We are grateful for the insightful comments made by Dr Marioni regarding the evidence for survivin as a prognostic biomarker in head and neck squamous cell carcinoma (HNSCC) [1], omitted from our review for reasons of space. We agree that targeting survivin in HNSCC is a strategy worthy of exploration, though, at present, limited numbers of patients treated in clinical trials [2, 3] prevent us from making conclusions regarding efficacy. Certainly, any advances in the systemic management of this challenging group of tumours would be welcome given the substantial burden of disease due to HNSCC, as highlighted by Dr Marioni.