Durable intracranial and extracranial response to nivolumab with appearance of secondary resistance in a heavily pretreated patient with head and neck cancer

• Published in: Head & neck Vol. 41; no. 6; pp. E86 - E92
• Main Authors: Cabezas-Camarero, Santiago, García-Barberán, Vanesa, Sáiz-Pardo Sanz, Melchor, Cabrera-Martín, María Nieves, Gimeno-Hernández, Jesús, Pérez-Segura, Pedro
• Format: Report
• Language: English
• Published: 01.06.2019
• ISSN: 1097-0347
• DOI: 10.1002/hed.25635

BACKGROUNDRecently, nivolumab was approved in the second-line setting of squamous cell cancer of the head and neck (SCCHN). The benefits of PD-(L)1 inhibitors in PD-L1(-) tumors are unclear, and no reports exist on the activity of these agents in brain metastases from SCCHN. Little is known regarding the mechanisms underlying acquired resistance to PD-(L)1 inhibition. METHODSA patient with PD-L1(-) metastatic SCCHN progressing to cetuximab-based chemotherapy received third-line nivolumab. T cell infiltration and mRNA expression of immune-related genes were compared in prenivolumab and postnivolumab biopsies from a progressing tumor lesion. RESULTSAn exceptional local and systemic response was achieved, including complete devitalization of brain metastases that lasted for more than a year. Increased T cell infiltration and upregulation of genes related to T cell exhaustion and resistance to PD-1 inhibition were found. CONCLUSIONDurable responses to PD-(L)1 inhibitors may be observed in biomarker-negative SCCHN. Mechanisms of resistance should be studied.