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.
Potentsial immunitetni keltirib chiqaradigan gepatitga shubha qilinganligi sababli, prednizolon (100 mg / kun) bilan davolash boshlandi va jigar ko'rsatkichlari sezilarli darajada kamaydi. Shunga qaramay, ipilimumab va nivolumabni davom ettirish va ipilimumabni ikkinchi marta yuborishdan 3 hafta o'tgach, revmatoid omil va jigar fermentlari ko'paydi, lekin prednizolonni qayta boshlaganidan keyin yana kamaydi. Davolash boshlanganidan 8 hafta o'tgach, kompyuter tomografiyasi o'simta sezilarli darajada kamayganligini va davolanishdan 4 oy o'tgach (b-rasm) deyarli to'liq remissiyani ko'rsatdi (rasm c).
Ushbu bemor 4 oylik davolanishdan so'ng to'liq remissiyaga erishdi, yon ta'sirlari o'rtacha va qayta tiklanadi. Shuning uchun nivolumab va ipilimumabni birgalikda qo'llash bosh va bo'yinning refrakter metastatik skuamoz hujayrali karsinomasini davolashning istiqbolli usuli bo'lishi mumkin. Bir necha sinovlar immuno-onkologiya usullarining samaradorligini standart kimyoviy terapiya sxemalari bilan taqqoslamoqda va biz natijalarni intiqlik bilan kutmoqdamiz.
