The TMB level of PIK3CA-Mut patients was higher than PIK3CA-WT patients in both MSKCC (Median [IQR]: 7.02[4.92-10.53] vs. 4.91[2.63-7.90], P=0.006) and TCGA (Median [IQR]: 3.03[1.98-4.42] vs. 2.62[1.66-3.92], P=0.045) cohort….PIK3CA-Mut is associated with higher TMB in ICI-treated HNSC patients. Survival analysis shows PIK3CA-Mut have a good link with longer OS after immunotherapy. These findings indicate that PIK3CA mutation may serve as a potential predictive biomarker for ICIs in HNSC.