Adverse event management as a pathway to optimal outcomes in head and neck squamous cell carcinoma patients: A clinical case

Cover Page

Cite item

Full Text

Abstract

Squamous cell carcinoma of the head and neck is the sixth most common cancer worldwide. However, malignant tumors of the middle ear are extremely rare. Squamous cell carcinoma is the most common histologic type of tumor in this area, accounting for more than 50% of cases. Complex anatomical and topographic features of the inner ear and inapparent clinical symptoms result in delayed diagnosis of this disease. A case of a patient with highly differentiated middle ear squamous cell carcinoma is presented. The patient received complex treatment, including drug antitumor therapy according to the TPEx protocol: docetaxel + cisplatin + cetuximab. Being highly effective, this protocol requires a multidisciplinary approach in order to ensure maximum safety of therapy. The case illustrates the classic “portrait” of a patient with recurrent or metastatic squamous cell carcinoma of the head and neck and also provides a comprehensive description of the spectrum of adverse events faced by such patients and their oncologists. Based on this clinical case, the features of management of such adverse events are analyzed.

About the authors

Varvara D. Sanikovich

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: sanikovich_v_d@staff.sechenov.ru
ORCID iD: 0000-0002-4840-4106

Res. Assist.

Russian Federation, Moscow

Marina I. Sekacheva

Sechenov First Moscow State Medical University (Sechenov University)

Email: sekacheva_m_i@staff.sechenov.ru
ORCID iD: 0000-0003-0015-7094

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Ekaterina V. Orlova

Sechenov First Moscow State Medical University (Sechenov University)

Email: orlovaderm@yandex.ru
ORCID iD: 0000-0002-1684-8781

Cand. Sci. (Med.)

Russian Federation, Moscow

Gaiane A. Gabrielian

Sechenov First Moscow State Medical University (Sechenov University)

Email: gaya0412@mail.ru
ORCID iD: 0000-0002-9238-4165

Graduate Student

Russian Federation, Moscow

Alexander M. Boroda

Sechenov First Moscow State Medical University (Sechenov University)

Email: boroda_a_m@staff.sechenov.ru
ORCID iD: 0000-0002-4196-6042

Res. Officer

Russian Federation, Moscow

Juliya S. Agakina

Sechenov First Moscow State Medical University (Sechenov University); Federal Research and Clinical Center of specialized types of health care and medical technology of the Federal Medical and Biological Agency

Email: agakina_yu_s@staff.sechenov.ru
ORCID iD: 0000-0002-3556-2703

Department Head; Аssistant

Russian Federation, Moscow; Moscow

Igor V. Reshetov

Sechenov First Moscow State Medical University (Sechenov University)

