Clinical trials in head and neck cancer and especially head and neck surgery present significant challenges including diversity primary sites and staging, patients compliance, and high disease and treatment related burdens. Nevertheless in recent years the number of surgical trials has dramatically increased and this is largely due to innovative trial designs and strategies that have coincided with treatment innovations such as antiPD-1 checkpoint immunotherapy. Major challenges remain to be overcome with regards to the evolution of trial design, health care inequities, therapeutic strategies. This panel seeks to explore some key factors that have led to novel strategies and successes in trial designs and remaining barriers yet to be overcome.