Neoadjuvant Immunotherapy of Oral Squamous Cell Carcinoma: Case Report and Assessment of Histological Response
BackgroundThe treatment of oral cancer remains challenging due to its infiltrative nature and a high tendency for tumour relapse leading to an overall poor prognosis. In the case of early recurrence, the patient’s prognosis deteriorates dramatically, with survival rate dropping to below 30%. Minimal...
Main Authors: | , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Frontiers Media S.A.
2021-07-01
|
Series: | Frontiers in Oncology |
Subjects: | |
Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2021.720951/full |
id |
doaj-5d9d52f4ee064855b8b39e137e2e98dc |
---|---|
record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Manuel Olmos Manuel Olmos Jacek Glajzer Jacek Glajzer Tjark-Ole Büntemeyer Tjark-Ole Büntemeyer Gesche Frohwitter Gesche Frohwitter Jutta Ries Jutta Ries Markus Eckstein Markus Eckstein Markus Hecht Markus Hecht Rainer Lutz Rainer Lutz Marco Rainer Kesting Marco Rainer Kesting Manuel Weber Manuel Weber |
spellingShingle |
Manuel Olmos Manuel Olmos Jacek Glajzer Jacek Glajzer Tjark-Ole Büntemeyer Tjark-Ole Büntemeyer Gesche Frohwitter Gesche Frohwitter Jutta Ries Jutta Ries Markus Eckstein Markus Eckstein Markus Hecht Markus Hecht Rainer Lutz Rainer Lutz Marco Rainer Kesting Marco Rainer Kesting Manuel Weber Manuel Weber Neoadjuvant Immunotherapy of Oral Squamous Cell Carcinoma: Case Report and Assessment of Histological Response Frontiers in Oncology case report immunotherapy oral cancer pembrolizumab neoadjuvant PD-1 - PD-L1 axis |
author_facet |
Manuel Olmos Manuel Olmos Jacek Glajzer Jacek Glajzer Tjark-Ole Büntemeyer Tjark-Ole Büntemeyer Gesche Frohwitter Gesche Frohwitter Jutta Ries Jutta Ries Markus Eckstein Markus Eckstein Markus Hecht Markus Hecht Rainer Lutz Rainer Lutz Marco Rainer Kesting Marco Rainer Kesting Manuel Weber Manuel Weber |
author_sort |
Manuel Olmos |
title |
Neoadjuvant Immunotherapy of Oral Squamous Cell Carcinoma: Case Report and Assessment of Histological Response |
title_short |
Neoadjuvant Immunotherapy of Oral Squamous Cell Carcinoma: Case Report and Assessment of Histological Response |
title_full |
Neoadjuvant Immunotherapy of Oral Squamous Cell Carcinoma: Case Report and Assessment of Histological Response |
title_fullStr |
Neoadjuvant Immunotherapy of Oral Squamous Cell Carcinoma: Case Report and Assessment of Histological Response |
title_full_unstemmed |
Neoadjuvant Immunotherapy of Oral Squamous Cell Carcinoma: Case Report and Assessment of Histological Response |
title_sort |
neoadjuvant immunotherapy of oral squamous cell carcinoma: case report and assessment of histological response |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Oncology |
issn |
2234-943X |
publishDate |
2021-07-01 |
description |
BackgroundThe treatment of oral cancer remains challenging due to its infiltrative nature and a high tendency for tumour relapse leading to an overall poor prognosis. In the case of early recurrence, the patient’s prognosis deteriorates dramatically, with survival rate dropping to below 30%. Minimal improvements in survival trends in recurrent and advanced stage tumours have been reported in recent decades. Neoadjuvant immunotherapy may represent a new therapeutic approach changing the standard of care in advanced oral cancer therapy.Case PresentationWe describe the case of a woman in her late 30’s who presented in mid-2019 with oral squamous cell carcinoma (OSCC) localized to the floor of the mouth. After initial R0 resection, selective neck dissection, and adjuvant brachytherapy, an early recurrence of OSCC located between the hyoid bone and the mandible was diagnosed at the end of 2019. An off-label treatment regimen was performed with neoadjuvant use of Pembrolizumab 19 days prior to salvage surgery. Radiological and histological assessment of T-cell and programmed cell death protein 1 ligand 1 (PD-L1) expression was performed before and after checkpoint inhibitor application. Neoadjuvant immunotherapy resulted in increased T-cell infiltration and PD-L1 expression, as well as a significant tumour necrosis rate. One cycle of Pembrolizumab led to significant regressive tumour changes with increases in immune infiltration, sclerosis, and necrosis of 75% of the tumour mass with only 25% vital tumour cells remaining. By June 2020, the patient remained without recurrence.ConclusionsThe case presented outlines the potential effects of neoadjuvant immunotherapy in recurrent or advanced OSCC prior to definitive surgical tumour treatment. The benefit of additional adjuvant treatment after histologic response will be discussed. The case is also analysed considering ongoing clinical trials of neoadjuvant immunotherapy for head and neck malignancies. |
topic |
case report immunotherapy oral cancer pembrolizumab neoadjuvant PD-1 - PD-L1 axis |
url |
https://www.frontiersin.org/articles/10.3389/fonc.2021.720951/full |
work_keys_str_mv |
