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
64P - Entrectinib in locally advanced/metastatic ROS1 and NTRK fusion-positive non-small cell lung cancer (NSCLC): Updated integrated analysis of STARTRK-2, STARTRK-1 and ALKA-372-001
Presenter: Filippo de Braud
Session: Poster display session
Resources:
Abstract
65P - Updated efficacy and safety of entrectinib in patients with NTRK fusion-positive tumours: Integrated analysis of STARTRK-2, STARTRK-1 and ALKA-372-001
Presenter: Christian Rolfo
Session: Poster display session
Resources:
Abstract
66P - Brain metastases, treatment patterns and outcomes in ROS1-positive NSCLC patients from US oncology community centers
Presenter: Matthew Krebs
Session: Poster display session
Resources:
Abstract
67P - Pooled safety analysis of tepotinib in Asian patients with advanced solid tumours
Presenter: Kentaro Yamazaki
Session: Poster display session
Resources:
Abstract
68P - A novel anti-EGFR antibody HLX07 for potential treatment of squamous cell carcinoma of the head and neck
Presenter: Ming Mo Hou
Session: Poster display session
Resources:
Abstract
69P - Irinotecan and cisplatin therapy-induced neutropenia as a prognostic factor in patients with extensive-disease small cell lung cancer
Presenter: Hiroshi Ishikawa
Session: Poster display session
Resources:
Abstract
70P - Is safe and efficient by intraoperative endoscopic nasobiliary drainage over primary closure of the common bile duct for cholecystolithiasis combined with common bile duct stones: A meta-analysis
Presenter: Jiasheng Cao
Session: Poster display session
Resources:
Abstract
71P - Irreversible electroporation versus radiotherapy after induction chemotherapy on survival in patients with locally advanced pancreatic cancer: A propensity score analysis
Presenter: Chaobin He
Session: Poster display session
Resources:
Abstract
72P - Novel technique of near-focus mode for accurate operation during endoscopic submucosal tunneling procedure: A two-center comparative study
Presenter: Wei Peng
Session: Poster display session
Resources:
Abstract
73P - Cabozantinib in combination with anti-PD1 immune checkpoint inhibitor in syngeneic tumour mouse models
Presenter: Rachel Sparks
Session: Poster display session
Resources:
Abstract