新辅助帕博利珠单抗联合尼妥珠单抗作为体弱老年上颌牙龈及腭部鳞状细胞癌患者手术桥接的病例报告

文献信息

中文摘要

背景： 在患有口腔鳞状细胞癌的老年患者中，肿瘤相关症状可损害经口进食并影响其手术耐受性。本病例描述了一种个体化的免化疗手术桥接方案，该方案将针对肿瘤的治疗与营养和功能支持相结合。
病例介绍： 一名75岁女性因左上颌牙龈及硬腭鳞状细胞癌就诊，伴有严重口腔疼痛、吞咽困难、2周内体重下降5 kg，美国东部肿瘤协作组体能状态评分为3分。活检证实为高分化鳞状细胞癌，表皮生长因子受体表达阳性，程序性死亡配体1联合阳性评分为70。由于初诊时认为顺铂不适用，她接受了帕博利珠单抗（200 mg，每3周一次）联合尼妥珠单抗（200 mg，每周一次）治疗，并同时给予支持治疗。两个治疗周期后，经口进食恢复，体重从70 kg增至75 kg，体能状态评分从3分改善至1分。计算机断层扫描显示明显退缩，报告为部分缓解。2025年12月12日行上颌骨切除术和左颈淋巴结清扫术。术后病理报告为完全缓解（ypT0N0），32枚淋巴结中0枚受累。术后维持免疫治疗仍在进行，截至2026年9月最后一次随访时未报告复发。
结论： 本病例说明，在一名临床体弱的老年患者中，术前帕博利珠单抗联合尼妥珠单抗并同时给予支持治疗作为确定性手术的桥接是可行的。该病例并未确立帕博利珠单抗联合尼妥珠单抗的疗效或比较安全性、任一药物的独立贡献或疾病控制的持久性。手术桥接这一概念值得在经过仔细选择的患者中进行前瞻性评估。

英文摘要

BACKGROUND: In older patients with oral squamous cell carcinoma, tumor-related symptoms can impair oral intake and compromise fitness for surgery. This case describes an individualized chemotherapy-free bridge-to-surgery approach that combined tumor-directed treatment with nutritional and functional support.
CASE PRESENTATION: A 75-year-old woman presented with left maxillary gingival and hard-palatal squamous cell carcinoma, severe oral pain, dysphagia, a 5-kg weight loss over 2 weeks, and an Eastern Cooperative Oncology Group performance status of 3. Biopsy confirmed well-differentiated squamous cell carcinoma with positive epidermal growth factor receptor expression and a programmed death ligand 1 combined positive score of 70. Because cisplatin was considered unsuitable at presentation, she received pembrolizumab (200 mg every 3 weeks) plus nimotuzumab (200 mg weekly), with concurrent supportive care. After two treatment cycles, oral intake recovered, body weight increased from 70 to 75 kg, and performance status improved from 3 to 1. Computed tomography showed marked regression, reported as a partial response. Maxillectomy and left neck dissection were performed on 12 December 2025. Postoperative pathology was reported as a complete response (ypT0N0), with 0 of 32 lymph nodes involved. Postoperative maintenance immunotherapy remained ongoing, and no recurrence was reported at the last follow-up in September 2026.
CONCLUSION: This case illustrates the feasibility of preoperative pembrolizumab plus nimotuzumab with concurrent supportive care as a bridge to definitive surgery in one clinically frail older patient. It does not establish the efficacy or comparative safety of pembrolizumab plus nimotuzumab, the independent contribution of either drug, or the durability of disease control. The bridge-to-surgery concept warrants prospective evaluation in carefully selected patients.