Pembrolizumab in the Precision Immunotherapy of Sinonasal Malignancies

Abstract

Sinonasal carcinoma constitutes a rare subset of head and neck tumors. The majority of patients are diagnosed at a locally advanced stage, and the prognosis following recurrence or metastasis is extremely poor. Pembrolizumab is a humanized monoclonal antibody that targets programmed death-1 (PD-1) and reactivates T-cell-mediated antitumor immunity by disrupting the PD-1/PD-L1 signaling axis. This review systematically summarizes the research progress of this agent in treating these malignancies, focusing on its mechanism, key clinical data, current indications, and safety management. Published evidence indicates that combining this antibody with chemotherapy yields encouraging efficacy as frontline therapy for recurrent/metastatic sinonasal squamous cell carcinoma (SSCC). A phase II trial demonstrated that 12 of 20 patients achieved a response, resulting in an objective response rate (ORR) of 60% and a disease control rate (DCR) of 100%, with a median progression-free survival (PFS) of 12.2 months. Individuals with a PD-L1 combined positive score (CPS) ≥20 derived more pronounced benefit, and the overall toxicity was manageable. Future efforts should aim to refine biomarker-driven strategies, explore combination regimens, and accumulate evidence for rare pathological subtypes, thereby advancing precision immunotherapy for these tumors.