Atypical response with bone pseudoprogression in a patient receiving nivolumab for advanced cutaneous squamous cell carcinoma

Leandro J C Oliveira,Rodrigo R Munhoz,Felipe G Barbosa,Carlos H Dos Anjos,Aline B L Gongora

doi:10.1186/s40425-018-0444-5

Abstract

Currently, there is no established standard of care for patients with metastatic CSCC. Based on the mechanisms of CSCC carcinogenesis has been postulated that these tumors may be amenable to PD-1/PD-L1 blockade.This case illustrates a patient with CSCC with nodal involvement and pulmonary metastases, refractory to two lines of platinum-based regimens and salvage surgery, for whom treatment with nivolumab was recommended. His clinical course was marked by an atypical pattern of response, with initial reduction of soft tissue/visceral lesions, yet development of new bone findings, followed by overall improvement in subsequent scans and sustained disease control upon treatment continuation.The case of patient with metastatic CSCC, refractory, received immunotherapy and evolved with atypical pattern of response.

Highlights

Cutaneous SCC (CSCC) is among the most frequent malignancies worldwide and accounts for approximately 20% of all cutaneous neoplasms [1, 2]
We present a case of a patient developing an atypical pattern of response, marked by bone pseudoprogression during therapy with nivolumab for advanced CSCC, followed by sustained response
Following more than 12 of nivolumab therapy, the patient continues to endure clinical benefit, with prolonged disease control and good tolerance. This case illustrates a patient with CSCC with multifocal nodal involvement and pulmonary metastases, refractory to two lines of platinum-based combination regimens and salvage surgery, for whom treatment with nivolumab was recommended

Summary

Introduction

Cutaneous SCC (CSCC) is among the most frequent malignancies worldwide and accounts for approximately 20% of all cutaneous neoplasms [1, 2]. A computed tomography (CT) of the chest revealed a 10 cm right axillary nodal conglomerate, additional supraclavicular lymphadenopathies and pulmonary nodules concerning for metastatic disease. These findings were subsequently confirmed by an FDG-PET/CT, and a right axillary mass biopsy was consistent with moderately-differentiated CSCC. Except for non-limiting fatigue, the patient had a remarkable tolerance to nivolumab, accompanied by early clinical response (reduction of right axillary/retropectoral mass). Re-staging PET-CT performed after 3 months of therapy revealed reduction in size and resolution of the metabolic activity of right axillary, cervical, retropectoral and mediastinal lymphadenopathies; pulmonary nodules were no longer appreciable. Following more than 12 of nivolumab therapy, the patient continues to endure clinical benefit, with prolonged disease control and good tolerance

Discussion

Findings

19. Estimate 2016