Exploration of Medicine

Table 2. Patient treatment history by line of therapy.

Line	Period	Regimen	Best response	EBV DNA (start → end)	Reason for discontinuation
—	Oct 2020–Mar 2021	Induction CisGem × 3 cycles + CCRT (IMRT 69.96 Gy + carboplatin)	Complete response	—	Treatment completion
1st	Jun 2023–Feb 2024	Cisplatin 70 mg/m² + gemcitabine 1,000 mg/m² Q21d × 6; then gemcitabine maintenance × 6	Partial response	76.4 → undetectable	Disease progression (Feb 2024)
2nd	Mar 2024–May 2024	Pembrolizumab 200 mg Q3W (compassionate use)	PD	Undetectable → 18 copies/mL	Radiology PD (cycle 4)
3rd	Jun 2024–Oct 2024	Biweekly paclitaxel + cetuximab (dose-reduced for toxicity)	PD	485 → 13,000 copies/mL	Unequivocal PD; grade 3 skin toxicity
4th	Dec 2024–Mar 2025	MDNA11 IV Q2W + pembrolizumab 400 mg Q6W (ABILITY-1, NCT05086692)	PD (iUPD → confirmed PD)	1,350 → 4,062 copies/mL	Clinical PD: worsening ulceration, dysphagia (3 cycles)
5th	May 2025–Jul 2025	Weekly carboplatin AUC2 + paclitaxel 70 mg/m²	Partial response (skin)	> 4,000 → 252 copies/mL	Disease re-progression (~8 cycles)
6th	Aug 2025–Nov 2025	Methotrexate 40 mg/m² weekly	PD	Rising (> 3,800 copies/mL)	No disease control; transition to palliative care

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AKI: acute kidney injury; AUC: area under the curve; CCRT: concurrent chemoradiotherapy; CisGem: cisplatin plus gemcitabine; ECOG PS: Eastern Cooperative Oncology Group performance status; EBV: Epstein–Barr virus; G-CSF: granulocyte colony-stimulating factor; IMRT: intensity-modulated radiotherapy; IV: intravenous; iRECIST: immune Response Evaluation Criteria in Solid Tumours; iUPD: unconfirmed progressive disease (iRECIST); PD: progressive disease; PEG: percutaneous endoscopic gastrostomy; Q2W: every 2 weeks; Q3W: every 3 weeks; Q6W: every 6 weeks; Q21d: every 21 days; RECIST: Response Evaluation Criteria in Solid Tumours.

Declarations

Acknowledgments

We sincerely acknowledge all the patients and their families, whose trust and participation have been the driving force behind this research.

Author contributions

CGR: Conceptualization, Data curation, Methodology, Investigation, Writing—original draft, Writing—review & editing. SCC: Data curation, Validation, Methodology, Investigation, Writing—review & editing. MPK: Data curation, Validation, Methodology, Software. ARR: Methodology, Validation, Writing—review & editing. OJGCM: Validation, Writing—review & editing. SJCS: Validation, Writing—review & editing. BCO: Data curation, Visualization, Investigation, Methodology, Supervision, Writing—original draft, Writing—review & editing. LCG: Conceptualization, Data curation, Validation, Methodology, Investigation, Supervision, Writing—original draft, Writing—review & editing. All authors read and approved the final version of the manuscript.

Conflicts of interest

Luis Cabezón-Gutiérrez declares the following conflicts of interest: Advisory roles: AstraZeneca, Roche, Eisai, and Bristol-Myers Squibb. Speaker’s bureau/honoraria: Roche, AstraZeneca, Bristol-Myers Squibb, Merck Serono, Grünenthal, Pfizer and Eisai. Travel, accommodation, and expenses (Conferences): Merck, Servier. Magda Palka-Kotlowska declares: Advisory roles: GlaxoSmithKline and Esteve. Speaker’s bureau/honoraria: Pfizer, Gilead, Daiichi Sankyo, GlaxoSmithKline, AstraZeneca, and Novartis. Sara Custodio-Cabello declares: Speaker’s bureau / Honoraria: Fresenius, Abbott, Astellas. Claudia García-Ruíz, Otto José Guillermo Chacón-Medina, Samuel Jesús Castañeda-Sánchez, Beatriz Chacón-Ovejero and Adriana Rosero-Rodriguez declare no conflicts of interest.

Ethical approval

Ethical approval for this case report was not required, as it has been exempted in accordance with institutional regulations governing retrospective single-patient reports. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki.

Consent to participate

Written informed consent for participation in this case report was obtained from the patient’s next of kin (family members), given that the patient is deceased.

Consent to publication

Written informed consent for publication of this case report, including accompanying clinical images, was obtained from the patient’s next of kin (family members), given that the patient is deceased.

Availability of data and materials

The data that support the findings of this case report are not publicly available due to patient privacy and confidentiality restrictions, but are available from the corresponding author upon reasonable request and subject to institutional approval.

Funding

Not applicable.

Copyright

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Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.

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