Inclusion of patients with ECOG PS2 in our real-world cohort is likely to have impacted results; however, since patients with ECOG PS0-1 also had inferior OS than the patients enrolled in KEYNOTE-048, a deeper understanding of clinical variables that might affect survival outcomes of patients with R/M HNSCC beyond ECOG PS and PD-L1 CPS is urgently needed. The gene discussed is CD274; the disease is head and neck squamous cell carcinoma.