Background: Recurrent and metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) has poor survival rates. Immunotherapy is the standard of care for R/M HNSCC, but objective responses occur in a minority of patients. Toll-like receptor (TLR) agonists promote antitumor immune responses and have been explored in clinical trials. Methods: A search for clinical trials using TLR agonists in HNSCC was performed under PRISMA guidelines. Data on patient characteristics, safety, and efficacy were collected and analyzed. Results: Three phase 1b trials with 40 patients and three phase 2 trials with 352 patients studying TLR8 and TLR9 agonists in combination with other treatment regimens for HNSCC were included. In phase 2 trials, there was no significant change in the objective response rate (RR = 1.13, CI 0.80–1.60) or association with increased grade 3+ adverse events (RR = 0.91, CI 0.76–1.11) associated with TLR agonist use. Conclusion: TLR agonists do not appear to provide additional clinical benefits or increase adverse events in the treatment of HNSCC. Given these results across multiple clinical trials and drug regimens, it is unlikely that additional trials of TLR agonists will demonstrate clinical benefits in HNSCC.

The COVID-19 pandemic caused major disruptions to healthcare services in 2020, delaying cancer diagnosis and treatment. While early-stage thyroid cancer often progresses slowly, it is crucial to determine whether treatment delays associated with the pandemic have impacted the clinical presentation and management of advanced-stage thyroid cancer. The purpose of our study was to determine the impact of the early COVID-19 pandemic on thyroid cancer presentation and treatment times. Utilizing the National Cancer Database, chi-squared tests and regression analyses were performed to compare patient demographic and clinical characteristics over time for 56,011 patients diagnosed with primary thyroid cancer who were treated at the Commission on Cancer-accredited sites in 2019 and 2020. We found that thyroid cancer diagnoses decreased between 2019 and 2020, with the biggest drop among patients with cT1 disease relative to other T stages. We also found that patients diagnosed with thyroid cancer in 2020 had similar treatment times to patients diagnosed in 2019, as measured by both the time between diagnosis and start of treatment and the time between surgery and start of radioactive iodine therapy. Overall, our study suggests that resources during the pandemic were allocated to patients with advanced thyroid disease, despite a decrease in diagnoses.

Background/Objectives: The COVID-19 pandemic led to unprecedented disruptions to cancer care, including the care of head and neck cancer. Given the necessity of timely treatment for mucosal cancers, it is important to understand how the pandemic affected the diagnosis, presentation, and treatment of mucosal head and neck cancer. Methods: The National Cancer Database was queried for patients with primary head and neck mucosal cancer. The number of annual diagnoses and the number of days between diagnosis and the start and end of any treatment were tracked over time from 2004 to 2020. Chi-square tests were used to compare differences in patient clinical and demographic characteristics in 2019 and 2020 to provide the most direct comparison. Multivariable linear regression and logic regression analyses were also used to compare three treatment quality measures between 2019 and 2020: number of days between diagnosis and start of treatment, number of days between surgery and start of postoperative radiation, and number of days between surgery and end of radiation. Results: The number of mucosal cancer diagnoses decreased (9.1%) during the early stages of the pandemic, with a larger decrease (12.4%) among patients receiving surgery. On multivariable analysis comparing 2020 to 2019, time to treatment was shorter (2.3 days; 95% CI, 1.69 to 2.85 days), and time from surgery to start of postoperative radiation was less likely to be delayed (OR, 0.91 of radiation greater than 42 days from surgery; 95% CI, 0.85 to 0.97). However, patients who were black, female, older, or uninsured were more likely to experience treatment delays. Conclusions: Overall, there were no treatment delays for patients with surgical head cancer and patients with neck cancer during the COVID-19 pandemic. However, vulnerable groups, such as patients who were black, female, older, and uninsured, were at higher risk of experiencing treatment delays.