{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T15:10:47Z","timestamp":1789657847508,"version":"4.0.1"},"reference-count":38,"publisher":"American Medical Association (AMA)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"abstract":"\n Importance<\/jats:title>\n Immune checkpoint inhibitors (ICIs) are recommended for recurrent\/metastatic head and neck squamous cell carcinoma (HNSCC), including patients with tumors with a programmed cell death 1 ligand 1 (PD-L1) combined positive score (CPS) of less than 1. However, the benefit of ICIs in this population remains uncertain.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To quantify the probability that ICIs are associated with improved or reduced survival in HNSCC with a PD-L1 CPS of less than 1 compared with standard non-ICI therapy.<\/jats:p>\n <\/jats:sec>\n \n Data Sources<\/jats:title>\n Systematic search of PubMed, Embase, Web of Science, and ClinicalTrials.gov from database inception to January 11, 2026.<\/jats:p>\n <\/jats:sec>\n \n Study Selection<\/jats:title>\n Phase 3 randomized clinical trials comparing ICI-based regimens vs standard non-ICI control in HNSCC reporting outcomes in the subgroup with a PD-L1 CPS of less than 1.<\/jats:p>\n <\/jats:sec>\n \n Data Extraction and Synthesis<\/jats:title>\n \n The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (\n PRISMA<\/jats:ext-link>\n ) reporting guideline was followed. Bayesian random-effects meta-analysis estimated hazard ratios (HRs) with 95% credible intervals (CrIs) and the posterior probability of HR being greater than 1.0 (favoring control), a continuous measure of evidence. Frequentist random-effects meta-analysis also estimated HRs with 95% CIs and\n P<\/jats:italic>\n values to assess statistical significance. All processes were performed independently by at least 2 reviewers, with discrepancies resolved through discussion or adjudication by a senior investigator.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was overall survival (OS), and the secondary outcome was a composite of disease-free survival (DFS), progression-free survival (PFS), and event-free survival (EFS).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The meta-analysis included 7 randomized clinical trials from 2018 to 2025 involving 630 patients with tumors with a PD-L1 CPS of less than 1. In the recurrent\/metastatic setting (3 trials), the bayesian HR for OS was 1.42 (95% CrI, 0.93-2.06), with a posterior probability of an HR exceeding 1.0 of 95.6%. The frequentist HR was 1.46 (95% CI, 1.17-1.83;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). In the locally advanced setting (4 trials), the bayesian HR for the composite of DFS, PFS, and EFS was 1.19 (95% CrI, 0.72-2.06), with posterior probability of an HR exceeding 1.0 of 76.8%. Across all trials, the bayesian HR was 1.43 (95% CrI, 0.97-2.07) for OS (4 trials) and 1.30 (95% CrI, 0.94-1.75) for the composite of DFS, PFS, and EFS (6 trials), with posterior probability of an HR exceeding 1.0 of 96.2% and 95.5%, respectively. The frequentist HRs were 1.47 (95% CI, 1.18-1.83) for OS and 1.31 (95% CI, 1.02-1.69) for the composite of DFS, PFS, and EFS.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This systematic review and meta-analysis found a high bayesian probability, alongside frequentist statistical significance, that ICIs were associated with reduced OS in patients with HNSCC with a PD-L1 CPS of less than 1. These subgroup-derived findings warrant validation and cautious use in this understudied population.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaoncol.2026.3626","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T15:00:38Z","timestamp":1789657238000},"source":"Crossref","is-referenced-by-count":0,"title":["Immunotherapy in Head and Neck Squamous Cell Carcinoma With PD-L1 Combined Positive Score Less Than 1"],"prefix":"10.1001","author":[{"given":"Meile","family":"Jin","sequence":"first","affiliation":[{"name":"Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songchen","family":"Shi","sequence":"additional","affiliation":[{"name":"Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhonghui","family":"Li","sequence":"additional","affiliation":[{"name":"Shenzhen 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