Work

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

Year: 2026

Type: article

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.

Source: Frontiers in Oncology

DOI: 10.3389/fonc.2026.1993693