Expert consensus on neoadjuvant PD-1 inhibitors for locally advanced oral squamous cell carcinoma (2026)

LI Jinsong; LIAO Guiqing; LI Longjiang; ZHANG Chenping; SHANG Chenping; ZHANG Jie; ZHONG Laiping; LIU Bing; CHEN Gang; WEI Jianhua; JI Tong; LI Chunjie; LIN Lisong; REN Guoxin; LI Yi; SHANG Wei; HAN Bing; JIANG Canhua; ZHANG Sheng; SONG Ming; LIU Xuekui; WANG Anxun; LIU Shuguang; CHEN Zhanhong; WANG Youyuan; LIN Zhaoyu; LI Haigang; DUAN Xiaohui; YE Ling; ZHENG Jun; WANG Jun; LV Xiaozhi; ZHU Lijun; CAO Haotian

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Expert consensus on neoadjuvant PD-1 inhibitors for locally advanced oral squamous cell carcinoma (2026)

Author: LI Jinsong ¹ ; LIAO Guiqing ² ; LI Longjiang ³ ; ZHANG Chenping ⁴ ; SHANG Chenping ⁵ ; ZHANG Jie ⁶ ; ZHONG Laiping ⁷ ; LIU Bing ⁵ ; CHEN Gang ⁵ ; WEI Jianhua ⁸ ; JI Tong ⁹ ; LI Chunjie ³ ; LIN Lisong ¹⁰ ; REN Guoxin ¹¹ ; LI Yi ¹² ; SHANG Wei ¹³ ; HAN Bing ¹⁴ ; JIANG Canhua ¹⁵ ; ZHANG Sheng ¹⁶ ; SONG Ming ¹⁷ ; LIU Xuekui ¹⁷ ; WANG Anxun ¹⁸ ; LIU Shuguang ¹⁹ ; CHEN Zhanhong ²⁰ ; WANG Youyuan ¹ ; LIN Zhaoyu ¹ ; LI Haigang ²¹ ; DUAN Xiaohui ²² ; YE Ling ²³ ; ZHENG Jun ²⁴ ; WANG Jun ²⁵ ; LV Xiaozhi ²⁶ ; ZHU Lijun ²⁷ ; CAO Haotian ¹
Author Information

1. Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
2. Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Sun Yat-sen University
3. Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University
4. Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University
5. Department of Oral and Maxillofacial Head and Neck Oncology Surgery, Hospital of Stomatology, Wuhan University
6. Department of Oral and Maxillofacial Surgery, Peking University Hospital of Stomatology
7. Department of Oral and Maxillofacial Head and Neck Surgery, Huashan Hospital, Fudan University
8. Department of Maxillofacial Oncology, School of Stomatology, Air Force Medical University
9. Department of Oral and Maxillofacial Surgery, Zhongshan Hospital, Fudan University
10. Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University
11. Department of Oral and Maxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University,
12. Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Chongqing Medical University
13. Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University
14. Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University
15. Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University
16. Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University
17. Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center
18. Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University
19. Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Southern Medical University
20. Department of Medical Oncology, The Third Affiliated Hospital, Sun Yat-sen University,
21. Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
22. Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
23. Department of Radiation Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
24. Department of Oral and Maxillofacial Surgery, Jiangmen Central Hospital
25. Department of Oral and Maxillofacial Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University
26. Department of Oral and Maxillofacial Surgery, Zhujiang Hospital, Southern Medical University
27. Department of Oral and Maxillofacial Surgery, Guangdong Provincial People's Hospital
Publication Type:Journal Article
Keywords: oral squamous cell carcinoma; locally advanced stage; neoadjuvant treatment; PD-1 inhibitor; immunotherapy; efficacy evaluation; immune-related adverse reactions; combined positive score; functional sur⁃gery; chemotherapy
From: Journal of Prevention and Treatment for Stomatological Diseases 2026;34(2):105-118
CountryChina
Language:Chinese
Abstract: Oral squamous cell carcinoma (OSCC) is a common head and neck malignancy. Approximately 50% to 60% of patients with OSCC are diagnosed at a locally advanced stage (clinical staging III-IVa). Even with comprehensive and sequential treatment primarily based on surgery, the 5-year overall survival rate remains below 50%, and patients often suffer from postoperative functional impairments such as difficulties with speaking and swallowing. Programmed death receptor-1 (PD-1) inhibitors are increasingly used in the neoadjuvant treatment of locally advanced OSCC and have shown encouraging efficacy. However, clinical practice still faces key challenges, including the definition of indications, optimization of combination regimens, and standards for efficacy evaluation. Based on the latest research advances worldwide and the clinical experience of the expert group, this expert consensus systematically evaluates the application of PD-1 inhibitors in the neoadjuvant treatment of locally advanced OSCC, covering combination strategies, treatment cycles and surgical timing, efficacy assessment, use of biomarkers, management of special populations and immune related adverse events, principles for immunotherapy rechallenge, and function preservation strategies. After multiple rounds of panel discussion and through anonymous voting using the Delphi method, the following consensus statements have been formulated: 1) Neoadjuvant therapy with PD-1 inhibitors can be used preoperatively in patients with locally advanced OSCC. The preferred regimen is a PD-1 inhibitor combined with platinum based chemotherapy, administered for 2-3 cycles. 2) During the efficacy evaluation of neoadjuvant therapy, radiographic assessment should follow the dual criteria of Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and immune RECIST (iRECIST). After surgery, systematic pathological evaluation of both the primary lesion and regional lymph nodes is required. For combination chemotherapy regimens, PD-L1 expression and combined positive score need not be used as mandatory inclusion or exclusion criteria. 3) For special populations such as the elderly (≥ 70 years), individuals with stable HIV viral load, and carriers of chronic HBV/HCV, PD-1 inhibitors may be used cautiously under the guidance of a multidisciplinary team (MDT), with close monitoring for adverse events. 4) For patients with a poor response to neoadjuvant therapy, continuation of the original treatment regimen is not recommended; the subsequent treatment plan should be adjusted promptly after MDT assessment. Organ transplant recipients and patients with active autoimmune diseases are not recommended to receive neoadjuvant PD-1 inhibitor therapy due to the high risk of immune related activation. Rechallenge is generally not advised for patients who have experienced high risk immune related adverse events such as immune mediated myocarditis, neurotoxicity, or pneumonitis. 5) For patients with a good pathological response, individualized de escalation surgery and function preservation strategies can be explored. This consensus aims to promote the standardized, safe, and precise application of neoadjuvant PD-1 inhibitor strategies in the management of locally advanced OSCC patients.
Full text:2026020510004002832局部晚期口腔鳞状细胞癌PD-1抑制剂新辅助治疗专家共识（2026年版）.pdf