Sustained complete response to erlotinib in squamous cell carcinoma of the head and neck:A case report
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摘要
BACKGROUND Squamous cell carcinoma of head and neck(SCCHN) is the fifth most common cancer worldwide. Inhibition of epidermal growth factor receptor signaling has been shown to be a critical component of therapeutic option. Herein, we report a case of durable complete response to erlotinib.CASE SUMMARY An 81-year-old Caucasian male who presented with metastatic poorly differentiated squamous cell carcinoma of right cervical lymph nodes(levels 2 and 3). Imaging studies including(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(CT) and contrast-enhanced CT scan of neck and chest did not reveal any other disease elsewhere. Panendoscopic examination with random biopsy did not reveal malignant lesion in nasopharynx,oropharynx, and larynx. He underwent modified neck dissection and postoperative radiation. Within 2 mo after completion of radiation, he developed local recurrence at right neck, which was surgically removed. Two mo after the salvage surgery, he developed a second recurrence at right neck. Due to suboptimal performance status and his preference, he started erlotinib treatment.He achieved partial response after first 2 mo of erlotinib treatment, then complete response after total 6 mo of erlotinib treatment. He developed sever skin rash and diarrhea including Clostridium difficile infection during the course of erlotinib treatment requiring dose reduction and eventual discontinuation. He remained in complete remission for more than two years after discontinuation of erlotinib.CONCLUSION We report a case of metastatic SCCHN achieving durable complete response from erlotinib. Patient experienced skin rash and diarrhea toxicities which were likely predictors of his treatment response.
BACKGROUND Squamous cell carcinoma of head and neck(SCCHN) is the fifth most common cancer worldwide. Inhibition of epidermal growth factor receptor signaling has been shown to be a critical component of therapeutic option. Herein, we report a case of durable complete response to erlotinib.CASE SUMMARY An 81-year-old Caucasian male who presented with metastatic poorly differentiated squamous cell carcinoma of right cervical lymph nodes(levels 2 and 3). Imaging studies including(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(CT) and contrast-enhanced CT scan of neck and chest did not reveal any other disease elsewhere. Panendoscopic examination with random biopsy did not reveal malignant lesion in nasopharynx,oropharynx, and larynx. He underwent modified neck dissection and postoperative radiation. Within 2 mo after completion of radiation, he developed local recurrence at right neck, which was surgically removed. Two mo after the salvage surgery, he developed a second recurrence at right neck. Due to suboptimal performance status and his preference, he started erlotinib treatment.He achieved partial response after first 2 mo of erlotinib treatment, then complete response after total 6 mo of erlotinib treatment. He developed sever skin rash and diarrhea including Clostridium difficile infection during the course of erlotinib treatment requiring dose reduction and eventual discontinuation. He remained in complete remission for more than two years after discontinuation of erlotinib.CONCLUSION We report a case of metastatic SCCHN achieving durable complete response from erlotinib. Patient experienced skin rash and diarrhea toxicities which were likely predictors of his treatment response.
BACKGROUND Squamous cell carcinoma of head and neck(SCCHN) is the fifth most common cancer worldwide. Inhibition of epidermal growth factor receptor signaling has been shown to be a critical component of therapeutic option. Herein, we report a case of durable complete response to erlotinib.CASE SUMMARY An 81-year-old Caucasian male who presented with metastatic poorly differentiated squamous cell carcinoma of right cervical lymph nodes(levels 2 and 3). Imaging studies including(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(CT) and contrast-enhanced CT scan of neck and chest did not reveal any other disease elsewhere. Panendoscopic examination with random biopsy did not reveal malignant lesion in nasopharynx,oropharynx, and larynx. He underwent modified neck dissection and postoperative radiation. Within 2 mo after completion of radiation, he developed local recurrence at right neck, which was surgically removed. Two mo after the salvage surgery, he developed a second recurrence at right neck. Due to suboptimal performance status and his preference, he started erlotinib treatment.He achieved partial response after first 2 mo of erlotinib treatment, then complete response after total 6 mo of erlotinib treatment. He developed sever skin rash and diarrhea including Clostridium difficile infection during the course of erlotinib treatment requiring dose reduction and eventual discontinuation. He remained in complete remission for more than two years after discontinuation of erlotinib.CONCLUSION We report a case of metastatic SCCHN achieving durable complete response from erlotinib. Patient experienced skin rash and diarrhea toxicities which were likely predictors of his treatment response.
