J Oncol Res Ther, an open access journal ISSN: 2574-710X 1 Volume 2018; Issue 05 Journal of Oncology Research and Therapy Case Report Patil P, et al. J Oncol Res Ther: JONT-163. Prolonged Survival with Anti-EGFR Therapy in Head and Neck Squamous Cell Carcinoma - A Case Series Pratik Patil, Vineet Govinda Gupta * , Ranga Rao Rangaraju, Waseem Abbas Department of Medical Oncology, Max Super Speciality Hospital, Shalimar Bagh, New Delhi, India * Corresponding author: Vineet Govinda Department of Medical Oncology, B-2 Basement, Max Super Speciality Hospital, Shalimar Bagh, New Delhi, India. Tel: +919013812875; Email: vineetgovindagupta@gmail.com Citation: Patil P, Gupta VG, Rangaraju RR, Abbas W (2018) Prolonged Survival with Anti-EGFR Therapy in Head and Neck Squamous Cell Carcinoma - A Case Series. J Oncol Res Ther: JONT-163. DOI: 10.29011/2574-710X. 000063 Received Date: 09 August, 2018; Accepted Date: 20 August, 2018; Published Date: 28 August, 2018 DOI: 10.29011/2574-710X. 000063 Abstract Head and Neck Cancer (HNC) is the sixth most common cancer worldwide, with about 650,000 patients newly diagnosed annually. In the late 1990s, surgery followed by postoperative Radiotherapy (RT) or RT alone was the standard therapeutic modal- ity for loco regionally advanced HNSCC (LA-HNSCC). Since chemotherapeutic agents were identifed to have additional effects when combined with RT, Chemo-Radiotherapy (CRT) has become the standard treatment over the last decade for patients with LA-HNSCC who were not candidates for surgery. Despite the heterogeneity of both tumor location and genetic aberrations, 90% of HNCs are Histologically Squamous Cell Carcinomas (HNSCCs). Hereby we present a case series of patients with HNSCC who were benefted with Anti-EGFR therapy with a prolonged survival. Introduction Head and Neck Cancer (HNC) is the sixth most common cancer worldwide, with about 650,000 patients newly diagnosed annually [1]. In the late 1990s, surgery followed by postoperative Radiotherapy (RT) or RT alone was the standard therapeutic mo- dality for loco regionally advanced HNSCC (LA-HNSCC). Since chemotherapeutic agents were identifed to have additional effects when combined with RT, Chemo-Radiotherapy (CRT) has become the standard treatment over the last decade for patients with LA- HNSCC who were not candidates for surgery. Clinical trials have demonstrated that concurrent CRT can improve Overall Survival (OS) compared with RT alone [2]. Despite the heterogeneity of both tumor location and genetic aberrations, 90% of HNCs are Histologically Squamous Cell Carcinomas (HNSCCs). At the time of diagnosis, most patients with HNSCC have loco regionally ad- vanced disease which requires a multimodality therapy [3]. The Epidermal Growth Factor Receptor (EGFR) is expressed in about 80% of patients with HNSCC [4]. EGFR overexpression has been found to be an independent factor associated with un- favorable prognosis in these patients [5]. Anti-EGFR agents can block the EGFR, thereby inhibiting its downstream function. While radiation increases EGFR expression in cancer cells, blockade of EGFR signaling makes cancer cells more sensitive to radiation [6]. Since a randomized phase III trial demonstrated survival beneft from the combination of cetuximab and RT compared with RT alone [7]. Trials further evaluated other agents like Panitumumab, other agents also in the concurrent setting. The good results in con- current setting also led to trials evaluating the addition of targeted therapy along with chemotherapy and radiotherapy [8]. Case Report Case 1 A 32 years old male patient who consumed moderate alcohol since last 10 year presented with chief complaints of pain in the left ear and minimal discharge with decreased hearing from left ear since 2 months. Biopsy-External auditory cancel was sugges- tive of SCC. Whole Body PET CT scan showed Hyper metabolic active disease at the site of known primary (left external auditory canal). He Underwent Wide local excision of left external auditory canal mass with left extended Parotidectomy. On histopathological examination, all margins were free; Overall features were in favor of Recurrent/Residual SCC left external ear pT2N0M0. On IHC, tumor cells were CK + 5/6, p63 +, EMA +: CEA-polyclonal -Fo- cal positive. He Underwent Radiation Therapy to a dose of PTV 45:4500cGy in 25 fractions + PTV 60: 6000cGy in 30 fractions. Follow up scans revealed a complete response until 36 months af- ter the radiotherapy followed by progression with multiple lung mets, meditational lymph node Mets. CT Guided Right lung mass biopsy was s/o Squamous cell carcinoma. On this patient was started on carboplatin with paclitaxel for 6 cycles showing a stable disease. Following which patient was started on Gefetinib 250 mg as a maintenance regimen which had a very good response without