RESUMO
BACKGROUND: Metastatic head and neck squamous cell carcinoma (HNSCC) carries a very poor prognosis. A better understanding of the molecular driver of the disease and the identification of biomarkers of response remain paramount for an effective personalized therapy. CASE REPORT: We report an original case of a 56-year-old patient diagnosed with metastatic HNSCC to both kidneys, who experienced a long-lasting complete response to a single-agent cetuximab, a monoclonal antibody-targeting EGFR. Comprehensive multiplatform biomarker analysis of the tumor revealed the presence of phosphatidyl-inositol 3 kinase mutation, EGFR overexpression, and the absence of PD-1/PD-L1 expression. Since PI3K, a downstream effector of EGFR, is activated, the tumor regression may have occurred mainly through a cetuximab-induced immune-mediated response, rather than EGFR signal blockade. It is plausible that this effect was enhanced by the lack of PD-1 and PD-L1 expression. CONCLUSION: Our case proposes that the absence of PD-1 and PD-L1 expression in conjunction with EGFR overexpression may correlate with better response to cetuximab in HNSCC. This hypothesis needs to be examined through a large clinical trial.
RESUMO
People with lung cancer (LCa) and symptomatic metastatic disease deserve palliative radiotherapy to promote a better quality of remaining life. On the other hand, in the case being described that of a LCa patient with brain and spinal metastases who died shortly after irradiation-- could management consisting of hospice and/or supportive care have been a better choice? Prognostic factors were analyzed in this retrospective study of the early deaths of 20 LCa patients with brain metastases in order to assist in a more rational decision making regarding treatment.