Email: ivreshetov@mail.ru
ORCID iD: 0000-0002-0909-6278

D. Sci. (Med.), Prof., Acad. RAS

Russian Federation, Moscow

References

  1. Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. 2024. Available at: https://gco.iarc.who.int/today. Accessed: 15.05.2024.
  2. Srivani N, Joyce TM. Clinicopathology of Middle Ear Tumours: A Retrospective Study from a Tertiary Care Hospital, Hyderabad, India. J Clin Diagn Res. 2022;16(7):EC27-31. doi: 10.7860/JCDR/2022/52936/16646
  3. Gurgel RK, Karnell LH, Hansen MR. Middle ear cancer: a population-based study. Laryngoscope. 2009;119(10):1913-7. doi: 10.1002/lary.20202
  4. Hu XD, Wu TT, Zhou SH. Squamous cell carcinoma of the middle ear: report of three cases. Int J Clin Exp Med. 2015;8(2):2979-84.
  5. Attakkil A, Thorawade V, Jagade M, et al. Squamous Cell Carcinoma of the Middle Ear Mimicking CSOM with Intracranial Complications: A Diagnostic Dilemma. International Journal of Otolaryngology and Head & Neck Surgery. 2014;3:376-81. doi: 10.4236/ijohns.2014.36067
  6. Pontes F, Garcia AR, Domingues I, et al. Survival predictors and outcomes of patients with recurrent and/or metastatic head and neck cancer treated with chemotherapy plus cetuximab as first-line therapy: A real-world retrospective study. Cancer Treat Res Commun. 2021;27:100375. doi: 10.1016/j.ctarc.2021.100375
  7. Burtness B, Harrington KJ, Greil R, et al.; KEYNOTE-048 Investigators. Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study. Lancet. 2019;394(10212):1915-28. doi: 10.1016/S0140-6736(19)32591-7. Erratum in: Lancet. 2020;395(10220):272. doi: 10.1016/S0140-6736(20)30116-1. Erratum in: Lancet. 2020;395(10224):564. doi: 10.1016/S0140-6736(20)30254-3. Erratum in: Lancet. 2021;397(10291):2252. doi: 10.1016/S0140-6736(21)01119-3
  8. Rettig EM, D'Souza G, Thompson CB, et al. Health-related quality of life before and after head and neck squamous cell carcinoma: Analysis of the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey linkage. Cancer. 2016;122(12):1861-70. doi: 10.1002/cncr.30005
  9. Quinten C, Coens C, Mauer M, et al.; EORTC Clinical Groups. Baseline quality of life as a prognostic indicator of survival: a meta-analysis of individual patient data from EORTC clinical trials. Lancet Oncol. 2009;10(9):865-71. doi: 10.1016/S1470-2045(09)70200-1
  10. Rogers SN, Waylen AE, Thomas S, et al. Quality of life, cognitive, physical and emotional function at diagnosis predicts head and neck cancer survival: analysis of cases from the Head and Neck 5000 study. Eur Arch Otorhinolaryngol. 2020;277(5):1515-23. doi: 10.1007/s00405-020-05850-x
  11. Head & Neck Cancers: Essentials for Clinicians. Edited by L Licitra, MV Karamouzis. 2017.
  12. Lop J, Venegas MDP, Pujol A, et al. Causes of long-term mortality in patients with head and neck squamous cell carcinomas. Eur Arch Otorhinolaryngol. 2022;279(7):3657-64. doi: 10.1007/s00405-021-07211-8
  13. Zapata I, Alvarez M, Hidalgo R, et al. Causes of death in patients with locally advanced head and neck cancer treated with radiotherapy and systemic therapy. BMC Cancer. 2019;19(1):1241. doi: 10.1186/s12885-019-6427-1
  14. Болотина Л.В., Владимирова Л.Ю., Деньгина Н.В., и др. Практические рекомендации по лекарственному лечению опухолей головы и шеи. Практические рекомендации RUSSCO, часть 1. Злокачественные опухоли. 2023;13(#3s2):100-19 [Bolotina LV, Vladimirova LIu, Den'gina NV, et al. Prakticheskie rekomendatsii po lekarstvennomu lecheniiu opukholei golovy i shei. Prakticheskie Rekomendatsii RUSSCO, Chast' 1. Zlokachestvennye Opukholi. 2023;13(#3s2):100-19 (in Russian)]. doi: 10.18027/2224-5057-2023-13-3s2-1-100-119
