UTILIZATION OF NIVOLUMAB IN ADENOID CYSTIC CARCINOMA AFTER PROGRESSION ON PLATINUM BASED CHEMOTHERAPY D. Maslov¹; K. Thomas¹²; M. Matrana²³ ¹University of Queensland, Ochsner Clinical School, New Orleans ²Department of Internal Medicine and ³Department of Hematology and Oncology, Ochsner Medical Center, New Orleans Case: A 22-year-old man presented with a 6-month history of nasal congestion, epistaxis and rhinorrhea for which he had been seen multiple times. He received multiple doses of antibiotics and steroids with no improvement. Physical exam showed no abnormalities, except for sinus tenderness. Given his recurrent symptoms, a non-contrast CT of the sinuses revealed a mass with erosion of the lateral wall of the nasal cavity, lateral wall of the maxillary sinus and pterygoif plates. PET scan confirmed a metastatic disease in the right iliac crest and right cervical lymph node; biopsy was consistent with adenoid cystic carcinoma (ACC) nasopharynx. Patient received proton therapy to the main lesion and intensity-modulated radiotherapy (IMRT) to the iliac bone lesion with concurrent cisplatin. Four months later, a new metastasis in the right ischiumwas found, and stereotactic irradiation treatment was initiated. Genetic profiling located MDM2 mutation. He completed a Phase 1 Trial focusing on this targetable mutation but had progression of disease (PD) with new lung metastasis. He went onto a second trial utilizing DS3032b (a MDM2 inhibitor) but subsequently had PD. Patient was then started on Nivolumab and died twelve weeks later. Discussion: comprises approximately 10% of all neoplasms of the salivary glands. The rarity of this condition makes diagnosis challenging. High mortality rates in ACC is due to late distant metastases and local recurrences. ACC treatment is usually considered palliative, as there is no strong evidence that survival is extended by systemic chemotherapy. Immunotherapy has been utilized in the treatment of metastatic and recurrent head and neck cancers and have shown clinically significant activity in those who have progressed ACC
case exemplifies how Multiple Sclerosis can present acutely with neurological features that are consistent with other diseases such as an acute stroke. A high index of suspicion is needed in cases of unresolving symptoms of stroke to make a correct diagnosis with complete neurological recovery.
on platinum based chemotherapy. To date, no study has evaluated the efficacy of immunotherapy in ACC. Our patient demonstrated a survival of 3 month following the administration of Nivolumab after progressing on first line treatment. This case illustrates the difficulty in identifying ACC and the importance of a thorough workup. The use of Nivolumab may serve as an option to extend survival in patients with ACC.
24 J LA MED SOC | VOL 171 | NO. 1
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