Concurrent Nimotuzumab with Radiation Therapy in Locally Advanced Cancers of Oropharynx and Hypopharynx: A Review of 6 Cases

Abstract

Background: The prevalence of head and neck cancers in the world is around 57% and predominantly occurs in Asian countries. It accounts for 30% of all cancers in India. The cure rate of locally advanced squamous cell carcinoma of the head and neck (SCCHN) has only 30% - 60% even after combined therapeutic approaches. Epidermal Growth Factor Receptor (EGFR) antagonists are the most researched targets in the management of head and neck cancers. Claims at superior tumor control and additional survival benefit without any added toxicity make it an attractive option. With this case series we intend to see how nimotuzumab, a humanized monoclonal antibody, fares in difficult cases of head and neck cancers. Case Description: In this case series, total six patients of locally advanced cancer of head and neck region were treated weekly using cisplatin and nimotuzumab concurrently with radiation therapy (RT) for 6 - 7 weeks. Depending upon the disease stage as well as the general condition of the patient, different dose cycles and radiation doses were tailored. Patients were monitored for regular physical examinations and hematological tests followed by pre and post treatment computed tomography (CT) scans, Fludeoxyglucose positive emission tomography (FDG PET-CT) scans, and histopathology. All patients were assessed for toxicities and managed consequently. After completion of radiation and follow-up, 6 weeks later post treatment CT scans were carried out. Conclusion: This case series shows that combination of chemoradiation with nimotuzumab achieved good response rates with no evidence of residual disease/disease progression on follow-up. The patients’ tolerability with combination therapy was good and toxicity was acceptable. Nimotuzumab was found beneficial in combination with chemoradiation for locally advanced head and neck cancers.