Neoadjuvant pembrolizumab plus nimotuzumab enables rapid nutritional recovery and pathological complete response in a frail elderly patient with maxillary gingival and palatal squamous cell carcinoma: a case report

Introduction Frail older adults with head and neck squamous cell carcinoma (HNSCC) frequently present with severe cancer-related malnutrition and are often ineligible for cisplatin-based neoadjuvant regimens. Low toxicity bridging strategies that can reverse frailty and enable curative surgery are needed. Patient concerns and clinical findings A 75-year-old frail woman presented with left maxillary gingival and palatal squamous cell carcinoma complicated by severe malnutrition and poor performance status (ECOG 3; nutritional risk screening NRS-2002 ≥3). She reported significant oral pain and dysphagia with rapid nutritional decline. Diagnosis, interventions, and outcomes After biopsy-confirmed squamous cell carcinoma and staging work-up, cisplatin was deemed unsuitable due to frailty and nutritional compromise. The patient received neoadjuvant pembrolizumab combined with the anti-EGFR monoclonal antibody nimotuzumab alongside intensive supportive care. Imaging demonstrated marked tumor regression, accompanied by rapid symptom relief and improvement in nutritional and functional indices. Definitive surgical resection was subsequently performed. Serial histopathology revealed a pathological complete response with extensive treatment-related regression changes (ypT0N0). Conclusion Neoadjuvant PD-1 blockade combined with anti-EGFR therapy, together with proactive nutritional and functional support, may provide an effective and tolerable bridge to curative surgery in frail patients with locally advanced oral/maxillary HNSCC. Rigorous pathologic assessment across serial sections is essential to confirm true pathological complete response.