免疫藥物Nivolumab合併Cisplatin及Gemcitabine治療轉移性鼻咽癌的療效及安全性

The Safety and Efficacy of Nivolumab Treatment Combined with Cisplatin and Gemcitabine in a Patient with Metastatic Nasopharyngeal Carcinoma

轉移性鼻咽癌是臨床上非常棘手的狀況，雖然以鉑金類（platinum-based）為主的化學藥物治療，被公認為第一線治療處方，但目前仍無最佳的化學治療處方。Cisplatin合併gemcitabine的化學藥物治療已被證明對復發或轉移性鼻咽癌病人具有更好的治療作用。此外，免疫藥物的發展，也為復發及轉移性鼻咽癌患者提供了另一個治療的選項。但是在化療藥物的基礎上，若同時合併使用免疫藥物，是否會增加臨床上治療的急性血液毒副作用，則尚未有完整的報告。本篇文章分享臨床上使用化學藥物合併免疫藥物治療（gemcitabine＋cisplatin＋nivolumab），在轉移性鼻咽癌患者的治療順應性及急性血液毒副作用，其次提供病人在接受治療後的成效。該病人在治療過程中急性副作用的嚴重程度為第三級貧血及第二級白血球低下，但病人仍可以非常順利按照預定的治療計劃，接受了12次的化學藥物治療合併免疫藥物治療。而病人在接受治療後，經檢查證實後多處轉移病灶完全緩解，目前仍無病存活至今超過22個月。總結來說，臨床上使用化學藥物治療合併免疫藥物治療，對轉移性鼻咽癌的治療上，並不會增加非預期的急性血液毒副作用，且相當有效。

Although platinum-based systemic treatment is the first choice for patients with metastatic nasopharyngeal carcinoma; the best treatment option is still under investigation and it remains a clinical challenging issue. Combination of cisplatin and gemcitabine is proved to be an effective regimen in recurrent/metastatic nasopharyngeal carcinoma. Besides, immuno-drug therapy (anti-programmed cell death ligand 1; pembrolizumab or nivolumab) also displayed a considerable treatment breakthrough for patients with recurrent/metastatic head and neck cancer. However, it is unknown whether combination of immuno-drug with chemotherapy will increase adverse effects or not in patients with nasopharyngeal carcinoma. We shared our clinical experience of therapeutic compliance and acute hematologic adverse effects for patients with metastatic nasopharyngeal carcinoma treating by nivolumab in combination with cisplatin and gemcitabine. Secondary, the clinical tumor response after treatment was also reported. The most common acute hematologic adverse effects were grade 3 anemia followed by grade 2 leukopenia; nevertheless, the patient received this chemotherapy regimen for 12 cycles without interruption. A complete response was documented by [18F]-fluorodeoxyglucose positron emission tomography scan and the patient is still under regular follow up with disease-free status for more than 22 months. In conclusion, combination of nivolumab with cisplatin and gemcitabine does not increase the treatment-related toxicities in patients with metastatic nasopharyngeal carcinoma and this chemotherapy regimen is an effective treatment option.