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Case Reports
. 2024 Jan;7(1):e1915.
doi: 10.1002/cnr2.1915. Epub 2023 Oct 22.

Durable and dramatic response to checkpoint inhibition combined with COX-2 inhibitor celecoxib in a patient with p16+ metastatic sinonasal undifferentiated carcinoma: A case study

Jonathan Q Trinh  1 , Cassaundra Acosta  2 , Arti Easwar  3 , Robert Galamaga  2 , Alan Tan  4
Affiliations
Case Reports

Durable and dramatic response to checkpoint inhibition combined with COX-2 inhibitor celecoxib in a patient with p16+ metastatic sinonasal undifferentiated carcinoma: A case study

Jonathan Q Trinh et al. Cancer Rep (Hoboken). 2024 Jan.

Abstract

Background: Sinonasal undifferentiated carcinoma (SNUC) is an exceedingly rare head and neck malignancy. No consensus exists on treatment for metastatic disease.

Case: A 56-year-old female was diagnosed with SNUC after endorsing sinus congestion, diplopia, and right orbital pain. Initially treated with surgery and radiation, she later developed significant metastatic disease. She demonstrated progression of her hepatic metastases under pembrolizumab therapy. However, the addition of ipilimumab and a COX-2 inhibitor resulted in significant improvement in her lesions as well as an ongoing durable response. Her regimen was complicated by immune-related adverse events successfully treated with steroids.

Conclusion: Dual checkpoint inhibition deserves consideration when treating metastatic SNUC, especially after single agent therapy has failed. The positive effect of this treatment may be augmented by IDO1 inhibition.

Keywords: IDO1; dual checkpoint inhibition; immunotherapy; metastatic; sinonasal undifferentiated carcinoma.

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Conflict of interest statement

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Figures

FIGURE 1
FIGURE 1
Histopathological findings in metastatic Sinonasal undifferentiated carcinoma (SNUC). Hematoxylin–Eosin (H&E) staining of liver tissue shows complete replacement of normal liver parenchyma by neoplastic high grade cells with extensive necrosis (A: ×40). The atypical cells show irregular nuclear borders, vesicular chromatin and prominent nucleoli, with abundant atypical mitoses (arrow) and apoptosis (circle) (B: ×600). Immunohistochemical stain for p16 (CINtec) is positive (nuclear and cytoplasmic staining) in the areas with viable tumor (C: ×20).
FIGURE 2
FIGURE 2
Computed tomography scans of hepatic metastases. (A) Initial presentation with largest diameter 15.5 centimeters. (B) Improvement of metastases at outside hospital after finishing treatment. (C) Continued improvement after 11 weeks from last treatment. (D) Continued improvement after 24 weeks from last treatment.
See this image and copyright information in PMC

References

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Supplementary concepts