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.
Nekuda kwekufungidzirwa kweanogona kuzvidzivirira anokonzerwa nehutachiona hwehutachiona, kurapwa ne prednisolone (100 mg / zuva) kwakatangwa, uye zviyero zveropa zvakaderedzwa zvakanyanya. Zvakangodaro, kuenderera mberi kwekutungamira kweipilimumab uye nivolumab, uye masvondo matatu mushure mechipiri kutungamira kweipilimumab, rheumatoid factor uye enzymes yechiropa yakawedzera asi yakadzikira zvakare mushure mekutanga zvekare prednisolone. Pamasvondo masere mushure mekutanga kwekurapwa, CT scan yakaratidza kuti bundu rakadzikira zvakanyanya, uye mwedzi mina mushure mekurapwa (Mufananidzo b), kuregererwa kwakazara (Mufananidzo c).
Uyu murwere akawana kuregererwa kwakakwana mushure memwedzi mina yekurapwa, aine zvine mwero uye zvinodzoserwa mhedzisiro. Naizvozvo, iko kusanganisa kushandiswa kwe nivolumab uye ipilimumab inogona kuve inovimbisa yekurapa sarudzo yeanodzora metastatic squamous cell carcinoma yemusoro nemutsipa. Miedzo yakati wandei iri kuenzanisa kushanda kweye immuno-oncology nzira neyakajairwa chemotherapy regimens, uye isu tiri kumirira nemoyo wese mhedzisiro.
