Anti-PD-1 monoclonal antibody-resistant esophageal squamous cell
carcinoma showing the abscopal effect: A case report with T-cell
receptor/B-cell receptor repertoire analysis
Abstract
Background Several good results of clinical trial of nivolumab or
involving nivolumab in advanced esophageal squamous cell carcinoma were
reported. However, the response rate was still poor. A rare phenomenon
called the “abscopal effect” refers to the regression of not only the
irradiated tumor but also non-irradiated distant tumors after local
radiotherapy. The mechanism is not completely clear, but it is thought
that the activation of anti-tumor immunity induced by radiotherapy is
the main factor. Case A 66-year-old man with recurred and nivolumab
resistant esophageal squamous cell carcinoma in left-side cervical and
abdominal para-aortal lymph node metastasis was treated with a total of
40 Gy (10 fractions) of radiotherapy to the left-side cervical lymph
node metastasis which caused neck pain as a palliative treatment.
Nivolumab was resumed the day after completion of radiotherapy. At 3
months after radiotherapy showed that the irradiated lesion in the left
neck had regressed to a scar-like appearance. Notably, the abdominal
para-aortal lymph nodes outside the irradiation area, which had
previously tended to progress, had also shrunk (abscopal effect). The T
cell receptor and B cell receptor (TCR/BCR) repertoire analysis before
and after radiotherapy revealed that radiotherapy caused the changes in
the TCR/BCR repertoire. Conclusion Changes in the TCR/BCR receptor
repertoire repertoires were assumed to be a part of the mechanism of the
abscopal effect. The findings in this patient suggest that combination
of immune checkpoint inhibitors and radiotherapy can be a promising
treatment approach, even for patients with immune checkpoint inhibitors
resistant cancer.