Pembrolizumab for neoadjuvant and adjuvant treatment of resectable locally advanced head and neck squamous cell carcinoma

Section 7 of the National Institute for Health and Care Excellence (Constitution and Functions) and the Health and Social Care Information Centre (Functions) Regulations 2013 requires integrated care boards, NHS England and, with respect to their public health functions, local authorities to comply with the recommendations in this evaluation within 90 days of its date of publication.

Chapter 2 of Appraisal and funding of cancer drugs from July 2016 (including the new Cancer Drugs Fund) – A new deal for patients, taxpayers and industry states that for those drugs with a draft recommendation for routine commissioning, interim funding will be available (from the overall Cancer Drugs Fund budget) from the point of marketing authorisation, or from release of positive draft guidance, whichever is later. Interim funding will end 90 days after positive final guidance is published (or 30 days in the case of drugs with an Early Access to Medicines Scheme designation or cost comparison evaluation), at which point funding will switch to routine commissioning budgets. The NHS England Cancer Drugs Fund list provides up-to-date information on all cancer treatments recommended by NICE since 2016. This includes whether they have received a marketing authorisation and been launched in the UK.

The Welsh ministers have issued directions to the NHS in Wales on implementing NICE technology appraisal guidance. When a NICE technology appraisal guidance recommends the use of a drug or treatment, or other technology, the NHS in Wales must usually provide funding and resources for it within 60 days of the first publication of the final draft guidance.

When NICE recommends a treatment 'as an option', the NHS must make sure it is available within the period set out in the paragraphs above. This means that, if a patient has resectable locally advanced head and neck squamous cell carcinoma and the healthcare professional responsible for their care thinks that pembrolizumab is the right treatment, it should be available for use, in line with NICE's recommendations.

Pembrolizumab can be used, within its marketing authorisation, as an option to treat resectable locally advanced head and neck squamous cell carcinoma in adults whose tumours express PD‑L1 with a combined positive score of 1 or more: • as neoadjuvant monotherapy • then as adjuvant treatment with radiotherapy, with or without cisplatin • then as monotherapy. Pembrolizumab can only be used if the company provides it according to the commercial arrangement . as neoadjuvant monotherapy then as adjuvant treatment with radiotherapy, with or without cisplatin then as monotherapy. Pembrolizumab can only be used if the company provides it according to the commercial arrangement . Pembrolizumab must be funded in the NHS in England for the condition and population in the recommendations, if it is considered the most suitable treatment option. Pembrolizumab must be funded in England within 90 days of final publication of this guidance. There is enough evidence to show that pembrolizumab provides benefits and value for money, so it can be used routinely across the NHS in this population. NICE has produced tools and resources to support the implementation of this guidance . Usual treatment for resectable locally advanced head and neck squamous cell carcinoma is surgery. After surgery (known as adjuvant treatment) people can have radiotherapy with or without cisplatin. There are no treatments available before surgery (known as neoadjuvant treatment). Clinical trial evidence shows that neoadjuvant and adjuvant pembrolizumab increases how long people have before their condition gets worse. The evidence also suggests that it may increase how long people live compared with usual treatment. The most likely cost-effectiveness estimates for neoadjuvant and adjuvant pembrolizumab are within the range that NICE considers an acceptable use of NHS resources. So, it can be used. For all the evidence, see the committee papers . For more information on streamlined evaluations, see NICE's technology appraisal and highly specialised technologies guidance manual .

Pembrolizumab (Keytruda, MSD) as monotherapy is indicated 'for the treatment of resectable locally advanced head and neck squamous cell carcinoma as neoadjuvant treatment, continued as adjuvant treatment in combination with radiation therapy with or without concomitant cisplatin and then as monotherapy in adults whose tumours express PD-L1 with a CPS ≥ 1'.

The dosage schedule is available in the summary of product characteristics for pembrolizumab .

The list price is £2,630.00 per 100 mg vial (excluding VAT; BNF online accessed March 2026).

The company has a commercial arrangement . This makes pembrolizumab available to the NHS with a discount. The size of the discount is commercial in confidence.

For information, the Carbon Reduction Plan for UK carbon emissions is published on MSD's webpage on responsibility .

Pembrolizumab can be used, within its marketing authorisation, as an option to treat resectable locally advanced head and neck squamous cell carcinoma in adults whose tumours express PD‑L1 with a combined positive score of 1 or more: • as neoadjuvant monotherapy • then as adjuvant treatment with radiotherapy, with or without cisplatin • then as monotherapy. Pembrolizumab can only be used if the company provides it according to the commercial arrangement . as neoadjuvant monotherapy then as adjuvant treatment with radiotherapy, with or without cisplatin then as monotherapy. Pembrolizumab can only be used if the company provides it according to the commercial arrangement . Pembrolizumab must be funded in the NHS in England for the condition and population in the recommendations, if it is considered the most suitable treatment option. Pembrolizumab must be funded in England within 90 days of final publication of this guidance. There is enough evidence to show that pembrolizumab provides benefits and value for money, so it can be used routinely across the NHS in this population. NICE has produced tools and resources to support the implementation of this guidance . Usual treatment for resectable locally advanced head and neck squamous cell carcinoma is surgery. After surgery (known as adjuvant treatment) people can have radiotherapy with or without cisplatin. There are no treatments available before surgery (known as neoadjuvant treatment). Clinical trial evidence shows that neoadjuvant and adjuvant pembrolizumab increases how long people have before their condition gets worse. The evidence also suggests that it may increase how long people live compared with usual treatment. The most likely cost-effectiveness estimates for neoadjuvant and adjuvant pembrolizumab are within the range that NICE considers an acceptable use of NHS resources. So, it can be used. For all the evidence, see the committee papers . For more information on streamlined evaluations, see NICE's technology appraisal and highly specialised technologies guidance manual .

Pembrolizumab can be used, within its marketing authorisation, as an option to treat resectable locally advanced head and neck squamous cell carcinoma in adults whose tumours express PD‑L1 with a combined positive score of 1 or more: • as neoadjuvant monotherapy • then as adjuvant treatment with radiotherapy, with or without cisplatin • then as monotherapy. Pembrolizumab can only be used if the company provides it according to the commercial arrangement . as neoadjuvant monotherapy then as adjuvant treatment with radiotherapy, with or without cisplatin then as monotherapy. Pembrolizumab can only be used if the company provides it according to the commercial arrangement . Pembrolizumab must be funded in the NHS in England for the condition and population in the recommendations, if it is considered the most suitable treatment option. Pembrolizumab must be funded in England within 90 days of final publication of this guidance. There is enough evidence to show that pembrolizumab provides benefits and value for money, so it can be used routinely across the NHS in this population. NICE has produced tools and resources to support the implementation of this guidance . Usual treatment for resectable locally advanced head and neck squamous cell carcinoma is surgery. After surgery (known as adjuvant treatment) people can have radiotherapy with or without cisplatin. There are no treatments available before surgery (known as neoadjuvant treatment). Clinical trial evidence shows that neoadjuvant and adjuvant pembrolizumab increases how long people have before their condition gets worse. The evidence also suggests that it may increase how long people live compared with usual treatment. The most likely cost-effectiveness estimates for neoadjuvant and adjuvant pembrolizumab are within the range that NICE considers an acceptable use of NHS resources. So, it can be used. For all the evidence, see the committee papers . For more information on streamlined evaluations, see NICE's technology appraisal and highly specialised technologies guidance manual .