**5. Future directions**

Large-scale clinical trials are difficult in hypopharyngeal tumors due to the poor prognosis and uncommon incidence of such tumors. The future direction in the management of hypopharyngeal cancers is the use of immunotherapy [46]. The role of immune checkpoint inhibitors like Pembrolizumab and Nivolumab has shown promising results in recurrent or metastatic head and neck squamous cell carcinomas [47, 48]. New studies must be done to assess the effectiveness of these agents in larynx preservation. The expression of ERCC1 as a predictive biomarker in head and neck cancers including hypopharynx for chemotherapy response to 5-FU/cisplatin for both organ preservation and survival has been identified [49]. Validation of the various biomarkers is required to select the ideal candidates that can benefit from various treatments.
