Treatment Response of Gingival Squamous-Cell Carcinoma to Palliative Intent Immunotherapy

Round 1

Reviewer 1 Report

This study is interesting with clinical significance. Immunotherapy has revolutionized the tumor therapy. The authors put forward a new and comprehensive point of view on of immune checkpoint inhibitors treatment on Gingival Squamous Cell Carcinoma. The followings are some comments to the authors.

Comments:

1. PD-L1 expression is an important factor affecting immunotherapy. PD-L1 expression in the 3 patients is different. How to explain the influence of this difference on efficacy? I suggest the authors explain that in the discussion section.

2. MSI-H/dMMR is also an important factor affecting immunotherapy. Whether the 3 patients were tested for MSI-H/dMMR? If so, please provide the test results.

3. The three patients received different treatments before immunotherapy. Please explain whether these differences affect the efficacy of immunotherapy in the discussion section.

4. The dosage and dosing interval of pembrolizumab is different for Patient #3 and Patient #1/ 2 (Patient #3:The standard infusion dosage of 200 mg every 3 weeks was initially administered at first. Once tolerance was established, the transition was made to extended dosing: 400 mg every 6 weeks) . Please explain whether this difference has any effect on the efficacy of pembrolizumab in the discussion section.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

The authors investigated a really interesting question, whether the use of PD-1 immune checkpoint inhibitor medications may have efficacy in locally advanced cases as a part of first line therapy. The introduction is well-written, summarize the current knowledge about mechanism of effect of PD-1 immune checkpoint inhibitor medications. Authors presented two cases, where significant regression could be observed. The initial results are very promising, and further investigation/cases/follow-up with well-defined criteria are needed. I recommend the manuscript for publication.

Author Response

Please see the attachment

Author Response File: Author Response.pdf