Pri bolnikih z metastatskim malignim melanomom lahko kombinacija ipilimumaba (protitelo CTLA4) in zaviralca programirane smrti (PD)-1 nivolumaba bistveno izboljša prognozo 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.
Zaradi suma na morebitni imunsko povzročeni hepatitis se je začelo zdravljenje s prednizolonom (100 mg / dan) in jetrni parametri so se znatno zmanjšali. Kljub temu se je nadaljnje dajanje ipilimumaba in nivolumaba ter 3 tedne po drugem dajanju ipilimumaba revmatoidni faktor in jetrni encimi povečali, vendar so se po ponovnem zagonu prednizolona spet zmanjšali. Po 8 tednih po začetku zdravljenja so CT preiskave pokazale, da se je tumor znatno zmanjšal, in 4 mesece po zdravljenju (slika b) skoraj popolna remisija (slika c).
Ta bolnik je po 4 mesecih zdravljenja dosegel popolno remisijo z zmernimi in reverzibilnimi neželenimi učinki. Zato lahko kombinirana uporaba nivolumaba in ipilimumaba postane obetavna možnost zdravljenja ognjevzdržnega metastatskega ploščatoceličnega karcinoma glave in vratu. Številni preskusi primerjajo učinkovitost imuno-onkoloških metod s standardnimi shemami kemoterapije in nestrpno pričakujemo rezultate.
