Complete remission of an oropharyngeal cancer to nivolumab even after immunotherapy discontinuation

Prognosis in recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) is poor. With approval of the PD-1 inhibitor Nivolumab patients were for the first time able to benefit from improved survival with stable quality of life. However, the objective response rate remains modest with only 13.3 %. Complete remission is possible, but it occurs infrequently. We report a case of persisting complete remission despite discontinuation of Nivolumab.

A 62 years old man presented with a cT4 cN2c M0 oropharyngeal secondary cancer. He had a previous history of curatively treated hypopharyngeal cancer by surgery and adjuvant radiotherapy ten years ago. Salvage surgery was not feasible due to advanced tumor expansion and re-irradiation was not possible. Therefore, the patient received a palliative chemotherapy with cisplatin and docetaxel. As the disease progressed after six cycles, a Nivolumab immunotherapy was initiated.

Re-staging has shown a complete remission already after four doses of immunotherapy. The patient has received a total of 46 doses of Nivolumab prior to discontinuation. Therapy-related adverse effects have been present at no time. Until now, no tumor recurrence has occurred under regular clinical and radiological surveillance for six months in total.

Clinical experience about discontinuation of an immunotherapy responding to HNSCC is scarce. Whereas there are recommendations about the duration of immunotherapy in other tumor entities, this is not the case in HNSCC. Decisions about when to stop a successful immunotherapy have to be discussed on a case-by-case basis.

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Publication History

Article published online:
10 June 2020