Despite a decline in the incidence of squamous cell carcinomas (SCCs) over the past 20 years, their survival rate has remained nearly the same, indicating that treatment options have not improved relative to other cancer types. Immunotherapies have a high potential for a sustained effect in SCC patients, but their response rate is low.Here, we review the suppressive role of transforming growth factor-beta (TGFβ) on the antitumor immune response in SCC and present its potential as a therapeutic target in combination with the current range of immunotherapies available for SCC patients. We conclude that SCCs are an optimal cancer type to study the effectiveness of TGFβ inhibition due to the prevalence of dysregulated TGFβ signaling in them. K E Y W O R D S head and neck squamous cell carcinoma, immune checkpoint blockade, immunotherapy, tumor microenvironment 1 | INTRODUCTION Squamous cell carcinomas (SCCs) are cancers that arise from areas of stratified epithelium and are primarily found in the skin, lung, and the epithelial lining of the oropharyngeal and nasopharyngeal cavities.Although skin SCC incidence cannot be estimated because most cancer registries do not collect data on it, deaths associated with nonmelanoma skin cancer, which is primarily SCC, exceed melanoma deaths due to the high number of SCC cases. 1 Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide and accounts for 53,000 new cases each year in the United States. 2 Although its incidence has decreased slightly, its mortality rate has slightly increased since 2012, 2 indicating that current therapeutic options for patients with HNSCC have stagnated and novel therapeutics have not yet improved the majority of patient outcomes. The current standard of care is a combination of radiotherapy, surgery, and chemotherapy; patients who do not respond to those typically have incurable recurring metastatic disease. The primary causes of HNSCC are either HPV or heavy tobacco and alcohol use. HPV -HNSCCs are associated with worse prognoses and a less inflammatory immune microenvironment. 3It is long established that mutagen-induced SCC results in elevated levels of secreted transforming growth factor-beta (TGFβ) in the tumor microenvironment. 4 The TGFβ signaling pathway has been reviewed in depth elsewhere, 5,6 and is summarized here in Figure 1.Briefly, when the TGFβ receptor complex binds TGFβ ligand, it phosphorylates receptor-associated Smad2 and Smad3 proteins. Smad2 and Smad3 form a complex with Smad4, which translocates to the nucleus, binds to Smad binding elements on genetic loci, and regulates numerous transcriptional pathways. The TGFβ receptor complex also activates numerous noncanonical signaling pathways independently of Smad proteins. In tobacco and alcohol-associated cases, HNSCC is often preceded by dysregulation of TGFβ signaling, resulting in elevated levels of TGFβ within a tumor while tumor cells Abbreviations: CAF, cancer-associated fibroblast; CTL, cytotoxic T lymphocyte; HNSCC, head and neck squamous ...