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Case 2.14
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
This is stage IV disease, so the aim is to control his pain and possibly also induce remission. I will suggest palliative radiotherapy to the skin MDT.The MDT oncologist may also suggest concomitant immunotherapy such as Cemiplimab, which is a PD-1 systemic checkpoint inhibitor.Charcoal dressings may also help with the odour until then.
Squamous Cell Carcinoma
Published in Debjani Sahni, Adam Lerner, Bilal Fawaz, Advanced Skin Cancer, 2022
Systemic therapies are used mostly for metastatic cSCCs but are also considered for unresectable disease or when RT is not possible. In recent years, two classes of therapies have emerged for cSCC treatment: Targeted and immunologic therapies. The main targeted therapy is in the form of EGFR inhibitors (e.g., cetuximab). EGFR is expressed in more than 90% of cSCC and is responsible for cellular proliferation, survival, angiogenesis, and metastasis. In 2006, the FDA approved cetuximab for the treatment of locally advanced or metastatic mucosal SCC. Its use in cSCC is still off-label. The other form of systemic treatment currently approved for use in cSCC is checkpoint inhibitor immunotherapy, specifically the PD-1 inhibitor cemiplimab.12
Antibody-Based Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
Developed jointly by Regeneron and Sanofi, cemiplimab (LibtayoTM) was approved by the FDA in 2018 for the treatment of metastatic cutaneous squamous cell carcinoma (CSCC) or locally advanced CSCC in patients who are not candidates for curative surgery or radiotherapy. It is currently being studied in multiple clinical trials, including Phase III clinical trials in patients with cervical and non-small-cell lung cancer. At the time of writing, Phase II studies are also underway in patients with basal cell, head and neck, liver, oropharyngeal, and prostate cancer, and glioblastoma. Phase I studies are also underway in ovarian, fallopian tube and peritoneal cancers, and multiple myeloma.
New and emerging drugs for the treatment of advanced cutaneous squamous cell carcinoma
Published in Expert Opinion on Emerging Drugs, 2023
Flavia Bonini, Luana Guimarães de Sousa, Renata Ferrarotto
Cemiplimab, an anti-PD1-1 monoclonal antibody, was the first ICI approved for patients with advanced CSCC by both US Food and Drug Administration (FDA) and European Medicines Agency (EMA). In 2018, Migden et al. reported results from a phase I and the pivotal phase II studies of cemiplimab at a 3 mg/kg dose every two weeks in patients with advanced CSCC [33]; the overall response rates (ORR) was 50% and 47% for patients in the phase I and II studies, respectively. The expansion cohorts of the phase I study comprised patients with LA- or mCSCC (N = 26), while the phase II study included only patients with mCSCC (N = 59). Importantly, authors reported a duration of response (DOR) ≥ 6 months of 54% and 57% for patients in the phase I and II cohorts, respectively, and the median DOR was not reached. Treatment-related adverse events (TRAE) for cemiplimab were considered manageable and well tolerated with the most common being diarrhea (27%), fatigue (24%), and nausea (17%) in the phase II study; overall 7% of patients discontinued treatment due to an adverse event [33].
Combination regimens and immunologic mechanisms to enhance the efficacy of cemiplimab for cutaneous squamous cell carcinoma
Published in Expert Review of Anticancer Therapy, 2022
Hannah L. Hanania, Daniel J. Lewis
With the addition of other immunologic therapies to cemiplimab, adverse effects and increased toxicities must be considered. Intralesional use represents a method of utilizing combination therapies with a reduced risk of increased toxicity, as well as increased efficacy [15]. In addition, resistance to therapy is a major limitation of immunotherapy, often leading to tumor progression or relapse. Combination therapies therefore enable a wide array of treatment options with possible reduction of resistance to therapy. Overall, we believe the use of cemiplimab in combination with other immunostimulatory therapies leads to a synergistic, augmented antitumor response, particularly in patients with a limited response to cemiplimab monotherapy or disease refractory to other therapies. Further study is warranted to assess the efficacy of combination regimens involving cemiplimab in the treatment of advanced cSCC.
Management of periocular cutaneous squamous cell carcinoma with perineural invasion: a case series and literature review
Published in Orbit, 2022
Thomas J. E. Clark, Gerald J. Harris
The use of systemic chemotherapy in the treatment of high-risk cutaneous SCC is increasing as new agents emerge. Platinum-based drugs (e.g., cisplatin and carboplatin) continue to be first-line agents for SCCHN.24 Cetuximab, a chimeric monoclonal antibody targeting the epidermal growth factor receptor (EGFR), has gained more widespread use following a landmark study by Bonner et al.32 The authors reported significantly improved locoregional control, overall survival, and progression-free survival with definitive RT + cetuximab compared to RT alone in stage III–IV nonmetastatic SCC of the oropharynx, hypopharynx, or larynx. Cemiplimab, a human monoclonal antibody directed against the programmed death 1 (PD-1) ligand, recently gained approval by the FDA and the European Medicines Agency.33 In Phase 1 and 2 studies, respectively, the agent induced positive responses in 13 of 26 patients with locally advanced or metastatic cutaneous SCC, and in 28 of 59 patients with metastatic cutaneous SCC.34