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Immunotherapy-Based Therapeutic Strategies for Recurrent Advanced Squamous Cell Carcinoma of the Head and Neck: A Case Report and Literature Review.

ABSTRACT: We present a patient with locoregionally advanced laryngeal carcinoma, who experienced recurrence 2 months after surgery. We exploratively treated this patient with immunotherapy combined with targeted therapy with or without radiation therapy. The patient exhibited a significant and durable response. Thus far, there are no standard or effective second-line therapeutic modalities for recurrent locoregionally advanced laryngeal carcinoma. The efficacy of conventional chemotherapy with anti-epidermal growth factor receptor (anti-EGFR) remains unsatisfactory. The addition of immunotherapy resulted in substantial improvement in the progression-free survival (PFS) and overall survival (OS) of this patient. In this case, immunotherapy combined with anti-EFGR was administered, leading to good tumor response; based on this observation, radiotherapy was added to further intensify tumor control. This therapeutic strategy may be a novel option for recurrent locoregionally advanced squamous cell carcinoma of the head and neck.

SUBMITTER: Nie H

PROVIDER: S-EPMC8335395 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Cetuximab remains to date the only targeted therapy approved for the treatment of head and neck squamous cell carcinoma (HNSCC). The EGFR pathway plays a key role in the tumorigenesis and progression of this disease as well as in the resistance to radiotherapy (RT). While several anti-EGFR agents have been tested in HNSCC, cetuximab, an IgG1 subclass monoclonal antibody against EGFR, is the only drug with proven efficacy for the treatment of both locoregionally-advanced (LA) and recurrent/metastatic (R/M) disease. The addition of cetuximab to radiotherapy is a validated treatment option in LA-HNSCC. However, its use has been limited to patients who are considered unfit for standard of care chemoradiotherapy (CRT) with single agent cisplatin given the lack of direct comparison of these two regimens in randomized phase III trials and the inferiority suggested by metanalysis and phase II studies. The current use of cetuximab in HNSCC is about to change given the recent results from randomized prospective clinical trials in both the LA and R/M setting. Two phase III studies evaluating RT-cetuximab vs. CRT in Human Papillomavirus (HPV)-positive LA oropharyngeal squamous cell carcinoma (De-ESCALaTE and RTOG 1016) showed inferior overall survival and progression-free survival for RT-cetuximab combination, and therefore CRT with cisplatin remains the standard of care in this disease. In the R/M HNSCC, the EXTREME regimen has been the standard of care as first-line treatment for the past 10 years. However, the results from the KEYNOTE-048 study will likely position the anti-PD-1 agent pembrolizumab as the new first line treatment either alone or in combination with chemotherapy in this setting based on PD-L1 status. Interestingly, cetuximab-mediated immunogenicity through antibody dependent cell cytotoxicity (ADCC) has encouraged the evaluation of combined approaches with immune-checkpoint inhibitors in both LA and R/M-HNSCC settings. This article reviews the accumulated evidence on the role of cetuximab in HNSCC in the past decade, offering an overview of its current impact in the treatment of LA and R/M-HNSCC disease and its potential use in the era of immunotherapy.

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Immunotherapy-Based Therapeutic Strategies for Recurrent Advanced Squamous Cell Carcinoma of the Head and Neck: A Case Report and Literature Review.

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