引文
1 Ferlay J,Soerjomataram I,Dikshit R,Eser S,Mathers C,Rebelo M,Parkin DM,Forman D,Bray F.Cancer incidence and mortality worldwide:sources,methods and major patterns in GLOBOCAN 2012.Int J Cancer 2015;136:E359-E386[PMID:25220842 DOI:10.1002/ijc.29210]
2 Marur S,Forastiere AA.Head and Neck Squamous Cell Carcinoma:Update on Epidemiology,Diagnosis,and Treatment.Mayo Clin Proc 2016;91:386-396[PMID:26944243 DOI:10.1016/j.mayocp.2015.12.017]
3 Grandis JR,Tweardy DJ.Elevated levels of transforming growth factor alpha and epidermal growth factor receptor messenger RNA are early markers of carcinogenesis in head and neck cancer.Cancer Res1993;53:3579-3584[PMID:8339264]
4 Rubin Grandis J,Melhem MF,Gooding WE,Day R,Holst VA,Wagener MM,Drenning SD,Tweardy DJ.Levels of TGF-alpha and EGFR protein in head and neck squamous cell carcinoma and patient survival.J Natl Cancer Inst 1998;90:824-832[PMID:9625170 DOI:10.1093/jnci/90.11.824]
5 Etienne MC,Pivot X,Formento JL,Bensadoun RJ,Formento P,Dassonville O,Francoual M,Poissonnet G,Fontana X,Schneider M,Demard F,Milano G.A multifactorial approach including tumoural epidermal growth factor receptor,p53,thymidylate synthase and dihydropyrimidine dehydrogenase to predict treatment outcome in head and neck cancer patients receiving 5-fluorouracil.Br J Cancer 1999;79:1864-1869[PMID:10206306 DOI:10.1038/sj.bjc.6690297]
6 Vermorken JB,Mesia R,Rivera F,Remenar E,Kawecki A,Rottey S,Erfan J,Zabolotnyy D,Kienzer HR,Cupissol D,Peyrade F,Benasso M,Vynnychenko I,De Raucourt D,Bokemeyer C,Schueler A,Amellal N,Hitt R.Platinum-based chemotherapy plus cetuximab in head and neck cancer.N Engl J Med2008;359:1116-1127[PMID:18784101 DOI:10.1056/NEJMoa0802656]
7 Strojan P,Ferlito A,Medina JE,Woolgar JA,Rinaldo A,Robbins KT,Fagan JJ,Mendenhall WM,Paleri V,Silver CE,Olsen KD,Corry J,Suárez C,Rodrigo JP,Langendijk JA,Devaney KO,Kowalski LP,Hartl DM,Haigentz M,Werner JA,Pellitteri PK,de Bree R,Wolf GT,Takes RP,Genden EM,Hinni ML,Mondin V,Shaha AR,Barnes L.Contemporary management of lymph node metastases from an unknown primary to the neck:I.A review of diagnostic approaches.Head Neck 2013;35:123-132[PMID:22034046 DOI:10.1002/hed.21898]
8 Soulieres D,Senzer NN,Vokes EE,Hidalgo M,Agarwala SS,Siu LL.Multicenter phase II study of erlotinib,an oral epidermal growth factor receptor tyrosine kinase inhibitor,in patients with recurrent or metastatic squamous cell cancer of the head and neck.J Clin Oncol 2004;22:77-85[PMID:14701768DOI:10.1200/JCO.2004.06.075]
9 Stewart JS,Cohen EE,Licitra L,Van Herpen CM,Khorprasert C,Soulieres D,Vodvarka P,Rischin D,Garin AM,Hirsch FR,Varella-Garcia M,Ghiorghiu S,Hargreaves L,Armour A,Speake G,Swaisland A,Vokes EE.Phase III study of gefitinib compared with intravenous methotrexate for recurrent squamous cell carcinoma of the head and neck[corrected].J Clin Oncol 2009;27:1864-1871[PMID:19289630DOI:10.1200/JCO.2008.17.0530]
