Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2019; 7(5): 616-622
Published online Mar 6, 2019. doi: 10.12998/wjcc.v7.i5.616
Sustained complete response to erlotinib in squamous cell carcinoma of the head and neck: A case report
Mie Mie Thinn, Chung-Tzu Hsueh, Chung-Tsen Hsueh
Mie Mie Thinn, Division of Hematology and Medical Oncology, Loma Linda Veterans Administration Medical Center, Loma Linda, CA 92357, United States
Chung-Tzu Hsueh, Department of Dentistry, Cathay General Hospital, Taipei City 106, Taiwan
Chung-Tsen Hsueh, Division of Medical Oncology and Hematology, Department of Medicine, Loma Linda University, Loma Linda, CA 92357, United States
Author contributions: Hsueh CT performed clinical examination and collected data; Thinn MM, Hsueh CT and Hsueh CT designed the report, analyzed the data and wrote the paper; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the surviving spouse of deceased patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Chung-Tsen Hsueh, MD, PhD, Professor, Division of Medical Oncology and Hematology, Department of Medicine, Loma Linda University, 11175 Campus Street, CSP 11015, Loma Linda, CA 92357, United States.
Telephone: +1-909-5588107 Fax: +1-909-5580219
Received: December 19, 2018
Peer-review started: December 20, 2018
First decision: January 5, 2019
Revised: January 12, 2019
Accepted: January 29, 2019
Article in press: January 29, 2019
Published online: March 6, 2019

Squamous cell carcinoma of head and neck (SCCHN) is the fifth most common cancer worldwide. Inhibition of epidermal growth factor receptor signaling has been shown to be a critical component of therapeutic option. Herein, we report a case of durable complete response to erlotinib.


An 81-year-old Caucasian male who presented with metastatic poorly differentiated squamous cell carcinoma of right cervical lymph nodes (levels 2 and 3). Imaging studies including (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (CT) and contrast-enhanced CT scan of neck and chest did not reveal any other disease elsewhere. Panendoscopic examination with random biopsy did not reveal malignant lesion in nasopharynx, oropharynx, and larynx. He underwent modified neck dissection and postoperative radiation. Within 2 mo after completion of radiation, he developed local recurrence at right neck, which was surgically removed. Two mo after the salvage surgery, he developed a second recurrence at right neck. Due to suboptimal performance status and his preference, he started erlotinib treatment. He achieved partial response after first 2 mo of erlotinib treatment, then complete response after total 6 mo of erlotinib treatment. He developed sever skin rash and diarrhea including Clostridium difficile infection during the course of erlotinib treatment requiring dose reduction and eventual discontinuation. He remained in complete remission for more than two years after discontinuation of erlotinib.


We report a case of metastatic SCCHN achieving durable complete response from erlotinib. Patient experienced skin rash and diarrhea toxicities which were likely predictors of his treatment response.

Keywords: Squamous cell carcinoma of head and neck, Epidermal growth factor receptor, Erlotinib, Complete response, Skin rash, Tyrosine kinase inhibitor, Case report

Core tip: We present a patient with recurrent/metastatic squamous cell carcinoma of head and neck who had durable complete response after completion of 6-mo erlotinib treatment. Patient experienced severe skin rash and diarrhea toxicities from erlotinib. The severity of these adverse effects has been shown to be predictors of treatment response from inhibitors of epidermal growth factor receptor.