relevant biomarkers for selecting patients for immunotherapy, as it reflects not only tumor cell characteristics but also the immune status of the tumor microenvironment. This is essential for the personalization of treatment and for optimizing therapeutic decision-making. The article also addresses emerging directions in immunotherapy, including its use in neoadjuvant and adjuvant settings. These approaches may contribute to tumor burden reduction, increase the likelihood of organ-preserving treatment, improve systemic control of micrometastatic disease, and reduce the risk of recurrence after radical therapy. At the same time, the authors emphasize the need for careful patient selection, biomarker assessment, multidisciplinary discussion, and regular clinical and laboratory monitoring due to the risk of immune-related adverse events. Dermatologic, gastrointestinal, endocrine, hepatic, and pulmonary toxicities require timely recognition and appropriate management according to the severity of clinical manifestations. Two clinical cases of pembrolizumab use are presented. In the first case, partial tumor regression was achieved after disease progression following previous polychemotherapy and radiotherapy. In the second case, a patient with recurrent laryngeal cancer demonstrated complete tumor regression after four pembrolizumab administrations, confirmed by laryngoscopy and computed tomography. In both cases, treatment was well tolerated and was not associated with significant complications. These observations support the clinical potential of PD-1 / PD-L1 inhibitors as an important component of modern multidisciplinary treatment strategies for patients with malignant tumors of the larynx and pharynx.
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