The Synergistic Effect of Immune Checkpoint Blockade and Radiotherapy in Recurrent/Metastatic Sinonasal Cancer

Abstract

Treatment options for recurrent/metastatic sinonasal cancer (RMSNC) patients are limited. We present two cases with RMSNC treated with a combination of immune checkpoint blockade and hypo-fractionated stereotactic radiotherapy (HSRT). Case 1 presented with RMSNC three months after the primary treatment. The patient progressed under first-line chemotherapy and pembrolizumab was offered. The disease progressed after the sixth cycle. We performed reirradiation with HSRT to the primary site. Case 2 presented with local recurrence eight years after the primary treatment for maxillary sinus cancer. He refused surgery and chemotherapy and was offered nivolumab treatment. After two doses, we performed reirradiation with HSRT.Case 1 showed regression at both the local and the metastatic sites after radiotherapy. The second patient’s symptoms resolved completely three months after radiotherapy.The HSRT and immune checkpoint blockade combination is a promising treatment option for patients with RMSNC.

Complete response to immunotherapy in sinonasal undifferentiated carcinoma

“…[9][10] Until now, to our knowledge, only 2 cases of sinonasal cancers, not undifferentiated carcinoma, treated with immunotherapy have been reported, concurrently with radiation. 11 The present case adds to the literature the experience of a long-lasting response with an immunecheckpoint inhibitor in a patient with SNUC. Intriguingly, the response observed is not related to PD-L1 expression or the presence of TILs.…”

Abscopal effect as part of treatment of oligometastatic head and neck cancer: A case report

“…Recently, a maxillary sinus cancer patient treated with immunotherapy and radiotherapy achieved a dramatic response of disease, underlying the possibility of obtaining “abscopal effect” in head and neck tumor 23 …”

“…Recently, a maxillary sinus cancer patient treated with immunotherapy and radiotherapy achieved a dramatic response of disease, underlying the possibility of obtaining "abscopal effect" in head and neck tumor. 23 At the present time, prospective randomized studies are necessary to define the better approach to oligometastatic disease. It is essential to select patients for systemic treatment alone, combination of systemic and ablative metastases-directed treatments, aggressive treatment of primary combined to ablative metastases-directed treatments or aggressive treatment of primary site alone (including evaluation of combination of radio/immunotherapy).…”

Abscopal Effect, From Myth to Reality: From Radiation Oncologists' Perspective

“…In this patient, pembrolizumab was used as second-line therapy, and tumor progression was observed under pembrolizumab. When RT came into the picture and combined with immunotherapy, complete treatment response was achieved [ 19 ].…”