10 Machiels JP,Haddad RI,Fayette J,Licitra LF,Tahara M,Vermorken JB,Clement PM,Gauler T,Cupissol D,Grau JJ,Guigay J,Caponigro F,de Castro G,de Souza Viana L,Keilholz U,Del Campo JM,Cong XJ,Ehrnrooth E,Cohen EE;LUX-H&N 1 investigators.Afatinib versus methotrexate as second-line treatment in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck progressing on or after platinum-based therapy(LUX-Head&Neck 1):an open-label,randomised phase 3 trial.Lancet Oncol 2015;16:583-594[PMID:25892145 DOI:10.1016/S1470-2045(15)70124-5]
11 de Souza JA,Davis DW,Zhang Y,Khattri A,Seiwert TY,Aktolga S,Wong SJ,Kozloff MF,Nattam S,Lingen MW,Kunnavakkam R,Stenson KM,Blair EA,Bozeman J,Dancey JE,Vokes EE,Cohen EE.Aphase II study of lapatinib in recurrent/metastatic squamous cell carcinoma of the head and neck.Clin Cancer Res 2012;18:2336-2343[PMID:22371453 DOI:10.1158/1078-0432.CCR-11-2825]
12 Cohen EE,Halpern AB,Kasza K,Kocherginsky M,Williams R,Vokes EE.Factors associated with clinical benefit from epidermal growth factor receptor inhibitors in recurrent and metastatic squamous cell carcinoma of the head and neck.Oral Oncol 2009;45:e155-e160[PMID:19586795 DOI:10.1016/j.oraloncology.2009.05.637]
13 Ruan Y,Jiang J,Guo L,Li Y,Huang H,Shen L,Luan M,Li M,Du H,Ma C,He L,Zhang X,Qin S.Genetic Association of Curative and Adverse Reactions to Tyrosine Kinase Inhibitors in Chinese advanced Non-Small Cell Lung Cancer patients.Sci Rep 2016;6:23368[PMID:26988277 DOI:10.1038/srep23368]
14 Liu S,Kurzrock R.Toxicity of targeted therapy:Implications for response and impact of genetic polymorphisms.Cancer Treat Rev 2014;40:883-891[PMID:24867380 DOI:10.1016/j.ctrv.2014.05.003]
15 Perisanidis C.Prevalence of EGFR Tyrosine Kinase Domain Mutations in Head and Neck Squamous Cell Carcinoma:Cohort Study and Systematic Review.In Vivo 2017;31:23-34[PMID:28064216 DOI:10.21873/invivo.11020]
16 Van Allen EM,Lui VW,Egloff AM,Goetz EM,Li H,Johnson JT,Duvvuri U,Bauman JE,Stransky N,Zeng Y,Gilbert BR,Pendleton KP,Wang L,Chiosea S,Sougnez C,Wagle N,Zhang F,Du Y,Close D,Johnston PA,McKenna A,Carter SL,Golub TR,Getz G,Mills GB,Garraway LA,Grandis JR.Genomic Correlate of Exceptional Erlotinib Response in Head and Neck Squamous Cell Carcinoma.JAMA Oncol2015;1:238-244[PMID:26181029 DOI:10.1001/jamaoncol.2015.34]
17 Wen Y,Li H,Zeng Y,Wen W,Pendleton KP,Lui VW,Egloff AM,Grandis JR.MAPK1E322K mutation increases head and neck squamous cell carcinoma sensitivity to erlotinib through enhanced secretion of amphiregulin.Oncotarget 2016;7:23300-23311[PMID:27004400 DOI:10.18632/oncotarget.8188]
18 Dumbrava EI,Alfattal R,Miller VA,Tsimberidou AM.Complete Response to a Fibroblast Growth Factor Receptor Inhibitor in a Patient With Head and Neck Squamous Cell Carcinoma Harboring FGFAmplifications.JCO Precision Oncology 2018;1-7[DOI:10.1200/PO.18.00100]
