In patients with metastatic malignant melanoma, the combination of ipilimumab ( CTLA4 antibody) and programmed death (PD)-1 inhibitor nivolumab can significantly improve the prognosis compared with monotherapy . Based on these results, the combination of nivolumab and ipilimumab has been approved by the FDA for the treatment of patients with unresectable or metastatic melanoma. So far, there is no data on the combined use of nivolumab and ipilimumab for squamous cell head and neck cancer. According to the latest report, a 46-year-old man with refractory squamous cell head and neck cancernivolumabThe combined ipilimumab treatment was very successful.
In December 2016, a poorly differentiated squamous cell carcinoma of the tongue pT1, pN2b, L1, V0, G3 was diagnosed. There are no signs of human papillomavirus infection. After R0 resection and cervical lymphadenectomy, he received adjuvant chemoradiotherapy with cisplatin 35 mg/m2 weekly.
In April 2016, a neck CT scan showed a significant increase in cervical lymph nodes. Biopsy confirmed lymph node metastasis with no signs of further metastasis. Can not be surgically removed, so 5-FU, cisplatin and cetuximab were used for systemic intensive chemotherapy. CT scans after two cycles showed poor disease stability (Figure a).
The patient had a positive PD-L1 expression. Due to the lack of other treatment options, nivolumab (3 mg/kg body weight every 2 weeks) and ipilimumab (1 mg/kg every 6 weeks) were started in July 2016. It is worth noting that the patient has long-term autoimmune hepatitis. Ten days after the start of treatment, an increase in rheumatoid factor and liver enzymes was detected. Liver MRI showed no pathological abnormalities and hepatitis serology was negative.
A causa del sospetto di una potenziale epatite immuno-indotta, è stato avviato il trattamento con prednisolone (100 mg/die) e i parametri epatici sono stati significativamente ridotti. Tuttavia, la somministrazione continua di ipilimumab e nivolumab e 3 settimane dopo la seconda somministrazione di ipilimumab, il fattore reumatoide e gli enzimi epatici sono aumentati ma sono nuovamente diminuiti dopo la ripresa del prednisolone. A 8 settimane dall'inizio del trattamento, le scansioni TC hanno mostrato che il tumore era significativamente ridotto e 4 mesi dopo il trattamento (Figura b), remissione quasi completa (Figura c).
Questo paziente ha raggiunto la remissione completa dopo 4 mesi di trattamento, con effetti collaterali moderati e reversibili. Pertanto, l'uso combinato di nivolumab e ipilimumab può diventare un'opzione di trattamento promettente per il carcinoma a cellule squamose metastatico refrattario della testa e del collo. Diversi studi stanno confrontando l'efficacia dei metodi immuno-oncologici con i regimi chemioterapici standard e attendiamo con impazienza i risultati.
