PMC8335395_01
(A-C) Head and neck CT showed lymph node enlargement (10 x 12 cm) on the left side of the neck (January 6, 2020). (D-F) Head and neck CT, performed 10 days after the first cycle of treatment, showed progression of the tumor mass (13 x 10 cm) (March 11, 2020). (G-I) PR was detected after the first course of combination therapy with sintilimab and nimotuzumab (April 11, 2020). (J-L) Head and neck MRI revealed PR (May 18, 2020). CT, computed tomography; MRI, magnetic resonance imaging; PR, partial response.
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A head and neck computed tomography (CT) following admission revealed a left neck lymph node enlargement (10 x 12 cm) ( Figures 1A-C ). However, a reexamination using a head and neck CT on March 11, 2020 revealed progression of the tumor mass (13 x 10 cm) ( Figures 1D-F ). The patient was reexamined on May 18, 2020; head and neck MRI showed a maximum tumor mass diameter of 3 x 4 cm and PR to therapy ( Figures 1J-L ).
(A) IHC showed positivity for PD-L1. (Dako 22C3 antibody was used to provide positive control and negative control.) This specimen was sliced from formalin-fixed paraffin-embedded tissue. (B, C) The patient developed grade IV drug-induced dermatitis after the first course of combination therapy with sintilimab and nimotuzumab. HE, hematoxylin-eosin; IHC, immunohistochemistry; PD-L1, programmed death-ligand 1.
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The results of the immunohistochemical analysis yielded a combined positive score (CPS) of 95 and a tumor proportion score of 95% for PD-L1, which indicated positivity ( Figure 2A ). Four days after the treatment, the patient developed grade IV drug dermatitis ( Figures 2B, C ).
(A-C) Head and neck CT revealed PD (June 12, 2020). (D-F) Images captured prior to radiotherapy (January 6, 2020). (G-I) Images captured after the end of radiotherapy (August 20, 2020). (J-L) The tumor mass had almost completely regressed by December 23, 2020. CT, computed tomography; PD, progressive disease.
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Unfortunately, physical examination revealed an enlargement of the tumor mass ( Figures 3A-C ). Compared to baseline imaging data before radiotherapy ( Figures 3D-F ), reexamination revealed that the size of the neck mass was significantly reduced ( Figures 3G-I ). A head and neck MRI revealed that the neck mass had nearly disappeared ( Figures 3J-L ).
Schematics and timeline of treatment. AP, albumin paclitaxel; CR, complete response; N, nimotuzumab; PD, progressive disease; PR, partial response; S, sintilimab; SD, stable disease; TPF, docetaxel, cisplatin, and 5-fluorouracil.
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The entire treatment process and disease status of the patient are summarized in  Figure 4 .