Abstract YO25
Case summary
Background
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.
Methods
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.
Results
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.
Conclusion
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
Resources from the same session
273P - MALT1- A20 and NF-κB expression pattern in patients with non-Hodgkin lymphomas
Presenter: Alshimaa Alhanafy
Session: Poster display session
Resources:
Abstract
274P - Treatment stratification of non-Hodgkin large B-cell lymphoma patients based on the identification of mutational c-MYC gene
Presenter: Raimkul Karakulov
Session: Poster display session
Resources:
Abstract
275P - Primary central nervous system lymphoma treated with high-dose methotrexate and rituximab: Preliminary results in Vietnam
Presenter: Gia Nguyen Hoang
Session: Poster display session
Resources:
Abstract
276P - Chronic myelod leukemia in chronic phase (CML-CP) with lymphadenopathy at diagnosis: A retrospective analysis
Presenter: GEDALA Veni Prasanna
Session: Poster display session
Resources:
Abstract
277P - Characteristics of BCR-ABL rearrangement variants in Pakistani patients with chronic myeloid leukemia and acute lymphocytic leukemia
Presenter: Zeeshan Ahmed
Session: Poster display session
Resources:
Abstract
278P - A systematic literature review of the cost-effectiveness of treatments, costs, and resource use in patients with Burkitt lymphoma
Presenter: Gautamjeet Mangat
Session: Poster display session
Resources:
Abstract
280P - Risk stratification of CML-CP in a real-world scenario, comparison of S.H.E. with rate of fall of BCR/ABL
Presenter: Kundan Mishra
Session: Poster display session
Resources:
Abstract
281P - Selective depletion of tumour-associated SAMHD1 by HSP90 inhibitors enhances the anti-AML effect of cytarabine
Presenter: Jing Sun
Session: Poster display session
Resources:
Abstract
282P - Inhibition of miR-144 and miR-199 promote myeloma pathogenesis via upregulation of versican and FAK/STAT3 signaling
Presenter: Nidh Gupta
Session: Poster display session
Resources:
Abstract
283P - Effect of study-level factors on treatment-free remission rate in patients with chronic myeloid leukemia: A systematic review and meta-analysis
Presenter: Jinhyun Cho
Session: Poster display session
Resources:
Abstract