Response to nivolumab combining radiotherapy and nimotuzumab in metastatic oral squamous cell carcinoma patient with strong PD-L1 expression: a case report

Abstract

Immune checkpoint inhibitors (ICIs) have been approved for the treatment of oral squamous cell carcinoma (OSCC). However, not all patients would benefit from ICIs. Thus, in order to improve the response rate, the efficacy and safety of combination immunotherapy is still under evaluation. We report a 71-year-old female patient with a recurrent metastatic oral cavity cancer. Immunohistochemical examination showed more than 50% of tumor cells to express the programmed cell death receptor ligand 1 (PD-L1). The patient received nivolumab plus radiotherapy and nimotuzumab. Both clinically and radiologically response was observed and the patient reached a partial response (PR). This is the first case describing the efficacy and safety of nivolumab plus radiotherapy and nimotuzumab in an OSCC patient with a strong PD-L1 expression, showing a tolerable safety profile and a promising response. The combination immunotherapy may be a potential treatment option for patients with OSCC.

Recent findings on the impact of ErbB receptors status on prognosis and therapy of head and neck squamous cell carcinoma

“…The results of a recent study performed on a small number of PD-L1-positive oral HNSCC patients indicate that the combination of PD-1 inhibitors (Nivolumab or Sintilimab), anti-EGFR targeted therapy (Nimotuzumab) and chemotherapy (Paclitaxel) could improve the response rate and survival outcome ( 161 ). In a case report of a patient with recurrent/metastatic oral squamous cell carcinoma, the efficacy of the PD-1 inhibitor Nivolumab in combination with the anti-EGFR antibody Nimotuzumab and radiotherapy has also been described in terms of decreased metabolic activity in cancer cells, reduction of lung lesions dimensions, progression-free survival and tolerable safety profile ( 162 ). To mention a few of the ongoing studies, the triple combination of ICIs, Cetuximab and radiotherapy for patients with advanced HNSCC is being investigated in clinical trials employing the anti-PD-L1 antibodies Avelumab and Durvalumab and the anti-CTLA-4 antibody Ipilimumab ( Table 2 ; 157 ).…”

Prognostic impact of extended neck dissection in oral squamous cell carcinoma: a retrospective study

“…Recently, the usefulness of immune checkpoint inhibitors (ICIs) for recurrent or metastatic HNSCC has been reported (19,20). Furthermore, combination therapy with ICIs and radiation might be used in the future (21)(22)(23).…”

PD-1/PD-L1, Treg-related proteins, and tumour-infiltrating lymphocytes are associated with the development of oral squamous cell carcinoma

“…1 Recently, immunomodulatory drugs targeting epidermal growth factor receptor (EGFR; cetuximab) and PD-1/PD-L1 (pembrolizumab and nivolumab), among others, have been approved or used in OSCC management. 2,3 The potential use of biomarkers to identify suitable candidates for immunotherapy treatment has not been clearly addressed.…”

“…26 The importance of Treg markers and the PD-1/PD-L1 pathway in OSCC has been investigated, and PD1/PDL1 inhibitors utilised for OSCC management. 3 However, the role of specific TILs and immunomodulation in oral precursor lesions and their association with the development of OSCC has not been fully understood. Therefore, this study aimed to characterise the expression of specific immunomodulatory biomarkers in a range of oral epithelial disorders and to assess their diagnostic utility.…”