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A case of recurrent oral cancer treated with interchangeable administrations of immune checkpoint inhibitors and chemotherapy agents

Programmed death 1 （PD-1） immune checkpoint inhibitors （ICIs） have demonstrated efficacy for recurrent and/ or metastatic squamous cell carcinoma of the head and neck （R/M-SCCHN）. On the other hand, some patients are refractory to these inhibitors; although the efficacy of salvage chemotherapy after ICIs has been shown, there have been few reports on subsequent drug therapy options. Herein, we present a case of recurrent oral cancer that showed significant efficacy in with multiple use of nivolumab and chemotherapy agents interchangeably. A 76-year-old female was previously treated with the EXTREME regimen （combined with cetuximab, 5-fluorouracil, and cisplatin） for recurrent oral cancer. Since the lesions clinically progressed, nivolumab was applied as second-line treatment. After nivolumab treatment, weekly Paclitaxel was administered as third-line salvage chemotherapy due to tumor progression. Then, nivolumab was administered multiple times with chemotherapy alternately, and a partial response was obtained. After 33 months from the first-line chemotherapy for recurrent oral cancer, the patient chose to receive palliative care owing to the development of a new lesion on the tongue. The patient died as a result of progressive disease one month later.