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Video

Head and Neck Surgery

(A596) Pembrolizumab/cetuximab for betel nut-related oral cavity squamous cell carcinoma: A Case Series

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Jonathan D. West, MD

    Resident
    University of Southern California/LAC USC Med Ctr
    Los Angeles, California, United States

    • Co-Author(s)

  • WM

    William Moss, MD

    Staff physician
    Commonwealth Healthcare Corporation Hospital
    Saipan, California, United States

  • MW

    Mark Wallace, DO

    Commonwealth Healthcare Corporation Hospital, Northern Mariana Islands, United States

  • DK

    Daniel I. Kwon, MD

    Associate Professor of Head and Neck Surgery
    University of Southern California
    Los Angeles, California, United States

    • Senior Author(s)

  • PB

    Peter Brett, MD

    Oncologiy Director, CHCC
    Commonwealth Healthcare Corporation Hospital
    Saipan, Northern Mariana Islands

Disclosure(s):
Jonathan D. West, MD: No relevant relationships to disclose.
William Moss, MD: No relevant relationships to disclose.
Daniel I. Kwon, MD: No relevant relationships to disclose.


Introduction: The Northern Mariana Islands (NMI) is a remote, resource-limited US territory in the western Pacific Ocean with high rates of betel nut use - a well-known carcinogen causing oral cavity squamous cell cancers (OCSCC). With high prevalence of OCSCC, patients in CNMI often present with advanced stage or unresectable disease without immediate access to traditional treatment modalities. Prior studies have demonstrated the efficacy of pembrolizumb/cetuximab (Key/Erb) in recurrent or metastatic head and neck squamous cell carcinoma. We present a case series documenting the application of this treatment to advanced betel nut-related (BNR) OCSCC.

Methods: Retrospective case series from 2019 to 2024. All included patients were residents of the NMI, diagnosed with advanced BNR OCSCC and determined unlikely to benefit from traditional primary surgical resection, radiation treatment or systemic chemotherapy. All patients were treated with pembrolizumab 400mg IV day 1 and cetuximab 500 mg/sq m IV days 1, 15, 29. Cycle repeated every 42 days for up to 2 years if effective and well tolerated. Treatment response was determined by physical examination and imaging.

Results: A total of 31 patients were treated. Four (13%) patients had a complete response, 15 (48%) had partial response, and 2 (6%) patients maintained stable disease status. Ten (32%) had progression of disease without response. Five patients who had partial response subsequently underwent curative surgical treatment. Median overall survival was 15 months with progression free survival of 10 months. A quarter of patients had grade 3 side effects including rash, diabetes and hepatitis, but there were no cases of grade 4-5 side effects.

Conclusions: Concurrent pembrolizumb/cetuximab for advanced BNR OCSCC has shown promise in our series with most patients experiencing at least partial response and several with complete responses. Formal prospective trials should be considered.