Case report: Patient specific combination of surgery and immunotherapy in advanced squamous cell carcinoma of the head and neck – a case series and review of literature

Olmos M, Lutz R, Büntemeyer TO, Glajzer J, Nobis CP, Ries J, Möst T, Eckstein M, Hecht M, Gostian AO, Erdmann M, Foerster Y, Kesting MR, Weber M (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Frontiers in Immunology Frontiers Research Foundation / Frontiers Media

Book Volume: 13

Article Number: 970823

DOI: 10.3389/fimmu.2022.970823

Abstract

Background: Prognosis of patients with recurrent or metastatic head and neck cancer is generally poor. Adjuvant immunotherapy (IT) featuring immune checkpoint inhibition (ICI) is standard of care in advanced stage head and neck squamous cell carcinoma (HNSCC) and cutaneous squamous cell carcinoma (CSCC). ICI response rates in CSCC are described as higher than in HNSCC. IT is constantly shifting into earlier disease stages which confronts the surgeon with immunotherapeutically pre-treated patients. It is therefore becoming increasingly difficult to assess which patients with symptomatic tumor disease and a lack of curative surgical option might benefit from salvage surgery. Case presentations: The following 6 cases describe therapeutic decision-making regarding ICI and (salvage) surgery in patients with advanced stage HNSCC or CSCC. Cases A and B focus on neoadjuvant ICI followed by salvage surgery. In Cases C and D salvage surgery was performed after short-term stabilization with partial response to ICI. The last two cases (Cases E and F) address the surgical approach after failure of ICI. All cases are discussed in the context of the current study landscape and with focus on individual decision-making. For better understanding, a timetable of the clinical course is given for each case. Conclusions: ICI is rapidly expanding its frontiers into the neoadjuvant setting, frequently confronting the surgeon with heavily pretreated patients. Salvage surgery is a viable therapeutic concept despite the rise of systemic treatment options. Decision-making on surgical intervention in case of a salvage surgery remains an individual choice. For neoadjuvant ICI monitoring regarding pathological tumor response or tumor necrosis rate, we suggest correlation between the initial biopsy and the definite tumor resectate in order to increase its significance as a surrogate marker. Scheduling of neoadjuvant ICI should be further investigated, as recent studies indicate better outcomes with shorter time frames.

Authors with CRIS profile

Rainer Lutz Department of Oral and Cranio-Maxillofacial Surgery Tjark-Ole Büntemeyer Department of Oral and Cranio-Maxillofacial Surgery Christopher-Philipp Nobis Department of Oral and Cranio-Maxillofacial Surgery Jutta Ries Department of Oral and Cranio-Maxillofacial Surgery Tobias Möst Department of Oral and Cranio-Maxillofacial Surgery Markus Eckstein Institute of Pathology Markus Hecht Medizinische Fakultät Antoniu-Oreste Gostian Department of Otorhinolaryngology – Head and Neck Surgery Yannick Foerster Department of Oral and Cranio-Maxillofacial Surgery Marco Rainer Kesting Lehrstuhl für Zahnmedizin, insbesondere Mund-, Kiefer-, und Gesichtschirurgie Manuel Weber Department of Oral and Cranio-Maxillofacial Surgery

How to cite

APA:

Olmos, M., Lutz, R., Büntemeyer, T.-O., Glajzer, J., Nobis, C.-P., Ries, J.,... Weber, M. (2022). Case report: Patient specific combination of surgery and immunotherapy in advanced squamous cell carcinoma of the head and neck – a case series and review of literature. Frontiers in Immunology, 13. https://doi.org/10.3389/fimmu.2022.970823

MLA:

Olmos, Manuel, et al. "Case report: Patient specific combination of surgery and immunotherapy in advanced squamous cell carcinoma of the head and neck – a case series and review of literature." Frontiers in Immunology 13 (2022).

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