Neoadjuvant pembrolizumab plus nimotuzumab as a bridge to surgery in a frail elderly patient with maxillary gingival and palatal squamous cell carcinoma: a case report
6 affiliations
- 1Department of Stomatology, The First Medical Center of People's Liberation Army (PLA) General Hospital
- 2Department of Stomatology, The Sixth Medical Center of People's Liberation Army (PLA) General Hospital
- 3Department of Ambulatory Medicine, The First Medical Center of People's Liberation Army (PLA) General Hospital
- 4Department of Stomatology, The 81st Group Army Hospital of the Chinese People’s Liberation Army
- 5Department of Radiation Oncology, The First Medical Center of People's Liberation Army (PLA) General Hospital
- 6Department of Pathology, The First Medical Center of People's Liberation Army (PLA) General Hospital
Abstract
Background: In older patients with oral squamous cell carcinoma, tumor-related symptoms can impair oral intake and compromise fitness for surgery. This case describes an individualized chemotherapy-free bridge-to-surgery approach that combined tumor-directed treatment with nutritional and functional support.
Case presentation: A 75-year-old woman presented with left maxillary gingival and hard-palatal squamous cell carcinoma, severe oral pain, dysphagia, a 5-kg weight loss over 2 weeks, and an Eastern Cooperative Oncology Group performance status of 3. Biopsy confirmed well-differentiated squamous cell carcinoma with positive epidermal growth factor receptor expression and a programmed death ligand 1 combined positive score of 70. Because cisplatin was considered unsuitable at presentation, she received pembrolizumab (200 mg every 3 weeks) plus nimotuzumab (200 mg weekly), with concurrent supportive care. After two treatment cycles, oral intake recovered, body weight increased from 70 to 75 kg, and performance status improved from 3 to 1. Computed tomography showed marked regression, reported as a partial response. Maxillectomy and left neck dissection were performed on 12 December 2025. Postoperative pathology was reported as a complete response (ypT0N0), with 0 of 32 lymph nodes involved. Postoperative maintenance immunotherapy remained ongoing, and no recurrence was reported at the last follow-up in September 2026.
Conclusion: This case illustrates the feasibility of preoperative pembrolizumab plus nimotuzumab with concurrent supportive care as a bridge to definitive surgery in one clinically frail older patient. It does not establish the efficacy or comparative safety of pembrolizumab plus nimotuzumab, the independent contribution of either drug, or the durability of disease control. The bridge-to-surgery concept warrants prospective evaluation in carefully selected patients.
Related
- 523 Lymphaticsparing neoadjuvant SABR and pembrolizumab (neo-ImmunoSABR) in HPVnegative HNSCC: results from a phase II multi-center trial with immune correlates
- TroFuse-032 study design: pembrolizumab plus sacituzumab tirumotecan or chemotherapy followed by pembrolizumab plus chemotherapy as neoadjuvant therapy for early-stage, triple-negative breast cancer or HR-low+/HER2− breast cancer
- Residual Invasive Disease After Neoadjuvant Therapy in Triple-Negative Breast Cancer: Risk Stratification and Postoperative Radiotherapy-Pembrolizumab Integration.
- Lenvatinib plus pembrolizumab in pretreated metastatic B3 thymoma and thymic carcinoma (PECATI): a single-arm, phase 2 trial
- Real-World Feasibility, Toxicity, and Early Outcomes of Neoadjuvant Pembrolizumab-Based Systemic Therapy in Early Triple-Negative Breast Cancer: A Single-Centre Chinese Cohort from Hong Kong
BibTeX
@article{lin2026neoadjuvant,
title = {{Neoadjuvant pembrolizumab plus nimotuzumab as a bridge to surgery in a frail elderly patient with maxillary gingival and palatal squamous cell carcinoma: a case report}},
author = {Quanquan Lin and Liang Shang and Zheng-Ze Guo and Feng Wang and Bing Li and Boning Cai and Lin Feng and Haizhong Zhang and Zhigang Song and Zhiyong Wu and Qing Xi},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1993693},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1993693/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Neoadjuvant pembrolizumab plus nimotuzumab as a bridge to surgery in a frail elderly patient with maxillary gingival and palatal squamous cell carcinoma: a case report
AU - Quanquan Lin
AU - Liang Shang
AU - Zheng-Ze Guo
AU - Feng Wang
AU - Bing Li
AU - Boning Cai
AU - Lin Feng
AU - Haizhong Zhang
AU - Zhigang Song
AU - Zhiyong Wu
AU - Qing Xi
PY - 2026
DA - 2026/10/19
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1993693
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1993693/full
AB - Background: In older patients with oral squamous cell carcinoma, tumor-related symptoms can impair oral intake and compromise fitness for surgery. This case describes an individualized chemotherapy-free bridge-to-surgery approach that combined tumor-directed treatment with nutritional and functional support. Case presentation: A 75-year-old woman presented with left maxillary gingival and hard-palatal squamous cell carcinoma, severe oral pain, dysphagia, a 5-kg weight loss over 2 weeks, and an Eastern Cooperative Oncology Group performance status of 3. Biopsy confirmed well-differentiated squamous cell carcinoma with positive epidermal growth factor receptor expression and a programmed death ligand 1 combined positive score of 70. Because cisplatin was considered unsuitable at presentation, she received pembrolizumab (200 mg every 3 weeks) plus nimotuzumab (200 mg weekly), with concurrent supportive care. After two treatment cycles, oral intake recovered, body weight increased from 70 to 75 kg, and performance status improved from 3 to 1. Computed tomography showed marked regression, reported as a partial response. Maxillectomy and left neck dissection were performed on 12 December 2025. Postoperative pathology was reported as a complete response (ypT0N0), with 0 of 32 lymph nodes involved. Postoperative maintenance immunotherapy remained ongoing, and no recurrence was reported at the last follow-up in September 2026. Conclusion: This case illustrates the feasibility of preoperative pembrolizumab plus nimotuzumab with concurrent supportive care as a bridge to definitive surgery in one clinically frail older patient. It does not establish the efficacy or comparative safety of pembrolizumab plus nimotuzumab, the independent contribution of either drug, or the durability of disease control. The bridge-to-surgery concept warrants prospective evaluation in carefully selected patients.
SN - 2234-943X
ER -