2 Marur S,Forastiere AA.Head and Neck Squamous Cell Carcinoma:Update on Epidemiology,Diagnosis,and Treatment.Mayo Clin Proc 2016;91:386-396[PMID:26944243 DOI:10.1016/j.mayocp.2015.12.017]
3 Grandis JR,Tweardy DJ.Elevated levels of transforming growth factor alpha and epidermal growth factor receptor messenger RNA are early markers of carcinogenesis in head and neck cancer.Cancer Res1993;53:3579-3584[PMID:8339264]
4 Rubin Grandis J,Melhem MF,Gooding WE,Day R,Holst VA,Wagener MM,Drenning SD,Tweardy DJ.Levels of TGF-alpha and EGFR protein in head and neck squamous cell carcinoma and patient survival.J Natl Cancer Inst 1998;90:824-832[PMID:9625170 DOI:10.1093/jnci/90.11.824]
5 Etienne MC,Pivot X,Formento JL,Bensadoun RJ,Formento P,Dassonville O,Francoual M,Poissonnet G,Fontana X,Schneider M,Demard F,Milano G.A multifactorial approach including tumoural epidermal growth factor receptor,p53,thymidylate synthase and dihydropyrimidine dehydrogenase to predict treatment outcome in head and neck cancer patients receiving 5-fluorouracil.Br J Cancer 1999;79:1864-1869[PMID:10206306 DOI:10.1038/sj.bjc.6690297]
6 Vermorken JB,Mesia R,Rivera F,Remenar E,Kawecki A,Rottey S,Erfan J,Zabolotnyy D,Kienzer HR,Cupissol D,Peyrade F,Benasso M,Vynnychenko I,De Raucourt D,Bokemeyer C,Schueler A,Amellal N,Hitt R.Platinum-based chemotherapy plus cetuximab in head and neck cancer.N Engl J Med2008;359:1116-1127[PMID:18784101 DOI:10.1056/NEJMoa0802656]
7 Strojan P,Ferlito A,Medina JE,Woolgar JA,Rinaldo A,Robbins KT,Fagan JJ,Mendenhall WM,Paleri V,Silver CE,Olsen KD,Corry J,Suárez C,Rodrigo JP,Langendijk JA,Devaney KO,Kowalski LP,Hartl DM,Haigentz M,Werner JA,Pellitteri PK,de Bree R,Wolf GT,Takes RP,Genden EM,Hinni ML,Mondin V,Shaha AR,Barnes L.Contemporary management of lymph node metastases from an unknown primary to the neck:I.A review of diagnostic approaches.Head Neck 2013;35:123-132[PMID:22034046 DOI:10.1002/hed.21898]
8 Soulieres D,Senzer NN,Vokes EE,Hidalgo M,Agarwala SS,Siu LL.Multicenter phase II study of erlotinib,an oral epidermal growth factor receptor tyrosine kinase inhibitor,in patients with recurrent or metastatic squamous cell cancer of the head and neck.J Clin Oncol 2004;22:77-85[PMID:14701768DOI:10.1200/JCO.2004.06.075]
9 Stewart JS,Cohen EE,Licitra L,Van Herpen CM,Khorprasert C,Soulieres D,Vodvarka P,Rischin D,Garin AM,Hirsch FR,Varella-Garcia M,Ghiorghiu S,Hargreaves L,Armour A,Speake G,Swaisland A,Vokes EE.Phase III study of gefitinib compared with intravenous methotrexate for recurrent squamous cell carcinoma of the head and neck[corrected].J Clin Oncol 2009;27:1864-1871[PMID:19289630DOI:10.1200/JCO.2008.17.0530]
