PD-L1 Score for Head and Neck Cancer: What It Means
CancerHead & Neck Cancer

Your PD-L1 Score: What It Is and How It Determines Head and Neck Cancer Treatment

Your PD-L1 Score: What It Is and How It Determines Head and Neck Cancer Treatment
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Published on April 20, 2026
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When your care team starts discussing treatment for head and neck cancer, you may hear the term “PD-L1,” which stands for “programmed death-ligand 1.” Testing for PD-L1 helps your oncologist determine whether immunotherapy, a treatment that helps your immune system recognize and destroy cancer cells more effectively, might be a good option.

What Is PD-L1, and Why Does It Matter?

PD-L1 is a protein that sits on the surface of cells, and it normally keeps the immune system from attacking healthy tissue. Some cancer cells take advantage of that same protein to protect themselves.

When PD-L1 is present on the surface of a cancer cell, it can connect with another protein called PD-1 on certain immune cells. This interaction tells your immune system not to attack, allowing the tumor to blend in and avoid being recognized.

 It essentially helps cancer cells “hide” from the immune system, says Jeff Yorio, MD, a medical oncologist at Texas Oncology in Austin, Texas.
Testing for PD-L1 has become a standard step for head and neck cancers that have returned (recurrent) or spread to other parts of the body (metastatic).

The results help your oncologist understand if your cancer is using this protein to stay invisible to your immune system. It also helps them determine how your cancer may respond to immunotherapy, especially a class of medications called immune checkpoint inhibitors, says Amanda C. Reyes, MD, a medical oncologist who specializes in head and neck cancers at City of Hope in Duarte, California.

CPS vs. TPS

PD-L1 results are reported as a score calculated in two ways: Combined positive score (CPS) or tumor proportion score (TPS). Both tell your oncologist how much PD-L1 is present, but they measure it differently.

CPS measures the percentage of cells in and around the tumor that carry PD-L1, says Emile Gogineni, DO, a radiation oncologist at The Ohio State University Comprehensive Cancer Center (Arthur G. James Cancer Hospital and Richard J. Solove Research Institute). This includes both tumor cells and nearby immune cells, he says.

CPS is reported as a percentage on a scale of 0 to 100, with anything below 1 considered negative, 1 to 19 considered low, and 20 or above considered high.

TPS, on the other hand, only looks at the percentage of cancer cells themselves that express PD-L1 and does not include surrounding immune cells, says Dr. Gogineni. A TPS score of 1 percent or higher is positive, and 50 percent or higher is considered high, says Dr. Reyes.

Because CPS looks at a larger number of cells and what’s happening in the tumor environment, it’s the scoring method most often used for head and neck cancer, says Dr. Yorio.

How the Test Is Performed

To calculate your PD-L1 score, a sample of the tumor tissue is needed, usually from a biopsy or surgery. The sample is sent to a lab, where it’s checked for PD-L1 using a special staining process — called immunohistochemistry — that makes the protein visible under a microscope.

“Typically, results for this take about five to seven days,” Yorio says, though in some cases, it can take as long as two weeks. “If the biopsy does not have enough cancer cells, it can be difficult to perform the test,” he notes.

What Your Score Means for Your Treatment Options

Your oncologist uses your PD-L1 score with other factors to determine the best treatment option. Treatment often includes immune checkpoint inhibitors (immunotherapy medications) like pembrolizumab (Keytruda) and nivolumab (Opdivo), which help interrupt the PD-L1 connection cancer cells use to hide, so that the immune system can recognize and attack them.

 Your score helps determine if immunotherapy should be used, as well as whether it would be best given alone or with chemotherapy. Generally, a higher CPS suggests a greater likelihood that the cancer will respond to immunotherapy, says Gogineni.

Here’s how CPS ranges are typically used to guide treatment:

CPS Less Than 1 (Negative)

A CPS of less than 1 means PD-L1 was not found at a meaningful level in the tumor cells or surrounding immune cells. In this case, immunotherapy alone is unlikely to work, Reyes says, and a chemotherapy-based approach may be recommended instead.

That said, a negative score does not completely rule out immunotherapy. “There are still some patients who have some benefit from immunotherapy drugs even though their PD-L1 test is negative,” says Yorio.

CPS 1 to 19 (Low Positive)

A CPS between 1 and 19 means PD-L1 is present but at a lower level. While immunotherapy can be used in recurrent and metastatic head and neck cancer when CPS is above 1, it tends to be less effective when the score is below 20, says Reyes.

In this range, combining immunotherapy with chemotherapy often works better than immunotherapy alone.

 But this approach is usually used for people in good health with significant symptoms, since it can carry more side effects, including nausea, vomiting, fatigue, and an increased risk of infection.

 Your oncologist will consider all of this when deciding on a treatment option.

CPS 20 or Above (High)

When a CPS comes back at 20 or above, it suggests the cancer may be using this protein to stay hidden from your immune system.

“High scores can indicate the benefit of single-agent immunotherapy,” says Reyes, meaning an immunotherapy can be used without chemotherapy. Research shows that people with higher CPS scores are more likely to respond well to immunotherapy alone.

Other Factors

Your PD-L1 score is only one important piece of the decision. Gogineni notes that, when putting a treatment plan together, your care team will also consider factors such as:

  • Your overall health
  • The extent and location of the disease
  • Whether your tumor is HPV-positive (a virus that can cause certain head and neck cancers and may affect how the cancer responds to treatment)
  • Previous treatments received
  • Your goals and preferences

If you aren’t feeling well enough to handle the demands of combination therapy, immunotherapy on its own can still be an option, says Reyes.

The Takeaway

  • PD-L1 is a protein that some cancer cells use to avoid being attacked by your immune system, and testing for it helps your care team understand if immunotherapy may be a good option for you.
  • In recurrent or metastatic head and neck cancer, the PD-L1 score helps guide whether immunotherapy will be used on its own or combined with chemotherapy.
  • Higher scores are more likely to respond to immunotherapy alone, while lower scores may still benefit from treatment but often require a combination approach.
  • Your PD-L1 score is just one part of the decision. Your oncologist will also consider your overall health, prior treatments, and other factors to choose the best plan for you.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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