While the standard for adjuvant head and neck cancer treatment hasn't changed since 2004, a new trial using perioperative pembrolizumab is forcing clinicians to rethink their entire workflow, starting with diagnosis. In this episode of the BackTable Podcast, head and neck surgical oncologist Dr. Adam Luginbuhl is joined by colleagues Dr. Dylan Roden and Dr. Ravindra Uppaluri to discuss the implementation and implications of the Keynote-689 trial, which introduced neoadjuvant and adjuvant immunotherapy for locally advanced head and neck cancer.---SYNPOSISThe doctors discuss the trial details, FDA approval, and practical challenges of integrating this new paradigm into clinical practice. The conversation covers critical points such as the necessity of CPS score testing, timely drug administration, patient monitoring, and the importance of collaboration among multidisciplinary teams.---TIMESTAMPS00:00 - Introduction02:18 - Keynote-689 Trial Explained04:42 - Implementation Challenges and Strategies06:40 - Practical Considerations for CPS Testing13:59 - Case Studies and Real-World Applications30:48 - Future Directions and Final Thoughts---RESOURCESKeynote-689https://www.nejm.org/doi/full/10.1056/NEJMoa24154342004 Cisplatin Phase III Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa032646