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Poster display session

YO25 - Hyperprogression after pembrolizumab in recurrent oropharyngeal cancer and the use of nab-paclitaxel as salvage treatment- A case report.


23 Nov 2019


Poster display session



Tumour Site


Izzati Rosli


I. Rosli1, C.T. Chong2, G.F. Ho3

Author affiliations

  • 1 Clinical Oncology Department, UMMC - University Malaya Medical Centre, 59100 - Kuala Lumpur/MY
  • 2 Radiotherapy And Oncology Department, University Malaya Medical Center, 50603 - Kuala Lumpur/MY
  • 3 Dept Of Clinical Oncology, University Malaya Medical Center, 59100 - Kuala Lumpur/MY


Abstract YO25

Case summary


Pembrolizumab is an immune checkpoint inhibitor, approved in recurrent head and neck cancer. Its use has been associated with hyperprogression, a phenomenon of extraordinarily rapid tumor progression in patients undergoing immunotherapy. Here, we report a case that showed hyperprogression after pembrolizumab in recurrent oropharyngeal cancer and the use of nab-paclitaxel as salvage treatment.


The patient was a 70 years old man with recurrent base of tongue cancer, who had progressed 2 months after receiving 2 cycles of cisplatin and 5-fluorouracil, followed by concurrent chemoradiotherapy (70Gy in 35 fractions over 7 weeks).

PD-L1 testing was done, which expressed 1-50% membrane positivity. He received second line treatment of intravenous Pembrolizumab 100mg, administered 3 weekly.

Clinical and radiological assessments were done, comparing the baseline CT scan and the CT scan after immunotherapy. Hyperprogression was confirmed by measuring the tumor growth kinetics (TGK). Hyperprogression is defined as a TGK ratio >2 with rapid progression.

The patient was started on intravenous nab-paclitaxel(125mg/m2), carboplatin (AUC 2.5), and bevacizumab (100mg) weekly for 2 weeks, administered 3 weekly after confirmation of hyperprogression with pembrolizumab treatment.


14 days after the administration of the first cycle of Pembrolizumab, patient developed bigger tongue swelling, occupying the whole oral cavity protruding beyond the lips. Hyperprogression was confirmed with a CT scan, where a larger tongue mass was observed (67% enlargement) with new lung lesions and a TGK of 3.

Patient review 3 weeks after cycle 1 of nab-paclitaxel, carboplatin and bevacizumab showed smaller tongue swelling. He was given a total of 3 cycles of chemotherapy but acquired neutropenia and pneumonia after cycle 2 and tumor bleed after cycle 3. He died of the disease 110 days after receiving his chemotherapy.


It is important to be aware that hyperprogression can occur early in the treatment using pembrolizumab. If used judiciously, nab-paclitaxel can be effective as salvage treatment in hyperprogression of oropharyngeal cancer.

Clinical trial identification

Editorial acknowledgement

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