Surgical Margin Reduction After Immunotargeted Neoadjuvant Therapy in Locally Advanced Hypopharyngeal Carcinoma - Preliminary Margin Results from neoCHANCE-1 Trial

Sep 22, 2026

Upload by Logic

Importance: Hypopharyngeal squamous cell carcinoma (HPSCC) is aggressive with poor outcomes, and neoadjuvant therapy (NAT) may enable organ preservation; however, defining safe surgical margins after NAT remains challenging. Objective: Evaluate the safety of reduced surgical margins after NAT with tislelizumab and afatinib versus an upfront surgery control by comparing pathological margins. Design: Prospective, single-center pilot cohort. Setting: Tertiary referral center in Western China.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Importance

Objective

Design

Setting

Participants

Intervention or Exposures

Main Outcome Measures

Results

Conclusions

Relevance

Key Messages

Pathological response and outcomes

Margin findings

Clinical implications

Surgical Margin Reduction After Immunotargeted Neoadjuvant Therapy in Locally Advanced Hypopharyngeal Carcinoma: A Preliminary Margin Results from neoCHANCE-1 Trial Journal of Otolaryngology-Head & Neck Surgery Volume 55: 1–10 © The Author(s) 2026 Article reuse guidelines: [sagepub.com/journals-permissions](sagepub.com/journals-permissions)[ ](sagepub.com/journals-permissions)[DOI: 10.1177/19160216251415526](DOI: 10.1177/19160216251415526)[ ](DOI: 10.1177/19160216251415526)[journals.sagepub.com/home/ohn](journals.sagepub.com/home/ohn) Dejuan Wang, MD1 ,2*, Jixing Wei, MD3*, Zheng Jiang, MD, MPH 1 ,2,3*, Zhigong Wei, MD, PhD3*, Mailudan Ainiwaer, MD 1 ,2, Pengwei Zhao, MD 1 ,2, Lixiao Fan, MD 1 ,2, Longhao Wang, MD, PhD 1 ,2, Leyu Li, MD 1 ,2, Dapeng Lei, MD, PhD4, Fei Chen, MD, PhD 1 ,2, Huijiao Chen, MD, PhD5, Xingchen Peng, MD, PhD3, and Jun Liu, MD, PhD 1 ,2 Abstract Importance. Hypopharyngeal squamous cell carcinoma (HPSCC) is an aggressive cancer with poor outcomes. Neoadjuvant therapy (NAT) may allow organ preservation, but determining safe surgical margins after NAT is a critical challenge. Objective. To evaluate the safety of reduced surgical margins after neoadjuvant tislelizumab and afatinib in locally advanced HPSCC by comparing pathological margins to an upfront surgery control group. Design. Prospective, single-center pilot cohort study. Setting. Tertiary referral center in Western China. Participants. Forty-one patients with locally advanced HPSCC; 32 received NAT (treatment group), and 9 served as an upfront surgery control group. Intervention or Exposures. Treatment group: 2 cycles of neoadjuvant tislelizumab plus 6 weeks of afatinib. Control group: upfront surgery. Both groups underwent resection with a 1.5 cm naked-eye surgical margin. Main Outcome Measures. Primary outcomes were minimal peripheral surgical margin (MPSM) and minimal deep surgical margin (MDSM). Secondary outcomes included radiological (RECIST v1.1) and pathological tumor response. Results. The NAT group had a 20/32 (62.5%) radiological objective response rate and a 16/32 (50.0%) major pathological response rate [including 9/32 (28.13%) pathological complete response]. The mean MPSM was significantly greater in the treatment group versus control [3.38 mm vs 1.71 mm; 95% Confidence interval (CI): 0.10-3.24; P = .038]. The mean MDSM was also significantly greater in the treatment group versus control (2.09 mm vs 1.04 mm; 95% CI: 0.12-1.97; P = .029). Conclusions. Combined immune-targeted NAT effectively downstages HPSCC. The significantly larger pathological margins observed support that reducing clinical surgical margins after this regimen is generally safe. Relevance. This NAT regimen may allow for less extensive resections, facilitating laryngeal preservation and improving quality of life without compromising oncologic safety. Larger validation studies are needed. Keywords hypopharyngeal cancer, surgical margin, neoadjuvant therapy, PD-1, EGFR Received September 6, 2025; accepted December 21, 2025. Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ([https://us.sagepub.com/en-us/nam/open-access-at-sage](https://us.sagepub.com/en-us/nam/open-access-at-sage)). Graphical Abstract 1 Department of Otolaryngology—Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China 2Head and Neck Surgical Center, West China Hospital, Sichuan University, Chengdu, China 3Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China 4Department of Otorhinolaryngology, Qilu Hosp

FAQs

What clinical question does the neoCHANCE-1 study address?

It evaluates whether reducing surgical margins after neoadjuvant therapy with tislelizumab plus afatinib is safe by comparing pathological margin outcomes with an upfront surgery control group.

How was neoadjuvant therapy administered in the treatment group?

Patients received 2 cycles of neoadjuvant tislelizumab combined with 6 weeks of afatinib before surgery.

What were the main margin findings between groups?

Compared with the upfront surgery group, the NAT group showed significantly larger minimal peripheral surgical margin (3.38 mm vs 1.71 mm) and minimal deep surgical margin (2.09 mm vs 1.04 mm), supporting the safety of margin reduction after this regimen.

Sep 22, 2026

Upload by Logic