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.
Alatan kacurigaan poténsial hépatitis imun-ngainduksi, perlakuan jeung prednisolone (100 mg / dinten) ieu dimimitian, sarta parameter ati anu nyata ngurangan. Sanajan kitu, terus administrasi ipilimumab na nivolumab, sarta 3 minggu sanggeus administrasi kadua ipilimumab, faktor rheumatoid jeung énzim ati ngaronjat tapi turun deui sanggeus restarting prednisolone. Dina 8 minggu sanggeus mimiti perlakuan, CT scan némbongkeun yén tumor ieu nyata ngurangan, sarta 4 bulan sanggeus perlakuan (Gambar b), remisi ampir lengkep (Gambar c).
Pasién ieu ngahontal remisi lengkep saatos 4 bulan diubaran, kalayan efek samping sedeng sareng malik. Ku alatan éta, gabungan gabungan nivolumab sareng ipilimumab tiasa janten pilihan pangobatan anu ngajangjikeun pikeun karsinoma sél skuamosa méstastik réfrakter tina sirah sareng beuheung. Sababaraha cobaan anu ngabandingkeun hasiat tina metode immuno-onkologi sareng réimén kémoterapi standar, sareng kami hoyong pisan ngantosan hasilna.
