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.
På grunn av mistanke om potensiell immunindusert hepatitt ble behandling med prednisolon (100 mg/dag) startet, og leverparametere ble betydelig redusert. Likevel, fortsatt administrering av ipilimumab og nivolumab, og 3 uker etter andre administrering av ipilimumab, økte revmatoidfaktor og leverenzymer, men reduserte igjen etter restart av prednisolon. 8 uker etter behandlingsstart viste CT-skanning at svulsten var betydelig redusert, og 4 måneder etter behandling (Figur b), nesten fullstendig remisjon (Figur c).
Denne pasienten oppnådde fullstendig remisjon etter 4 måneders behandling, med moderate og reversible bivirkninger. Derfor kan kombinert bruk av nivolumab og ipilimumab bli et lovende behandlingsalternativ for ildfast metastatisk plateepitelkarsinom i hode og nakke. Flere studier sammenligner effekten av immuno-onkologiske metoder med vanlige cellegiftkurer, og vi venter spent på resultatene.
