[Immunology of aging in head and neck cancer : From the tumor microenvironment to translational approaches and clinical response].

The immune system undergoes profound age-related changes that manifest as impaired immune function (immunosenescence) and chronic low-grade inflammation (inflammaging), both of which may influence the tumor biology of head and neck squamous cell carcinoma. While phenotypic analyses of peripheral and intratumoral immune cells have so far shown few age-associated differences, omics studies have identified senescence-related signatures linked to poor prognosis and reduced immune activity. Emerging translational data suggest that senolytic therapies may overcome mechanisms of immunosenescence-driven resistance to immune checkpoint inhibitors. Clinical trials and real-world evidence consistently demonstrate that current immunotherapies are effective and well tolerated in older patients. Overall, biological age-captured, for example, through geriatric frailty assessments or molecular markers-appears more relevant for tumor biology and therapeutic decision-making than mere chronological age.