Unexpected Response to Nivolumab in a “Fast Progressor” Head and Neck Cancer Patient

Abstract

Prior to the advent of immune checkpoint inhibitors targeting PD-1/PD-L1 axis no drug demonstrated to improve survival or quality of life in the second-line treatment of recurrent or metastatic head and neck squamous cell carcinoma (R/M-HNSCC). Nivolumab appear to have a clear clinical benefit for R/M-HNSCC, based on improved survival, good toxicity profile, reduction in symptoms and improvement in overall quality of life. This benefit seems to be greater for PD-L1 positive patients and independent of previous treatment, even being observed among heavily pre-treated patients. However, even in responding tumors acquired resistance to nivolumab usually occurred, limiting the drug’s activity. We report a case of unexpected prolonged stable disease in second-line treatment with nivolumab after a rapid progression disease under first-line chemotherapy in biomarker-positive R/M-HNSCC.

PD-1 blockade inhibits osteoclast formation and murine bone cancer pain

“…PD-1 treatment might reduce cancer pain and improve quality of life in patients with advanced non-small-cell lung cancer and advanced head and neck cancer (43,44). Case reports also indicate that nivolumab treatment can alleviate cancer pain in head and neck cancer patients with spinal bone metastasis and in renal cell carcinoma patients with multiple bone metastasis (45,46). In particular, Ansari et al showed a marked improvement in pain score, with a reduction from 8/10 to 3/10 (46).…”