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.
Kerana disyaki adanya hepatitis yang disebabkan oleh kekebalan tubuh, rawatan dengan prednisolon (100 mg / hari) dimulakan, dan parameter hati berkurang dengan ketara. Walaupun begitu, pemberian ipilimumab dan nivolumab berterusan, dan 3 minggu selepas pemberian kedua ipilimumab, faktor reumatoid dan enzim hati meningkat tetapi menurun lagi setelah memulakan semula prednisolon. Pada 8 minggu setelah bermulanya rawatan, imbasan CT menunjukkan bahawa tumornya berkurang dengan ketara, dan 4 bulan setelah rawatan (Gambar b), remisi hampir lengkap (Gambar c).
Pesakit ini mencapai pengampunan sepenuhnya setelah 4 bulan menjalani rawatan, dengan kesan sampingan yang sederhana dan terbalik. Oleh itu, penggunaan gabungan nivolumab dan ipilimumab boleh menjadi pilihan rawatan yang menjanjikan untuk karsinoma sel skuamosa metastatik refraktori di kepala dan leher. Beberapa percubaan membandingkan keberkesanan kaedah imuno-onkologi dengan rejimen kemoterapi standard, dan kami sangat menantikan hasilnya.
