Key Takeaways
- Two years after treatment, 77.8% of patients who got camrelizumab plus chemotherapy around surgery were event-free, versus 46.1% with surgery-based treatment alone.
- In one in four patients on the immunotherapy regimen, no cancer could be found in the removed tissue — versus none in the control group.
- This was a small phase 2 trial in China, and the drug is not approved in Canada, so the result needs a larger trial before it changes practice.
Treat before surgery, keep treating after — and the cancer stays away
For locally advanced head and neck cancer, surgery has always been the main event, with treatment before or after it playing a supporting role. A randomized trial published Thursday in JAMA Oncology suggests flipping that emphasis: giving the immunotherapy drug camrelizumab with chemotherapy before surgery, then continuing it afterwards, sharply cut the risk of the cancer coming back or the patient dying.
In the CAMORAL trial, 125 patients with resectable stage III–IVB head and neck squamous cell carcinoma at four Chinese hospitals were randomized to the immunotherapy regimen or to upfront surgery with standard follow-up treatment. Two years on, 77.8% of the immunotherapy group were event-free, versus 46.1% of controls — a hazard ratio of 0.34, meaning the risk of an event was cut by about two-thirds. Survival at two years, a secondary measure, was 92.0% versus 69.1%.
The surgical specimens told the same story: in 25.4% of immunotherapy patients, pathologists found no remaining cancer in the removed tissue at all, and nearly half had a major pathological response. In the control group, there were no complete or major responses.
The honest limits
The benefit came with heavier side effects: serious (grade 3 or worse) treatment-related adverse events affected 79.4% of the immunotherapy group versus 56.5% of controls. And the caveats matter: this is a phase 2 trial of just 125 patients, run in one country, with most tumours in the oral cavity; median follow-up was about two years; and camrelizumab is not approved in Canada, the United States or Europe. One co-author is affiliated with the drug's manufacturer, Jiangsu Hengrui Pharmaceuticals.
A health note: this research does not change any Canadian patient's treatment today. Head and neck cancer care is individualized by an oncology team, and anyone weighing trial options should raise results like these with their oncologist rather than seeking the drug independently.
The Twikup Take
A hazard ratio of 0.34 with a quarter of tumours gone before the pathology report is the kind of phase 2 result that earns a big phase 3, fast. It also fits the pattern reshaping cancer care: immunotherapy works best when it is given while the tumour is still there to teach the immune system what to hunt.
Image: Illustrative image.