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transplant patients on immunosuppressive therapy are at increased risk of certain malignancies, especially
cutaneous. These patients are mostly excluded from clinical trials so little prospective data exists. Retrospective
case reports and analyses indicate that there is increased risk for organ rejection [34,35] . This risk varies with organ
type and agent: renal transplants and PD-1 agents appear to have the highest risks. Lastly, patients with inherited
mutations that increase the risk for head and neck cancers, such as Li Fraumeni Syndrome and Fanconi
Anemia, may benefit from checkpoint inhibitor therapy, though there is no prospective or retrospective data
identifying these patients and their response rates or adverse event profiles.

CONCLUSION
Head and neck tumors are a historically difficult group of tumors to treat due to variability in histology,
location, and modest responses to systemic therapy. Response rates to systemic therapies are low, especially
in recurrent and metastatic tumors, and overall survival remains dismal. Checkpoint inhibitors such as
pembrolizumab and nivolumab provide an alternative to cytotoxic therapies in squamous cell tumors, with
adequate response rates and a modest overall survival benefit, and overall better tolerability in terms of
toxicities. Their use does require special attention to the unique irAEs that can occur. Other checkpoint
inhibitors including durvalumab, avelumab, atezolizumab, tremelimumab, and ipilumumab are actively
being explored in clinical trials. In addition, there are ongoing trials looking to move these agents into the
curative setting and combine them with more traditional therapy options to gain more cumulative survival
benefit. This is an interesting and exciting time for this field with potential advances that will hopefully
significantly improve patient outcomes.

DECLARATIONS
Authors’ contributions
Concept and design, data analysis: Costantini C, Quenelle N
Data acquisition, manuscript preparation: Quenelle N
Critical revision, finalizing of the manuscript: Costantini C

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Both authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2018.

REFERENCES
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carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-analysis of chemotherapy on head