AT manuelolmos neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT manuelolmos neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT jacekglajzer neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT jacekglajzer neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT tjarkolebuntemeyer neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT tjarkolebuntemeyer neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT geschefrohwitter neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT geschefrohwitter neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT juttaries neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT juttaries neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT markuseckstein neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT markuseckstein neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT markushecht neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT markushecht neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT rainerlutz neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT rainerlutz neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT marcorainerkesting neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT marcorainerkesting neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT manuelweber neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse AT manuelweber neoadjuvantimmunotherapyoforalsquamouscellcarcinomacasereportandassessmentofhistologicalresponse |
_version_ |
1721292724723777536 |
spelling |
doaj-5d9d52f4ee064855b8b39e137e2e98dc2021-07-21T12:31:05ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-07-011110.3389/fonc.2021.720951720951Neoadjuvant Immunotherapy of Oral Squamous Cell Carcinoma: Case Report and Assessment of Histological ResponseManuel Olmos0Manuel Olmos1Jacek Glajzer2Jacek Glajzer3Tjark-Ole Büntemeyer4Tjark-Ole Büntemeyer5Gesche Frohwitter6Gesche Frohwitter7Jutta Ries8Jutta Ries9Markus Eckstein10Markus Eckstein11Markus Hecht12Markus Hecht13Rainer Lutz14Rainer Lutz15Marco Rainer Kesting16Marco Rainer Kesting17Manuel Weber18Manuel Weber19Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, GermanyComprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, GermanyDepartment of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, GermanyComprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, GermanyDepartment of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, GermanyComprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, GermanyDepartment of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, GermanyComprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, GermanyDepartment of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, GermanyComprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, GermanyComprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, GermanyInstitute of Pathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, GermanyComprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, GermanyDepartment of Radiation Oncology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, GermanyDepartment of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, GermanyComprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, GermanyDepartment of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, GermanyComprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, GermanyDepartment of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, GermanyComprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, GermanyBackgroundThe treatment of oral cancer remains challenging due to its infiltrative nature and a high tendency for tumour relapse leading to an overall poor prognosis. In the case of early recurrence, the patient’s prognosis deteriorates dramatically, with survival rate dropping to below 30%. Minimal improvements in survival trends in recurrent and advanced stage tumours have been reported in recent decades. Neoadjuvant immunotherapy may represent a new therapeutic approach changing the standard of care in advanced oral cancer therapy.Case PresentationWe describe the case of a woman in her late 30’s who presented in mid-2019 with oral squamous cell carcinoma (OSCC) localized to the floor of the mouth. After initial R0 resection, selective neck dissection, and adjuvant brachytherapy, an early recurrence of OSCC located between the hyoid bone and the mandible was diagnosed at the end of 2019. An off-label treatment regimen was performed with neoadjuvant use of Pembrolizumab 19 days prior to salvage surgery. Radiological and histological assessment of T-cell and programmed cell death protein 1 ligand 1 (PD-L1) expression was performed before and after checkpoint inhibitor application. Neoadjuvant immunotherapy resulted in increased T-cell infiltration and PD-L1 expression, as well as a significant tumour necrosis rate. One cycle of Pembrolizumab led to significant regressive tumour changes with increases in immune infiltration, sclerosis, and necrosis of 75% of the tumour mass with only 25% vital tumour cells remaining. By June 2020, the patient remained without recurrence.ConclusionsThe case presented outlines the potential effects of neoadjuvant immunotherapy in recurrent or advanced OSCC prior to definitive surgical tumour treatment. The benefit of additional adjuvant treatment after histologic response will be discussed. The case is also analysed considering ongoing clinical trials of neoadjuvant immunotherapy for head and neck malignancies.https://www.frontiersin.org/articles/10.3389/fonc.2021.720951/fullcase reportimmunotherapyoral cancerpembrolizumabneoadjuvantPD-1 - PD-L1 axis |