10 Machiels JP,Haddad RI,Fayette J,Licitra LF,Tahara M,Vermorken JB,Clement PM,Gauler T,Cupissol D,Grau JJ,Guigay J,Caponigro F,de Castro G,de Souza Viana L,Keilholz U,Del Campo JM,Cong XJ,Ehrnrooth E,Cohen EE;LUX-H&N 1 investigators.Afatinib versus methotrexate as second-line treatment in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck progressing on or after platinum-based therapy(LUX-Head&Neck 1):an open-label,randomised phase 3 trial.Lancet Oncol 2015;16:583-594[PMID:25892145 DOI:10.1016/S1470-2045(15)70124-5]
11 de Souza JA,Davis DW,Zhang Y,Khattri A,Seiwert TY,Aktolga S,Wong SJ,Kozloff MF,Nattam S,Lingen MW,Kunnavakkam R,Stenson KM,Blair EA,Bozeman J,Dancey JE,Vokes EE,Cohen EE.Aphase II study of lapatinib in recurrent/metastatic squamous cell carcinoma of the head and neck.Clin Cancer Res 2012;18:2336-2343[PMID:22371453 DOI:10.1158/1078-0432.CCR-11-2825]
12 Cohen EE,Halpern AB,Kasza K,Kocherginsky M,Williams R,Vokes EE.Factors associated with clinical benefit from epidermal growth factor receptor inhibitors in recurrent and metastatic squamous cell carcinoma of the head and neck.Oral Oncol 2009;45:e155-e160[PMID:19586795 DOI:10.1016/j.oraloncology.2009.05.637]
13 Ruan Y,Jiang J,Guo L,Li Y,Huang H,Shen L,Luan M,Li M,Du H,Ma C,He L,Zhang X,Qin S.Genetic Association of Curative and Adverse Reactions to Tyrosine Kinase Inhibitors in Chinese advanced Non-Small Cell Lung Cancer patients.Sci Rep 2016;6:23368[PMID:26988277 DOI:10.1038/srep23368]
14 Liu S,Kurzrock R.Toxicity of targeted therapy:Implications for response and impact of genetic polymorphisms.Cancer Treat Rev 2014;40:883-891[PMID:24867380 DOI:10.1016/j.ctrv.2014.05.003]
15 Perisanidis C.Prevalence of EGFR Tyrosine Kinase Domain Mutations in Head and Neck Squamous Cell Carcinoma:Cohort Study and Systematic Review.In Vivo 2017;31:23-34[PMID:28064216 DOI:10.21873/invivo.11020]
16 Van Allen EM,Lui VW,Egloff AM,Goetz EM,Li H,Johnson JT,Duvvuri U,Bauman JE,Stransky N,Zeng Y,Gilbert BR,Pendleton KP,Wang L,Chiosea S,Sougnez C,Wagle N,Zhang F,Du Y,Close D,Johnston PA,McKenna A,Carter SL,Golub TR,Getz G,Mills GB,Garraway LA,Grandis JR.Genomic Correlate of Exceptional Erlotinib Response in Head and Neck Squamous Cell Carcinoma.JAMA Oncol2015;1:238-244[PMID:26181029 DOI:10.1001/jamaoncol.2015.34]
17 Wen Y,Li H,Zeng Y,Wen W,Pendleton KP,Lui VW,Egloff AM,Grandis JR.MAPK1E322K mutation increases head and neck squamous cell carcinoma sensitivity to erlotinib through enhanced secretion of amphiregulin.Oncotarget 2016;7:23300-23311[PMID:27004400 DOI:10.18632/oncotarget.8188]
18 Dumbrava EI,Alfattal R,Miller VA,Tsimberidou AM.Complete Response to a Fibroblast Growth Factor Receptor Inhibitor in a Patient With Head and Neck Squamous Cell Carcinoma Harboring FGFAmplifications.JCO Precision Oncology 2018;1-7[DOI:10.1200/PO.18.00100]