Große-Thie C, Maletzki C, Junghanss C, Schmidt K. Long-term survivor of metastatic squamous-cell head and neck carcinoma with occult primary after cetuximab-based chemotherapy: A case report. World J Clin Cases 2021; 9(24): 7092-7098 [PMID: 34540964 DOI: 10.12998/wjcc.v9.i24.7092]
Corresponding Author of This Article
Kathie Schmidt, MD, Medical Assistant, Department of Medicine, Clinic III-Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Ernst-Heydemann-Str. 6, Rostock 18057, Germany. kathie.schmidt@med.uni-rostock.de
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 26, 2021; 9(24): 7092-7098 Published online Aug 26, 2021. doi: 10.12998/wjcc.v9.i24.7092
Long-term survivor of metastatic squamous-cell head and neck carcinoma with occult primary after cetuximab-based chemotherapy: A case report
Christina Große-Thie, Claudia Maletzki, Christian Junghanss, Kathie Schmidt
Christina Große-Thie, Claudia Maletzki, Christian Junghanss, Kathie Schmidt, Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock 18057, Germany
Author contributions: Große-Thie C was the patient’s doctor in charge, responsible for collecting medical history and contributing to the revision of the manuscript; Schmidt K was responsible for collecting medical history, reviewing the literature, drafting the paper, and contributing to the revising of the manuscript; Maletzki C and Junghanss C treated and revised the manuscript; all the authors issued final approval for the version to be submitted.
Informed consent statement: The patient provided informed written consent prior to publication of the case report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016). The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kathie Schmidt, MD, Medical Assistant, Department of Medicine, Clinic III-Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Ernst-Heydemann-Str. 6, Rostock 18057, Germany. kathie.schmidt@med.uni-rostock.de
Received: February 19, 2021 Peer-review started: February 19, 2021 First decision: March 25, 2021 Revised: April 6, 2021 Accepted: July 14, 2021 Article in press: July 14, 2021 Published online: August 26, 2021
Abstract
BACKGROUND
Cancer of unknown primary (CUP) is a histological proven malignant tumor whose origin cannot be detected despite careful examination. Most cervical lymph node metastases in CUP (80%) will originate from head and neck sites, and 15% show infiltration of squamous carcinoma cells. The survival rates of CUP are poor: The 5-year-survival rate ranges from 10% to 15%. First-line treatment recommendation for advanced, inoperable squamous cell carcinoma of head/neck (HNSCC) was cetuximab plus platinum-fluorouracil chemotherapy until recently, when checkpoint inhibitors proved clinically beneficial therapies.
CASE SUMMARY
Here, we report a case of a 42-year-old female patient with cervical and abdominal lymph node and distant bone metastases of an occult primary of the head and neck (squamous cell carcinoma, human papillomavirus positive). The cancer was diagnosed during pregnancy 10 years ago, and after giving birth, the patient was treated with cetuximab plus platinum-fluorouracil chemotherapy achieving complete remission (CR). CR lasted 26 mo when new metastases (abdominal lymph node, lumbar vertebral body) emerged. Both manifestations were irradiated. From then on, the patient has not received any further treatment, and her disease has remained controlled. Ten years after the initial cancer diagnosis, the patient is still alive and in good health, representing an exceptional case of HNSCC.
CONCLUSION
This case illustrates the exceptional clinical course and benefits of combined therapy approaches in advanced metastatic HNSCC with occult primary.
Core Tip: A 42-year-old female patient suffered from metastatic squamous-cell head and neck cancer with occult primary with lymph node and bone metastases. She received palliative immune-chemotherapy with cetuximab, 5-fluorouracil, and platinum as first-line treatment, and subsequent irradiation of further abdominal lymph node and bone metastases. Although survival rates are very poor in this setting, the patient is still alive 10 years after treatment and in complete remission. Here, we present a rare case of long-term survival despite poor prognosis after palliative immunotherapy even before the era of immune checkpoint inhibitors.
