Long Term Remission and Cardiac Toxicity of a Combination of Ipilimumab and Nivolumab in a Patient With Metastatic Head and Neck Carcinoma After Progression Following Nivolumab Monotherapy

The prognosis of recurrent and/or metastatic squamous cell carcinoma of the head and neck (HNSCC) is very poor and treatment options are limited. Patients suffering from HNSCC tumor progression within 6 months after platinum-based chemotherapy have a median survival of 6 months or less (1, 2). Nivolumab, a programmed death 1 (PD-1) inhibitor, is approved for the treatment of HNSCC being refractory or progressive under platinum based therapy (3). Recent studies showed a significant response of the combination of nivolumab and the cytotoxic lymphocyte antigen 4 (CTLA4) antibody ipilimumab in different tumor types (4, 5). Ongoing trials elaborate the therapeutic success of this combination in HNSCC (NCT03406247, NCT02741570, NCT02919683, NCT03620123, NCT02823574). Thus, there is limited data concerning the efficacy of this innovative therapeutic regimen in HNSCC, especially after progression following monotherapy with a PD-1 inhibitor. A single case has reported a remarkable response to the combination of nivolumab and ipilimumab in a patient with platinum refractory HNSCC without previous immunotherapy (6). © 2019 Schwab, Kristiansen, Isaak, Held, Heine and Brossart.