Remarkable response to personalized combination immunotherapy of nivolumab plus ipilimumab in an 84-year-old patient with locally advanced squamous cell carcinoma: a case report

Background: The efficacy of nivolumab plus ipilimumab (NIVO + IPI) combination therapy has been established for advanced non-small-cell lung cancer (NSCLC). However, in elderly patients, the standard-dose regimens of NIVO + IPI exhibit high risk of immune-related adverse events (irAEs) and concerns over relapse due to treatment discontinuation. To our knowledge, this is the first report of safe and effective dose-optimized combination immunotherapy in an octogenarian patient with locally advanced NSCLC.

Case Description: We report an 84-year-old male with chronic obstructive pulmonary disease (COPD), a 25 pack-year smoking history. He was diagnosed with programmed death-ligand 1 (PD-L1)-positive, stage IIIC (T4N2M0) squamous cell carcinoma with a 140 mm mass invading superior vena cava (SVC) and chest wall. Given his age, chemotherapy intolerance, and PD-L1 status, the multidisciplinary team opted to initiate a tailored, reduced-dose NIVO 200 mg every 3 weeks (Q3W) plus IPI 50 mg every 6 weeks based on pharmacokinetic (PK) rationale. After 4 cycles of treatment, partial response (PR) was achieved with a 65% reduction in tumor size, along with resolution of the SVC invasion. The patient remained progression-free at 10 months of follow-up, without grade ≥2 irAEs.

Conclusions: This case successfully illustrates the safety and efficacy of personalized-dose combination immunotherapy strategy in a fragile octogenarian patient, highlighting the potential for dose optimization in geriatric oncology.