Meanwhile, KEYNOTE-048, a randomized, phase III study, stated that pembrolizumab with chemotherapy (platinum and 5-fluorouracil) was effective and safe as a first-line treatment for R/M HNSCC patients (43% were HPV+), and pembrolizumab alone was an appropriate first-line therapy for PD-L1 positive patients (71). This evidence concerns the gene CD274 and head and neck squamous cell carcinoma.