Overall, 57.2% of global Head and Neck cancers (HNCs) occur in Asia, especially in India, where it accounts for 30% of all cancers. According to Pan Health Care Global (HCG) Hospital data, 72 % of HNCs are hot tumours with a 62% PDL1 positive rate. The failure rates and recurrence rates of HNCs in India are soaring, which is a challenge, with patients being unaffordable to the newer treatments of full-dose checkpoint inhibitors, which becomes a hurdle in the successful treatment of HNCs. We explored the addition of low-dose immunotherapy (LDI) to chemotherapy in neoadjuvant settings in HNCs.

Material and Methods

To see the efficacy and safety of LDI and neoadjuvant chemotherapy in locally advanced PDL1 positive squamous cell carcinoma of HNCs treated at HCG Bangalore from April 2023 to December 2023. LDI Nivolumab 40mg is administered along with acceptable neoadjuvant chemotherapy, either TPF or Weekly Nab-paclitaxel + Carboplatin, based on the patient’s profile.


Of 19 cases, the M:F ratio was 1.7:1. The median age was 66 (42 to 72 years), 63.1% were oral cavity, and 31.5% oropharyngeal area, respectively. Comorbidities were noticed in 68.4%. PDL1 positivity < 20% in 63.15 % and >/= 20% in 36.85% respectively. Response assessment done after 9 weeks of therapy showed disease Complete Metabolic Response in 26.3%, good partial response in 68.4% and disease progression seen 5.26% respectively. Surgery done in 42.1% of cases and post-surgery the pathological complete remission was seen in 50%

Safey Profile Grade 1-2 Grade 3 -4
Alopecia 94.7% -
Mucositis 21% 5.26%
Nause /Vomiting 26.3% 5.26%
Diarrhea 26.3% 10.5%
Anemia 42.1% 5.26%
Neutropenia 47.3% 10.5%
Febrile Neutropenia -- 10.5%
Thrombocytopenia 26.3% 10.5%
Hypothyroidism 31.575 --
Altered LFT 15,7% --
Altered RFT 10.5% --


LDI with Neoadjuvant chemotherapy shows promising efficacy without adding toxicity, and further randomized study is needed to confirm this.