PMC9846513_01
Case Timeline.
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August 2020 ( Figures 1 ,  2A ).
(A-G) Lesion During Treatment Progression: (A) August 2020, First presentation to dermatology; (B) November 6, 2020, prior to initiating cemiplimab; (C) December 4, 2020, after 1 cycle of cemiplimab; (D) December 22, 2020, after 2 cycles of cemiplimab and 1 cycle of QuadShot radiotherapy; (E) January 14, 2021, after 3 cycles of cemiplimab and 2 cycles of QuadShot radiotherapy; (F) February 11, 2021, after 4 cycles of cemiplimab and 2 cycles QuadShot radiotherapy; (G) October 2021, after debulking and reconstruction.
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Figure 2C ). Cycle 2 Day 2 cemiplimab was given on December 3, 2020. Following the second dose of cemiplimab + first radiation cycle, the lesion decreased by 75% with significant improvement from disease involvement near the eye. Cycle 2, day 1 QUAD shot was given on December 17, 2020 ( Figure 2D ), and cycle 3, day 1 cemiplimab was given on December 23, 2020. There was a further 75% reduction in the size of the mass ( Figure 2E ), but the patient developed grade-2 hypothyroidism. Following cycle 4 of cemiplimab, with cycle 4, day 1 on January 4, 2021, the patient developed two fistulas in his maxillary sinus and nasal cavity, which were determined to be sites of disease regression ( Figure 2F ). To salvage as much viable tissue as possible, the patient was referred to surgery for debridement of necrotic tissue and reconstruction ( Figure 2G ).
PMC9846513_02
(A-G) Lesion During Treatment Progression: (A) August 2020, First presentation to dermatology; (B) November 6, 2020, prior to initiating cemiplimab; (C) December 4, 2020, after 1 cycle of cemiplimab; (D) December 22, 2020, after 2 cycles of cemiplimab and 1 cycle of QuadShot radiotherapy; (E) January 14, 2021, after 3 cycles of cemiplimab and 2 cycles of QuadShot radiotherapy; (F) February 11, 2021, after 4 cycles of cemiplimab and 2 cycles QuadShot radiotherapy; (G) October 2021, after debulking and reconstruction.
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Figure 2C ). Cycle 2 Day 2 cemiplimab was given on December 3, 2020. Following the second dose of cemiplimab + first radiation cycle, the lesion decreased by 75% with significant improvement from disease involvement near the eye. Cycle 2, day 1 QUAD shot was given on December 17, 2020 ( Figure 2D ), and cycle 3, day 1 cemiplimab was given on December 23, 2020. There was a further 75% reduction in the size of the mass ( Figure 2E ), but the patient developed grade-2 hypothyroidism. Following cycle 4 of cemiplimab, with cycle 4, day 1 on January 4, 2021, the patient developed two fistulas in his maxillary sinus and nasal cavity, which were determined to be sites of disease regression ( Figure 2F ). To salvage as much viable tissue as possible, the patient was referred to surgery for debridement of necrotic tissue and reconstruction ( Figure 2G ).
(A, B): (A) (top): MRI of head prior to initiating cemiplimab; (B) (bottom): MRI of head following completion of cemiplimab.
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A facial MRI from January 27, 2021 revealed near-complete regression of the tumor in the inferior orbit ( Figure 3B ), indicating the patient may be able to avoid left orbital exenteration, which would have been indicated prior to ICI treatment.
PMC9846513_03
(A-G) Lesion During Treatment Progression: (A) August 2020, First presentation to dermatology; (B) November 6, 2020, prior to initiating cemiplimab; (C) December 4, 2020, after 1 cycle of cemiplimab; (D) December 22, 2020, after 2 cycles of cemiplimab and 1 cycle of QuadShot radiotherapy; (E) January 14, 2021, after 3 cycles of cemiplimab and 2 cycles of QuadShot radiotherapy; (F) February 11, 2021, after 4 cycles of cemiplimab and 2 cycles QuadShot radiotherapy; (G) October 2021, after debulking and reconstruction.
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Figure 2C ). Cycle 2 Day 2 cemiplimab was given on December 3, 2020. Following the second dose of cemiplimab + first radiation cycle, the lesion decreased by 75% with significant improvement from disease involvement near the eye. Cycle 2, day 1 QUAD shot was given on December 17, 2020 ( Figure 2D ), and cycle 3, day 1 cemiplimab was given on December 23, 2020. There was a further 75% reduction in the size of the mass ( Figure 2E ), but the patient developed grade-2 hypothyroidism. Following cycle 4 of cemiplimab, with cycle 4, day 1 on January 4, 2021, the patient developed two fistulas in his maxillary sinus and nasal cavity, which were determined to be sites of disease regression ( Figure 2F ). To salvage as much viable tissue as possible, the patient was referred to surgery for debridement of necrotic tissue and reconstruction ( Figure 2G ).
(A, B): (A) (top): MRI of head prior to initiating cemiplimab; (B) (bottom): MRI of head following completion of cemiplimab.
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A facial MRI from January 27, 2021 revealed near-complete regression of the tumor in the inferior orbit ( Figure 3B ), indicating the patient may be able to avoid left orbital exenteration, which would have been indicated prior to ICI treatment.
PMC9846513_04