Nimotuzumab combined with radiotherapy for the treatment of hypopharyngeal cancer - A case report from a tertiary cancer center
Background: Nimotuzumab is a monoclonal antibody against epidermal growth factor receptor which can be combined with chemotherapy and radiotherapy for the treatment of locally advanced unresectable squamous cell carcinoma of head and neck region and its role has already been established in India.
Aim: The aim of this case report is to show the role of nimotuzumab in carcinoma hypopharynx.
Methods: We report a patient with stage III carcinoma of hypopharynx, who received radiotherapy along with weekly nimotuzumab owing to his comorbidities. The patient had tolerated the treatment very well without any major side effects. Results: The patient is on regular follow-up with a complete response (CR) of the disease and with the disease free interval (DFI) of 7 months.
Conclusions: Nimotuzumab along with radiotherapy can be safely given in the patients with carcinoma hypopharynx, who are ineligible for chemotherapy.
Relevance for patients: Nimotuzumab can be added with radiotherapy to the patients with head and neck malignancies who are ineligible for chemotherapy in order to improve the clinical outcome with minimal toxicity.
[1] Dwivedi RC, Kazi RA, Agrawal N, Nutting CM, Clarke PM, Kerawala CJ, et al. Evaluation of Speech Outcomes Following Treatment of Oral and Oropharyngeal Cancers. Cancer Treat Rev 2009;35:417-24.
[2] Tuljapurkar V, Dhar H, Mishra A, Chakraborti S, Chaturvedi P, Pai PS. The Indian Scenario of Head and Neck Oncology-Challenging the Dogmas. South Asian J Cancer 2016;5:105-10.
[3] Graham S, Dayal H, Rohrer T, Swanson M, Sultz H, Shedd D, et al. Dentition, Diet, Tobacco, and Alcohol in the Epidemiology of Oral Cancer. J Natl Cancer Inst 1977;59:1611-8.
[4] Joshi P, Dutta S, Chaturvedi P, Nair S. Head and Neck Cancers in Developing Countries. Rambam Maimonides Med J 2014;5:e0009.
[5] Chinn SB, Spector ME, Bellile EL, Rozek LS, Lin T, Teknos TN, et al. Efficacy of Induction Selection Chemotherapy vs Primary Surgery for Patients with Advanced Oral Cavity Carcinoma. JAMA Otolaryngol Head Neck Surg 2014;140:134-42.
[6] Keil F, Selzer E, Berghold A, Reinisch S, Kapp KS, De Vries A, et al. Induction Chemotherapy with Docetaxel, Cisplatin and 5-Fluorouracil Followed by Radiotherapy with Cetuximab for Locally Advanced Squamous Cell Carcinoma of the Head and Neck. Eur J Cancer 2013;49:352-9.
[7] Pignon JP, le Maître A, Maillard E, Bourhis J, MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy in Head and Neck Cancer (MACH-NC): An Update on 93 Randomised Trials and 17, 346 Patients. Radiother Oncol 2009;92:4-14.
[8] Agulnik M. New Approaches to EGFR Inhibition for Locally Advanced or Metastatic Squamous Cell Carcinoma of the Head and Neck (SCCHN). Med Oncol 2012;29:2481-91.
[9] Vermorken JB, Mesia R, Rivera F, Remenar E, Kawecki A, Rottey S, et al. Platinum-Based Chemotherapy Plus Cetuximab in Head and Neck Cancer. N Engl J Med 2008;359:1116-27.
[10] Rivera F, García-Castaño A, Vega N, Vega-Villegas ME, Gutiérrez-Sanz L. Cetuximab in Metastatic or Recurrent Head and Neck Cancer: The EXTREME Trial. Expert Rev Anticancer Ther 2009;9:1421-8.
[11] Guan M, Zhou YP, Sun JL, Chen SC. Adverse Events of Monoclonal Antibodies used for Cancer Therapy. Biomed Res Int 2015;2015:428169.
[12] Reddy BK, Lokesh V, Vidyasagar MS, Shenoy K, Babu KG, Shenoy A, et al. Nimotuzumab Provides Survival Benefit to Patients with Inoperable Advanced Squamous Cell Carcinoma of the Head and Neck: A Randomized, OpenLabel, Phase IIb, 5-Year Study in Indian Patients. Oral Oncol 2014;50:498-505.
[13] Garrido G, Tikhomirov IA, Rabasa A, Yang E, Gracia E, Iznaga N, et al. Bivalent Binding by Intermediate Affinity of Nimotuzumab: A Contribution to Explain Antibody Clinical Profile. Cancer Biol Ther 2011;11:373-82.
[14] Babu KG, Viswanath L, Reddy BK, Shenoy K, Shenoy A, Naveen T, et al. An Open-Label, Randomized, Study of h-R3mAb (Nimotuzumab) in Patients with Advanced (stage III or IVa) Squamous Cell Carcinoma of Head and Neck (SCCHN): Four-Year Survival Results from a Phase IIb Study. J Clin Oncol 2010;28:5530.
[15] Subramanian S, Sridharan N, Balasundaram V, ChaudhariS. Efficacy and Safety of Nimotuzumab in Unresectable, Recurrent, and/or Metastatic Squamous Cell Carcinoma of the Head and Neck: A Hospital-Based Retrospective Evidence. South Asian J Cancer 2018;7:188-92.
[16] Kumar A, Chakravarty N, Bhatnagar S, Chowdhary GS. Efficacy and Safety of Concurrent Chemoradiotherapy with or without Nimotuzumab in Unresectable Locally Advanced Squamous Cell Carcinoma of Head and Neck: Prospective Comparative Study-ESCORT-N Study. South Asian J Cancer 2019;8:108-11.
[17] Wang X, Gu J, Shao C, Han K, Meng J. Nimotuzumab Plus Chemotherapy with Docetaxel, Cisplatin, 5-Fluorouracil for Locally Advanced Head and Neck Squamous Cell Carcinoma: A Clinical Study. J Cancer Res Ther 2019;15:312-6.
[18] Yadav A, Goyal P, Agrawal CR, Bothra SJ, Jain P, Choudhury KD, et al. Efficacy and Tolerability of Nimotuzumab in Combination with Chemotherapy in Recurrent and Metastatic Squamous Cell Carcinoma of Head and Neck at a Cancer Center in Northern India. Indian J Cancer 2020;57:76-83.
[19] Somani N. Nimotuzumab with Concurrent ChemoRadiotherapy in Patients with Locally Advanced Squamous Cell Carcinoma of Head and Neck (LASCCHN). J Cancer Ther 2015;6:356-61.
[20] Bhatnagar AR, Singh DP. A Comparative Study of a Monoclonal Antibody Against EGFR (Nimotuzumab) Used in Combination with Chemoradiation Versus Chemoradiation Alone in the Treatment of Locally Advanced Inoperable Squamous cell Carcinoma of the Head and Neck. J Clin Oncol 2012;30 Suppl 30:51.