Abstract
BackgroundNivolumab is an immune checkpoint inhibitor specific for the programmed death 1 (PD-1) receptor that has led to clinical responses in many cancer types. Identifying biomarkers predictive of response to PD-1 blockade is an area of active investigation.Case presentationWe present a patient with recurrent, metastatic, PD-L1-negative small cell neuroendocrine carcinoma of the cervix (SCNEC) who experienced a complete response to nivolumab. Though nivolumab was discontinued over 4 months ago due to treatment-related adverse events, she continues to have no evidence of disease.ConclusionsImmune checkpoint inhibitors may be active in neuroendocrine cervical cancer, with potential for dramatic responses in a modest subset of patients.
Highlights
BackgroundSmall cell neuroendocrine carcinoma of the cervix (SCNEC) is a rare and aggressive histology
Nivolumab is an immune checkpoint inhibitor specific for the programmed death 1 (PD-1) receptor that has led to clinical responses in many cancer types
We present the clinical experience of a woman with recurrent, metastatic, small cell neuroendocrine carcinoma of the cervix (SCNEC) who had a complete response to treatment with nivolumab
Summary
Small cell neuroendocrine carcinoma of the cervix (SCNEC) is a rare and aggressive histology. Patients frequently present with locally advanced tumors or distant metastases, resulting in poor oncologic outcomes with a 5-year survival rate estimated at 36.8% for early stage disease and less than 10% for advanced disease [1, 2] Given these poor outcomes, as well as a lack of prospective data to guide treatment decisions, patients with SCNEC pose a therapeutic challenge. The primary tumor was 4.5 by 3.3 cm in size and involved half of the cervical stroma, with lymphovascular space involvement Her postoperative course was complicated by a pelvic abscess requiring re-exploration and washout. PET/CT demonstrated interval development of multiple hypermetabolic mesenteric deposits, largest measuring 21 mm with a standard uptake value (SUV) of 10.6 Thereafter, she was admitted for small bowel obstruction, with imaging revealing multifocal progression of the pelvic lesions (Fig. 1). Hematologic evaluation, inclusive of bone marrow biopsy, failed to identify an alternate source of her pancytopenia, which was attributed to nivolumab
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