title: Personalized Medicine Approach for an Exceptional Response to Multiple-recurrent and Metastatic HER2-positive Oropharyngeal Squamous Cell Carcinoma.
abstract: BACKGROUND
  Advanced stage squamous cell carcinoma of the head and neck carries an overall poor prognosis, and survivorship gains have remained relatively stagnant compared to other malignancies due to its complex tumor biology and lack of proven effective targeting agents.
  
  
  METHODS
  We present a case of an exceptional responder to molecular-targeted therapy for metastatic oropharyngeal squamous cell carcinoma using a chemotherapeutic agent FDA approved for breast cancer and targeting the HER2/Neu receptor in order to discuss the larger clinical implications.
  
  
  RESULTS
  The National Cancer Institute (NCI) has recently instituted the Exceptional Responders Initiative in order to identify such patients with unexpected outcomes in order to expedite the development of additional targeted therapies. This case illustrates the opportunity for cure using targeted oncogene identification in a scenario of recurrent squamous cell carcinoma with lung metastasis typically considered fatal.
  
  
  CONCLUSIONS
  Molecular tumor analysis is an infrequently utilized tool in head and neck squamous cell carcinoma; however, as understanding of biologic mechanisms improves, additional molecular targets will become available and expand treatment opportunities such as HER2/Neu targeting. The Exceptional Responders Initiative is a unique strategy with potential to expedite progress.
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Nolan B
authors.initials: NB
authors.lastname: Seim
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Stephen Y
authors.initials: SY
authors.lastname: Kang
authors.affiliation: 2 Indian Hill High School, Cincinnati, Ohio, USA.
authors.forename: Milan
authors.initials: M
authors.lastname: Bhandari
authors.affiliation: 3 Department of Internal Medicine, Division of Medical Oncology, The Christ Hospital, Cincinnati, Ohio, USA.
authors.forename: Riley G
authors.initials: RG
authors.lastname: Jones
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Teknos
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000378:metabolism / Q000556:secondary; D000068818:Cetuximab / Q000008:administration & dosage; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D000077143:Docetaxel; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D060828:Induction Chemotherapy; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000556:secondary; D008198:Lymph Nodes / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D009959:Oropharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D000072078:Positron Emission Tomography Computed Tomography; D057285:Precision Medicine; D050397:Radiotherapy, Intensity-Modulated; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D043823:Taxoids / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D000068878:Trastuzumab / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D000068818:Cetuximab; D002945:Cisplatin; D000077143:Docetaxel; D005472:Fluorouracil; D018719:Erb-b2 Receptor Tyrosine Kinases; D043823:Taxoids; D000068878:Trastuzumab; C508053:ERBB2 protein, human
keywords: HER2; head and neck cancer; oropharynx cancer; personalized medicine; squamous cell carcinoma