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.
Por suspeita de potencial hepatite imunoinduzida, foi iniciado tratamento com prednisolona (100 mg/dia), com redução significativa dos parâmetros hepáticos. No entanto, a administração continuada de ipilimumab e nivolumab, e 3 semanas após a segunda administração de ipilimumab, o fator reumatóide e as enzimas hepáticas aumentaram, mas diminuíram novamente após o reinício da prednisolona. 8 semanas após o início do tratamento, as tomografias computadorizadas mostraram que o tumor estava significativamente reduzido e 4 meses após o tratamento (Figura b), remissão quase completa (Figura c).
Este paciente obteve remissão completa após 4 meses de tratamento, com efeitos colaterais moderados e reversíveis. Portanto, o uso combinado de nivolumab e ipilimumab pode se tornar uma opção de tratamento promissora para o carcinoma espinocelular metastático refratário de cabeça e pescoço. Vários ensaios estão comparando a eficácia dos métodos de imuno-oncologia com os regimes de quimioterapia padrão, e estamos aguardando ansiosamente os resultados.
