The use of immunotherapy in the first line of treatment for patients with high expression of PD-L1 was anticipated in 2019 by Saada-Bouzid et al., who mentioned the potential of immunotherapy with Pemrolizumab to become first-line treatment in recurrent and metastatic HNSCC, particularly for patients with high PD-L1 levels [15]. The gene discussed is CD274; the disease is head and neck squamous cell carcinoma.