The Role of Immunotherapy and Radiation Therapy in Tumor Chemosensitivity in Advanced Head and Neck Cancer

Abstract

Patient: Male, 56Final Diagnosis: Advanced stage squamous cell carcinoma of the head and neckSymptoms: Rapidly enlarging mass in left neckMedication: —Clinical Procedure: —Specialty: OncologyObjective:Unusual clinical courseBackground:Cancer is the second leading cause of death internationally, resulting in millions of deaths each year. While treatment in the past has heavily relied on surgery and radiotherapy, chemotherapy and immunotherapy are being increasingly utilized depending on disease presentation.Case Report:A 56-year-old male presented to the Emergency Department with a 3-week history of a rapidly enlarging left supraclavicular neck mass. Computed tomography scan revealed a 12×13 cm mass extending from the angle of the mandible to the supraclavicular area. A biopsy confirmed advanced stage squamous cell carcinoma of the head and neck. The patient was started on a chemotherapy regimen of docetaxel, cisplatin, and 5-fluorouracil (TCF). The tumor progressed through chemotherapy, which was switched to cetuximab; however, this therapy was discontinued after an anaphylactic reaction. Palliative radiation treatment was begun along with pembrolizumab. Pembrolizumab was continued, and after 9 cycles, the patient’s cancer was almost in complete remission. Three months later, disease progression was once again noted with pembrolizumab treatment, which was subsequently discontinued. The patient was started on paclitaxel and carboplatin chemotherapy regimen as a last resort, despite failure of prior TCF treatment, and the patient responded, this time with complete remission in 4 months.Conclusions:This case demonstrates a unique outcome in which a patient who previously was resistant to chemotherapy, later responded to chemotherapy after a trial of radiation therapy and immunotherapy. Immunotherapy may have a synergistic effect with radiation therapy and play a role in tumor sensitivity to chemotherapy in head and neck cancer treatment.

Diagnostic accuracy and prognostic applications of CYFRA 21-1 in head and neck cancer: A systematic review and meta-analysis

“…HNC is a common malignant disease with relatively high morbidity and mortality[1, 5]. Although the advances in radiotherapy technology have greatly improved the therapeutic effects on patients with HNC, local recurrence still remains the main reason for treatment failure in this group of patients and more than 25% of them finally develop distant metastases[14, 15, 48]. Therefore, early diagnosis and precise prognosis of patients with HNC are very important and urgently needed.…”

“…Until now, the major treatments for most patients with HNC include radiotherapy alone or in combination with chemotherapy, but local recurrence still remains the main reason for treatment failure in this group of patients. About 50% of patients have local recurrence after primary tumor resection, and despite active treatment, 25% of them develop distant metastases[14–18]. Therefore, early diagnosis and precise prognosis of patients with HNC are critical and urgently required.…”

Re-irradiation for oligoprogression under Nivolumab in recurrent head and neck squamous cell carcinoma: A case report

“…Very limited data focus on R/M HNSCC. In these few reports [16][17][18][19][20], excellent clinical responses were observed with no major side effects (Supplementary Table 1). Our case report adds to this very limited series: the addition of state of the art re-irradiation to Nivolumab allowed to tackle the only macroscopic site of disease progression, defer the need of a further line of treatment and provide sustained clinical benefit.…”

Association Between Vitamin D Exposure and Head and Neck Cancer: A Systematic Review With Meta-Analysis

“…In recent years, treatments such as surgical resection, radiotherapy, chemotherapy, and immunotherapy have been improved and matured, conferring patients a certain degree of survival benefit. However, the prognosis for patients with HNC is still poor; 5-year overall survival is only 40 to 50% (7)(8)(9)(10)(11). Cancer prevention is a fundamental and effective means to reduce cancer incidence and mortality.…”