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.
Due to suspicion of potential immune-induced hepatitis, treatment with prednisolone (100 mg/day) was started, and liver parameters were significantly reduced. Nevertheless, continued administration of ipilimumab and nivolumab, and 3 weeks after the second administration of ipilimumab, rheumatoid factor and liver enzymes increased but decreased again after restarting prednisolone. At 8 weeks after the start of treatment, CT scans showed that the tumor was significantly reduced, and 4 months after treatment (Figure b), almost complete remission (Figure c).
This patient achieved complete remission after 4 months of treatment, with moderate and reversible side effects. Therefore, the combined use of nivolumab and ipilimumab may become a promising treatment option for refractory metastatic squamous cell carcinoma of the head and neck. Several trials are comparing the efficacy of immuno-oncology methods with standard chemotherapy regimens, and we are eagerly awaiting the results.