  15. Machiels JP, René Leemans C, Golusinski W, et al.; EHNS Executive Board; ESMO Guidelines Committee; ESTRO Executive Board. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020;31(11):1462-75. doi: 10.1016/j.annonc.2020.07.011
  16. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Head and Neck Cancers. Version 4.2024 – May 1, 2024.
  17. Black MD, Yoo J, Fung K, et al. Personalized Treatment of Recurrent, Metastatic Head and Neck Cancer Guided by Patient-Derived Xenograft Models. Cureus. 2024;16(2):e53645. doi: 10.7759/cureus.53645
  18. Guigay J, Aupérin A, Fayette J, et al.; GORTEC; AIO; TTCC, and UniCancer Head and Neck groups. Cetuximab, docetaxel, and cisplatin versus platinum, fluorouracil, and cetuximab as first-line treatment in patients with recurrent or metastatic head and neck squamous-cell carcinoma (GORTEC 2014-01 TPExtreme): a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol. 2021;22(4):463-75. doi: 10.1016/S1470-2045(20)30755-5
  19. Bonomo P, Paderno A, Mattavelli D, et al. Quality Assessment in Supportive Care in Head and Neck Cancer. Front Oncol. 2019;9:926. doi: 10.3389/fonc.2019.00926
  20. Королева И.А., Болотина Л.В., Гладков О.А., и др. Практические рекомендации по лекарственному лечению дерматологических реакций у пациентов, получающих противоопухолевую лекарственную терапию. Практические рекомендации RUSSCO, часть 2. Злокачественные опухоли. 2023;13(#3s2):108-31 [Koroleva IA, Bolotina LV, Gladkov OA, et al. Prakticheskie rekomendatsii po lekarstvennomu lecheniiu dermatologicheskikh reaktsii u patsientov, poluchaiushchikh protivoopukholevuiu lekarstvennuiu terapiiu. Prakticheskie Rekomendatsii RUSSCO, Chast' 2. Zlokachestvennye Opukholi. 2023;13(#3s2):108-31 (in Russian)].
  21. Doxycycline Side Effects from Drugs.com; 1996–2018. Available at: https://www.drugs.com/sfx/doxycycline-side-effects.html#professional-info. Accessed: 15.05.2024.
  22. Boland JW, Allgar V, Boland EG, et al. The relationship between pain, analgesics and survival in patients with advanced cancer; a secondary data analysis of the international European palliative care Cancer symptom study. Eur J Clin Pharmacol. 2020;76(3):393-402. doi: 10.1007/s00228-019-02801-2
  23. Fallon M, Giusti R, Aielli F, et al.; ESMO Guidelines Committee. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2018;29(Suppl. 4):iv166-91. doi: 10.1093/annonc/mdy152
  24. Katopodis P, Karteris E, Katopodis KP. Pathophysiology of Drug-Induced Hypomagnesaemia. Drug Saf. 2020;43(9):867-80. doi: 10.1007/s40264-020-00947-y
  25. Huang CL, Kuo E. Mechanism of hypokalemia in magnesium deficiency. J Am Soc Nephrol. 2007;18(10):2649-52. doi: 10.1681/ASN.2007070792
  26. Verzicco I, Regolisti G, Quaini F, et al. Electrolyte Disorders Induced by Antineoplastic Drugs. Front Oncol. 2020;10:779. doi: 10.3389/fonc.2020.00779
  27. Остроумова О.Д., Кочетков А.И., Клепикова М.В. Лекарственно-индуцированный дефицит электролитов. Часть 2. Лекарственно-индуцированная гипомагниемия. РМЖ. 2020;12:36-48 [Ostroumova OD, Kochetkov AI, Klepikova MV. Drug-induced electrolyte disorder. Part 2. Drug-induced hypomagnesemia. RMJ. 2020;12:36-48 (in Russian)].
  28. Workeneh BT, Uppal NN, Jhaveri KD, Rondon-Berrios H. Hypomagnesemia in the Cancer Patient. Kidney360. 2020;2(1):154-66. doi: 10.34067/KID.0005622020
  29. Сакаева Д.Д., Борисов К.Е., Булавина И.С., и др. Практические рекомендации по диагностике и лечению фебрильной нейтропении. Практические рекомендации RUSSCO, часть 2. Злокачественные опухоли. 2023;13(#3s2):62-71 [Sakaeva DD, Borisov KE, Bulavina IS, et al. Prakticheskie rekomendatsii po diagnostike i lecheniiu febril'noĭ neĭtropenii. Prakticheskie Rekomendatsii RUSSCO, Chast' 2. Zlokachestvennye Opukholi. 2023;13(#3s2):62-71 (in Russian)].
