[Neoadjuvant concepts compared to adjuvant and perioperative strategies in the treatment of head and neck cancer].

With the recent results of large phase III trials, immuno-oncological concepts are moving into the focus of curative treatment for locally advanced head and neck cancers. In particular, perioperative immunotherapy-i.e., the combination of neoadjuvant and adjuvant checkpoint inhibition-has emerged as a promising approach to improve event-free survival. This article presents current strategies of neoadjuvant therapy and systematically compares neoadjuvant with purely adjuvant immunotherapy in the curative setting of HNSCC. It contrasts the current data from the KEYNOTE-689 study (perioperative pembrolizumab) with those from the NIVOPOSTOP trial (adjuvant nivolumab), analyzing study designs and endpoints, as well as differences in risk definitions, distant metastasis rates, and surgical implications. In addition, the article discusses the potential roles of pathological response and microenvironment-dependent immune activation in therapeutic decision-making. The aim is to provide a current overview of which immuno-oncological strategies are presently available in the treatment of head and neck cancers and to highlight the key questions that need to be addressed in future studies.