  30. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Hematopoietic Growth Factors. Version 3.2024 – January 30, 2024.
  31. Орлова Р.В., Жабина А.С., Иванова А.К., и др. Практические рекомендации по лечению инфузионных реакций при проведении противоопухолевой лекарственной терапии. Практические рекомендации RUSSCO, часть 2. Злокачественные опухоли. 2023;13(#3s2):261-81 [Orlova RV, Zhabina AS, Ivanova AK, et al. Prakticheskie rekomendatsii po lecheniiu infuzionnykh reaktsii pri provedenii protivoopukholevoi lekarstvennoi terapii. Prakticheskie Rekomendatsii RUSSCO, Chast' 2. Zlokachestvennye Opukholi. 2023;13(#3s2):261-81 (in Russian)].
  32. Полонская А.С., Шатохина Е.А., Круглова Л.С. Дерматологические нежелательные явления ингибиторов рецептора эпидермального фактора роста: современный взгляд на междисциплинарную проблему. Опухоли головы и шеи. 2021;11(4):97-109 [Polonskaia AS, Shatokhina EA, Kruglova LS. Dermatologic adverse events associated with epidermal growth factor receptor inhibitors: current concepts of interdisciplinary problem. Head and Neck Tumor. 2021;11(4):97-109 (in Russian)]. doi: 10.17650/2222-1468-2021-11-4-97-109
  33. Bozzetti F, Cotogni P. Nutritional Issues in Head and Neck Cancer Patients. Healthcare (Basel). 2020;8(2):102. doi: 10.3390/healthcare8020102
  34. Kristensen MB, Isenring E, Brown B. Nutrition and swallowing therapy strategies for patients with head and neck cancer. Nutrition. 2020;69:110548. doi: 10.1016/j.nut.2019.06.028
  35. Сытов А.В., Зузов С.А., Кукош М.Ю., и др. Практические рекомендации по нутритивной поддержке онкологических больных. Практические рекомендации RUSSCO, часть 2. Злокачественные опухоли. 2023;13(#3s2):131-41 [Sytov AV, Zuzov SA, Kukosh MIu, et al. Prakticheskie rekomendatsii po nutritivnoi podderzhke onkologicheskikh bol'nykh. Prakticheskie Rekomendatsii RUSSCO, Chast' 2. Zlokachestvennye Opukholi. 2023;13(#3s2):131-41 (in Russian)].
  36. Martinovic D, Tokic D, Puizina Mladinic E, et al. Nutritional Management of Patients with Head and Neck Cancer-A Comprehensive Review. Nutrients. 2023;15(8):1864. doi: 10.3390/nu15081864

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Results of CT scan of the head from July 20, 2023: pathological tumor infiltration of soft tissues around the mastoid process of the left temporal bone, left parotid region.

Download (117KB)
Indexing metadata
3. Fig. 2. Day 7 of treatment. Papulopustular rash with mild infiltration on the face, chest and back, covering <10% of the body surface area (grade 1 according to CTCAE 5.0).

Download (292KB)
Indexing metadata
4. Fig. 3. Day 15 of treatment. Increase in the area of ​​acne-like rash, its intensity (grade 2 according to CTCAE 5.0).

Download (311KB)
Indexing metadata
5. Fig. 4. Day 22 of treatment. Positive dynamics of acne-like rash against the background of accompanying therapy in the form of absence of fresh pustules, reduction of the affected area and appearance of medium-lamellar post-inflammatory peeling.

Download (230KB)
Indexing metadata
6. Fig. 5. Skin changes during cetuximab monotherapy. a – total xerosis with pronounced peeling in the back area; b – acral keratoderma with linear cracks in areas of maximum skin stretch; c – total hematomas of the nail bed; d, e – lateral periungual folds with inflammatory granulomas and serous-hemorrhagic crusts.

Download (152KB)
Indexing metadata

Copyright (c) 2024 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies