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Queirolo P, Cinquini M, Argenziano G, Bassetto F, Bossi P, Boutros A, Clemente C, de Giorgi V, Del Vecchio M, Patuzzo R, Pennachioli E, Peris K, Quaglino P, Reali A, Zalaudek I, Spagnolo F. Guidelines for the diagnosis and treatment of cutaneous squamous cell carcinoma: a GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology. ESMO Open 2024; 9:103005. [PMID: 38688192 PMCID: PMC11067535 DOI: 10.1016/j.esmoop.2024.103005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/10/2024] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
Cutaneous squamous cell carcinoma (CSCC) accounts for ∼20%-25% of all skin tumors. Its precise incidence is often challenging to determine due to limited statistics and its incorporation with mucosal forms. While most cases have a favorable prognosis, challenges arise in patients presenting with locally advanced or metastatic forms, mainly appearing in immunocompromised patients, solid organ transplantation recipients, or those facing social difficulties. Traditionally, chemotherapy and targeted therapy were the mainstays for advanced cases, but recent approvals of immunotherapeutic agents like cemiplimab and pembrolizumab have revolutionized treatment options. These guidelines, developed by the Italian Association of Medical Oncologists (AIOM) using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach, aim to guide clinicians in diagnosing, treating, and monitoring patients with CSCC, covering key aspects from primitive tumors to advanced stages, selected by a panel of experts selected by AIOM and other national scientific societies. The incorporation of these guidelines into clinical practice is expected to enhance patient care and address the evolving landscape of CSCC management.
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Affiliation(s)
- P Queirolo
- Division of Melanoma, Sarcomas and Rare Tumors, IRCCS European Institute of Oncology, Milan
| | - M Cinquini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - G Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples
| | - F Bassetto
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, Padua
| | - P Bossi
- IRCCS Humanitas Research Hospital, Milan
| | - A Boutros
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa
| | - C Clemente
- Surgical Pathology Department, IRCCS Galeazzi Sant'Ambrogio, Milan
| | - V de Giorgi
- Dermatology Unit, Azienda USL Toscana Centro, Florence; Section of Dermatology, Department of Health Sciences, University of Florence, Florence
| | - M Del Vecchio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - R Patuzzo
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Melanoma and Sarcoma Unit, Milan
| | - E Pennachioli
- Division of Melanoma, Sarcomas and Rare Tumors, IRCCS European Institute of Oncology, Milan
| | - K Peris
- Dermatology, Department of Medicine and Translational Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology, Department of Medical and Surgery Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - P Quaglino
- Department of Medical Sciences, Clinic of Dermatology, University of Turin, Turin
| | - A Reali
- Radiation Oncology Department, Michele e Pietro Ferrero Hospital, Verduno
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste
| | - F Spagnolo
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova; Department of Surgical Sciences and Integrated Diagnostics (DISC), Plastic Surgery Division, University of Genova, Genoa, Italy.
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2
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Hoashi T, Ishikawa M, Uehara J, Oashi K, Maeda S, Kato J, Saruta H, Shichinohe R, Ohashi R, Nakamura Y, Koga H, Sugaya M. Japanese Dermatological Association guidelines: Outlines of Japanese clinical guidelines for basal cell carcinoma 2021. J Dermatol 2024; 51:e90-e105. [PMID: 38264942 DOI: 10.1111/1346-8138.16944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 01/25/2024]
Abstract
To summarize the current therapies for skin cancers, the Japanese Skin Cancer Society issued the first guidelines for skin cancers, including melanoma, squamous cell carcinoma, basal cell carcinoma (BCC), and extramammary Paget's disease, in 2007. These guidelines were revised in 2015. Herein, we present the English version of the 2021 edition of the Japanese clinical guidelines for BCC. In the latest edition, all procedures were performed according to the Grading of Recommendations, Assessment, Development and Evaluation systems. The clinical questions that could not be answered were selected for further analysis. A comprehensive literature search, systematic review, and recommendations for each clinical question were determined by a multidisciplinary expert panel comprising dermatologists, a plastic and reconstructive surgeon, and a pathologist. Surgical resection is the gold-standard therapy of BCC. Radiotherapy or topical treatments, other than surgical resection, have been used in some cases. Patients with unresectable or metastatic BCC require systemic therapy. Novel agents, such as immune response modifiers or hedgehog pathway inhibitors, are emerging worldwide for the treatment of BCC. Based on these viewpoints, four relevant clinical questions regarding, surgical resection, radiotherapy, topical treatment, and systemic therapy, were raised in this report that aims to help clinicians select suitable therapies for their patients.
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Affiliation(s)
| | - Masashi Ishikawa
- Department of Dermatology, Saitama Cancer Center, Saitama, Japan
| | - Jiro Uehara
- Department of Dermatologic Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kohei Oashi
- Department of Dermatology, Saitama Cancer Center, Saitama, Japan
| | - Shintaro Maeda
- Department of Dermatology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Junji Kato
- Department of Dermatology, Sapporo Medical University, Sapporo, Japan
| | - Hiroshi Saruta
- Department of Dermatology, Kurume University School of Medicine, Fukuoka, Japan
| | - Ryuji Shichinohe
- Department of Plastic and Reconstructive Surgery, Teine Keijinkai Hospital, Sapporo, Japan
| | - Ryuji Ohashi
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Yoshio Nakamura
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Koga
- Department of Dermatology, Shinshu University, Matsumoto, Japan
| | - Makoto Sugaya
- Department of Dermatology, International University of Health and Welfare, Narita, Japan
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3
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Goldfarb J, Fan J, de Sousa LG, Akhave N, Myers J, Goepfert R, Manisundaram K, Zhao J, Frank SJ, Moreno A, Ferrarotto R, Esmaeli B. Neoadjuvant Chemotherapy Alone or Combined with EGFR-Directed Targeted Therapy or Anti-PD-1 Immunotherapy for Locally Advanced Lacrimal Sac and Nasolacrimal Duct Carcinomas. Semin Ophthalmol 2024:1-7. [PMID: 38500295 DOI: 10.1080/08820538.2024.2324057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/22/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND/AIMS We describe our findings in patients with locally advanced lacrimal sac and nasolacrimal duct (NLD) carcinoma who received neoadjuvant systemic therapy. METHODS We identified patients with locally advanced primary lacrimal sac/NLD carcinoma treated with neoadjuvant systemic intravenous therapy at our institution during 2017-2019. RESULTS The study included seven patients, four men and three women; the mean age was 60.4 years (range: 43-76). All patients had locally advanced disease with significant orbital soft tissue invasion with or without skull base invasion making eye-sparing surgery not feasible as an initial step. Three patients had poorly differentiated squamous cell carcinoma; two, invasive carcinoma with basaloid and squamous features; one, high-grade carcinoma with features suggestive of sebaceous differentiation; and one, undifferentiated carcinoma. The neoadjuvant regimens were cisplatin and docetaxel (n = 1); carboplatin and docetaxel (n = 1); paclitaxel and cetuximab (n = 1); carboplatin, paclitaxel, and cetuximab (EGFR inhibitor) (n = 2); cisplatin, docetaxel, and pembrolizumab (anti-PD-1 immunotherapy) (n = 1); and carboplatin, paclitaxel, and pembrolizumab (n = 1). All patients had radiologic disease regression, and one patient had radiologic near-complete response. After neoadjuvant therapy, all patients underwent wide local excision and adjuvant concurrent chemoradiation. Two patients had a complete pathologic response. At a median follow-up period of 13 months after chemoradiation (range, 8-54 months), all patients were alive without evidence of disease. One patient had nodal metastasis treated with lymph node dissection and adjuvant chemoradiation. CONCLUSIONS Neoadjuvant systemic therapy can shrink tumors in patients with locally advanced primary lacrimal sac/NLD carcinoma with orbital or skull base invasion.
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Affiliation(s)
- Jeremy Goldfarb
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center Orbital Oncology & Ophthalmic Plastic Surgery, Houston, TX, USA
| | - Janet Fan
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center Orbital Oncology & Ophthalmic Plastic Surgery, Houston, TX, USA
| | - Luana Guimaraes de Sousa
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Neal Akhave
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ryan Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Krish Manisundaram
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center Orbital Oncology & Ophthalmic Plastic Surgery, Houston, TX, USA
| | - Jiawei Zhao
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center Orbital Oncology & Ophthalmic Plastic Surgery, Houston, TX, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy Moreno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Renata Ferrarotto
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bita Esmaeli
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center Orbital Oncology & Ophthalmic Plastic Surgery, Houston, TX, USA
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Trotier DC, Huang L, van Landingham SW, Burr AR, Ma VT. Review of recent advances in managing periocular skin malignancies. Front Oncol 2024; 14:1275930. [PMID: 38500654 PMCID: PMC10944901 DOI: 10.3389/fonc.2024.1275930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/15/2024] [Indexed: 03/20/2024] Open
Abstract
Management of cutaneous malignancies can be particularly challenging when they are located in the periocular region. The standard of care for localized disease is complete surgical excision, but this may not be possible without significant disruption to visual structures and facial appearance. Definitive radiation may be an option for some patients who cannot or do not wish to undergo surgery. Advances in systemic treatment options for locally advanced and metastatic skin cancers in the past 10 years have prompted investigation into neoadjuvant treatment of periocular cancers. The use of chemotherapy, immune checkpoint inhibitors, and targeted therapies have all been reported with varying degrees of success. For many patients, targeted therapies or immune checkpoint inhibitors should be considered depending on the cancer type, symptoms, and goals with the input of a multidisciplinary cancer care team. In this article, we systematically review the latest updates in surgical, radiotherapeutic, and medical management of periocular malignancies.
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Affiliation(s)
- Daniel C Trotier
- University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
- Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin-Madison, Madison, WI, United States
| | - Leslie Huang
- University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - Suzanne W van Landingham
- University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Adam R Burr
- University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI, United States
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Vincent T Ma
- University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
- Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin-Madison, Madison, WI, United States
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Dermatology, University of Wisconsin-Madison, Madison, WI, United States
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5
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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, van Akkooi A, Bataille V, Bastholt L, Dreno B, Dummer R, Fargnoli MC, Forsea AM, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NW, Lallas A, Leiter U, Malvehy J, Del Marmol V, Moreno-Ramirez D, Pellacani G, Peris K, Saiag P, Tagliaferri L, Trakatelli M, Ioannides D, Vieira R, Zalaudek I, Arenberger P, Eggermont AMM, Röcken M, Grob JJ, Lorigan P. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma: Part 2. Treatment-Update 2023. Eur J Cancer 2023; 193:113252. [PMID: 37708630 DOI: 10.1016/j.ejca.2023.113252] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 09/16/2023]
Abstract
In order to update recommendations on treatment, supportive care, education, and follow-up of patients with invasive cutaneous squamous cell carcinoma (cSCC), a multidisciplinary panel of experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS), the European Academy of Dermatology and Venereology (EADV), and the European Organisation of Research and Treatment of Cancer (EORTC) was formed. Recommendations were based on an evidence-based literature review, guidelines, and expert consensus. Treatment recommendations are presented for common primary cSCC (low risk, high risk), locally advanced cSCC, regional metastatic cSCC (operable or inoperable), and distant metastatic cSCC. For common primary cSCC, the first-line treatment is surgical excision with postoperative margin assessment or micrographically controlled surgery. Achieving clear surgical margins is the most important treatment consideration for patients with cSCCs amenable to surgery. Regarding adjuvant radiotherapy for patients with high-risk localised cSCC with clear surgical margins, current evidence has not shown significant benefit for those with at least one high-risk factor. Radiotherapy should be considered as the primary treatment for non-surgical candidates/tumours. For cSCC with cytologically or histologically confirmed regional nodal metastasis, lymph node dissection is recommended. For patients with metastatic or locally advanced cSCC who are not candidates for curative surgery or radiotherapy, anti-PD-1 agents are the first-line systemic treatment, with cemiplimab being the first approved systemic agent for advanced cSCC by the Food and Drugs Administration/European Medicines Agency. Second-line systemic treatments for advanced cSCC, include epidermal growth factor receptor inhibitors (cetuximab) combined with chemotherapy or radiotherapy. Multidisciplinary board decisions are mandatory for all patients with advanced cSCC, considering the risks of toxicity, the age and frailty of patients, and co-morbidities, including immunosuppression. Patients should be engaged in informed, shared decision-making on management and be provided with the best supportive care to improve symptom management and quality of life. The frequency of follow-up visits and investigations for subsequent new cSCC depends on underlying risk characteristics.
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Affiliation(s)
- Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Clio Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Celeste Lebbe
- Université Paris Cite, Dermato-Oncology AP-HP Hôpital Saint Louis, Cancer Institute APHP. Nord-Université Paris Cite, INSERM U976, Paris, France
| | - Alexander van Akkooi
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Melanoma Institute Australia, Sydney, New South Wales, Australia
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Reinhard Dummer
- Skin Cancer Centre at University Hospital, Zurich, Switzerland
| | - Maria Concetta Fargnoli
- Dermatology Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana Maria Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Department of Oncologic Dermatology, Elias University Hospital Bucharest, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Wj Kelleners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Dermatology, Maastricht University Medical Centre+, Maastricht University, Maastricht, the Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBER de enfermedades raras, Instituto Carlos III, Barcelona, Spain
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - David Moreno-Ramirez
- Department of Medical and Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré hospital, APHP, and EA 4340 'Biomarkers in Cancerology and Hemato-oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | - Myrto Trakatelli
- Department of Dermatology, Papageorgiou Hospital, Aristotle University Department of Medicine, Thessaloniki, Greece
| | | | - Ricardo Vieira
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alexander M M Eggermont
- University Medical Center Utrecht and Princess Máxima Center, Utrecht, the Netherlands; Comprehensive Cancer Center Munich, Technical University Munich and Ludwig Maximilian University, Munich, Germany
| | - Martin Röcken
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | | | - Paul Lorigan
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, Christie NHS Foundation Trust, Manchester, UK
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Marin-Acevedo JA, Withycombe BM, Kim Y, Brohl AS, Eroglu Z, Markowitz J, Tarhini AA, Tsai KY, Khushalani NI. Cetuximab for Immunotherapy-Refractory/Ineligible Cutaneous Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:3180. [PMID: 37370790 DOI: 10.3390/cancers15123180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Anti-PD1 therapy demonstrated impressive, prolonged responses in advanced cutaneous squamous cell carcinoma (CSCC). Therapy for ICI-refractory/ineligible disease remains unclear. We performed a retrospective analysis in locally-advanced/metastatic CSCC using cetuximab across three cohorts: immediately after ICI failure (A), not immediately following ICI failure (B), or without prior ICI (C). The primary endpoint was the overall response rate (ORR). Secondary endpoints included disease-control rate (DCR), progression-free survival (PFS), overall survival (OS), time-to-response (TTR) and toxicity. Twenty-three patients were included. In cohort A (n = 11), the ORR was 64% and DCR was 91%, with six ongoing responses at data cutoff. In cohort B (n = 2), all patients had progression as the best response. At a median follow-up of 21 months for A and B, TTR and PFS were 2.0 and 17.3 months, respectively. The median OS was not reached. In cohort C (n = 10), the ORR and DCR were 80%, including five ongoing responses at the data cutoff. At a median follow-up of 22.4 months, the TTR, PFS and OS were 2.5, 7.3 and 23.1 months, respectively. Cetuximab was well tolerated in all cohorts. In summary, cetuximab is effective in patients with failure/contraindications to ICI. Cetuximab immediately after ICI failure yielded particularly fast, durable responses. If confirmed, this could be the preferred therapy following ICI failure.
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Affiliation(s)
- Julian A Marin-Acevedo
- Medical Oncology, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
| | | | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Andrew S Brohl
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Zeynep Eroglu
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Joseph Markowitz
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Ahmad A Tarhini
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Kenneth Y Tsai
- Department of Pathology, Division of Dermatopathology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Nikhil I Khushalani
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
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7
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Advances in Cutaneous Squamous Cell Carcinoma Management. Cancers (Basel) 2022; 14:cancers14153653. [PMID: 35954316 PMCID: PMC9367549 DOI: 10.3390/cancers14153653] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Cutaneous squamous cell carcinoma (cSCC) is an increasingly prevalent and morbid cancer worldwide. Management of this cancer has changed significantly in the last decade through improved risk stratification and new therapies offering patients with locally advanced and metastatic disease more effective, less toxic, and more durable treatment options. Ongoing clinical trials are assessing new therapeutic options as well as optimizing existing regimens in efforts to better manage this cancer. The recent developments highlight the need for multidisciplinary care, especially for those with locally advanced and metastatic disease. Abstract cSCC is increasing in prevalence due to increased lifespans and improvements in survival for conditions that increase the risk of cSCC. The absolute mortality of cSCC exceeds melanoma in the United States and approaches that of melanoma worldwide. This review presents significant changes in the management of cSCC, focusing on improvements in risk stratification, new treatment options, optimization of existing treatments, and prevention strategies. One major breakthrough in cSCC treatment is the advent of immune checkpoint inhibitors (ICIs) targeting programmed cell death protein 1 (PD-1) and programmed death-ligand 1 (PD-L1), which have ushered in a renaissance in the treatment of patients with locally advanced and metastatic disease. These agents have offered patients with advanced disease decreased therapeutic toxicity compared to traditional chemotherapy agents, a more durable response after discontinuation, and improved survival. cSCC is an active field of research, and this review will highlight some of the novel and more developed clinical trials that are likely to impact cSCC management in the near future.
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8
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Ueda T, Kuro A, Kunieda S, Ozaki Y, Suzuki K, Hihara M, Komai H, Kakudo N. Giant Basal Cell Carcinoma in the Inguinal Region Invading the Femoral Vessels. EPLASTY 2022; 22:ic5. [PMID: 35611151 PMCID: PMC9108537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Takayuki Ueda
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Atsuyuki Kuro
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Sakurako Kunieda
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Yujiro Ozaki
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Kenji Suzuki
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Masakatsu Hihara
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Hiroyoshi Komai
- Department of Vascular Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Natsuko Kakudo
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, Osaka, Japan
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9
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Maeda T, Yoshino K. Management of elderly patients with advanced cutaneous squamous cell carcinoma. Jpn J Clin Oncol 2022; 52:214-220. [PMID: 35088087 DOI: 10.1093/jjco/hyab213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 12/29/2021] [Indexed: 11/12/2022] Open
Abstract
The incidence of cutaneous squamous cell carcinoma has been increasing rapidly in recent years, especially among the elderly. The purpose of this review article is to summarize the findings of studies on systemic therapy for advanced cutaneous squamous cell carcinoma, to review geriatric screening tools, which can assess frailty and predict treatment outcomes, and discuss the indications of their use in advanced cases. A literature review revealed that studies on systemic therapy for advanced cutaneous squamous cell carcinoma often included relatively older patients. However, there has been little research on the safety and efficacy of systemic therapy for advanced disease that takes older age and frailty into account. Notably, studies on geriatric screening for skin cancer have been conducted in recent years, mainly to detect early-stage resectable cases. The Geriatric 8 screening tool is considered the most useful for predicting post-operative complications in patients with early-stage cancer, as it can evaluate comorbidities, polypharmacy and cognition, has appropriate measurement properties, can be quickly executed and is clinically relevant, easily understandable and interpretable. This geriatric screening tool may also be applicable in advanced-stage cancer. In conclusion, despite the fact that advanced cutaneous squamous cell carcinoma occurs mainly in the elderly, the importance of geriatric screening has not yet been fully appreciated by dermato-oncologists. In the future, geriatric screening tools should be actively used in clinical trials for the appropriate assessment of drug efficacy and toxicity in elderly patients with advanced cutaneous squamous cell carcinoma.
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Affiliation(s)
- Takuya Maeda
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Koji Yoshino
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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10
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Aboul-Fettouh N, Morse D, Patel J, Migden MR. Immunotherapy and Systemic Treatment of Cutaneous Squamous Cell Carcinoma. Dermatol Pract Concept 2021; 11:e2021169S. [PMID: 34877077 DOI: 10.5826/dpc.11s2a169s] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 12/11/2022] Open
Abstract
Cutaneous squamous cell carcinomas (cSCC) represent one of the most diagnosed non-melanoma skin cancers and its incidence is increasing globally. Whereas early stage and low risk cSCC is typically treated with surgery, and in some cases other localized therapeutic modalities, locally advanced or metastatic cSCC is a cause of significant morbidity and mortality that requires a different approach to therapy. Therapeutic attempts at treating advanced cSCC include a multi-disciplinary approach with considerations for surgery, radiation, and systemic therapies. In this review, we will discuss the various systemic therapies that have been trialed for advanced cSCC, beginning with the early cytotoxic and platinum-based agents as well as their corresponding limitations. We will then review the targeted approaches using EGFR inhibitors prior to discussing the more recent immunotherapeutics that have shown good tumor responses in this often-lethal disease.
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Affiliation(s)
- Nader Aboul-Fettouh
- Department of Dermatology, The University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Daniel Morse
- Department of Dermatology, The University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Jigar Patel
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael R Migden
- Departments of Dermatology and Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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11
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Kramb F, Doerfer C, Meiwes A, Ramakrishnan K, Eigentler T, Garbe C, Keim U, Leiter U. Real-world Treatment Patterns and Outcomes with Systemic Therapies in Unresectable Locally Advanced and Metastatic Cutaneous Squamous Cell Carcinoma in Germany. Acta Derm Venereol 2021; 102:adv00637. [PMID: 34842930 DOI: 10.2340/actadv.v101.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Advanced cutaneous squamous cell carcinoma is a challenge to treat. Conventional systemic treatment options include chemotherapy and epidermal growth factor receptor-inhibitors. The aim of this study was to assess clinical outcomes with systemic treatments in advanced cutaneous squamous cell carcinoma. Patients receiving systemic treatment at the Tübingen Dermato-Oncology centre between 2007 and 2017 were identified (n = 59). Median age was 76 years (interquartile range (IQR) 71-80 years), 83.1% of patients were male, 72.9% had metastatic cutaneous squamous cell carcinoma, and 27.1% had unresectable locally advanced cutaneous squamous cell carcinoma. During median follow-up of 52 weeks (IQR 27-97 weeks), overall response rate was 14.3%, and disease control rate was 53.6%. Median progression-free survival was 15 weeks (IQR 8-42 weeks), and median overall survival was 52 weeks (IQR 27-97 weeks). Patients receiving chemoradiation vs chemo-therapy alone showed better overall survival (hazard ratio 0.41, p = 0.014,) and progression-free survival (hazard ratio 0.42, p = 0.009); no differences were observed for metastatic cutaneous squamous cell carcinoma vs locally advanced cutaneous squamous cell carcinoma patients. Although chemotherapy and/or cetuximab showed limited outcomes in advanced cutaneous squamous cell carcinoma, such therapy may still be an option when anti-PD-1 treatment is contraindicated.
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Affiliation(s)
| | | | | | | | | | | | | | - Ulrike Leiter
- Center of Dermatooncology, Department of Dermatology, Eberhard-Karls-University, Liebermeisterstrasse 25, DE-72076 Tuebingen, Germany.
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12
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Yan F, Tillman BN, Nijhawan RI, Srivastava D, Sher DJ, Avkshtol V, Homsi J, Bishop JA, Wynings EM, Lee R, Myers LL, Day AT. High-Risk Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Clinical Review. Ann Surg Oncol 2021; 28:9009-9030. [PMID: 34195900 DOI: 10.1245/s10434-021-10108-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Given the rapidly evolving nature of the field, the current state of "high-risk" head and neck cutaneous squamous cell carcinoma (HNcSCC) is poorly characterized. METHODS Narrative review of the epidemiology, diagnosis, workup, risk stratification, staging and treatment of high-risk HNcSCC. RESULTS Clinical and pathologic risk factors for adverse HNcSCC outcomes are nuanced (e.g., immunosuppression and perineural invasion). Frequent changes in adverse prognosticators have outpaced population-based registries and the variables they track, restricting our understanding of the epidemiology of HNcSCC and inhibiting control of the disease. Current heterogeneous staging and risk stratification systems are largely derived from institutional data, compromising their external validity. In the absence of staging system consensus, tumor designations such as "high risk" and "advanced" are variably used and insufficiently precise to guide management. Evidence guiding treatment of high-risk HNcSCC with curative intent is also suboptimal. For patients with incurable disease, an array of trials are evaluating the impact of immunotherapy, targeted biologic therapy, and other novel agents. CONCLUSION Population-based registries that broadly track updated, nuanced, adverse clinicopathologic risk factors, and outcomes are needed to guide development of improved staging systems. Design and development of randomized controlled trials (RCTs) in advanced-stage HNcSCC populations are needed to evaluate (1) observation, sentinel lymph node biopsy, or elective neck dissection for management of the cN0 neck, (2) indications for surgery plus adjuvant radiation versus adjuvant chemoradiation, and (3) the role of immunotherapy in treatment with curative intent. Considering these knowledge gaps, the authors explore a potential high-risk HNcSCC treatment framework.
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Affiliation(s)
- Flora Yan
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brittny N Tillman
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Divya Srivastava
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David J Sher
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vladimir Avkshtol
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jade Homsi
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Erin M Wynings
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rebecca Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Larry L Myers
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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13
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Intra-arterial infusion chemotherapy in the treatment of advanced basosquamous carcinoma of the nose. JAAD Case Rep 2021; 14:97-100. [PMID: 34307816 PMCID: PMC8283267 DOI: 10.1016/j.jdcr.2021.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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14
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Reddy P, Yao M, Patel M. Investigative Landscape in Advanced Non-Melanoma Skin Cancers. Curr Treat Options Oncol 2021; 22:56. [PMID: 34097150 DOI: 10.1007/s11864-021-00853-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 01/21/2023]
Abstract
OPINION STATEMENT Advanced non-melanoma skin cancers have been challenging to treat due to limited treatment options. Treatment paradigm has shifted with the approval of immunotherapeutic agents cemiplimab and pembrolizumab which have been a key development and have changed the landscape of advanced or metastatic squamous cell skin cancers. Hedgehog inhibitors, vismodegib and sonidegib, remain upfront options for advanced or metastatic basal cell carcinomas. Current clinical trials are continuing to evaluate the use of immune checkpoint inhibitors and hedgehog pathway inhibitors. There is further need for ongoing research and development of new therapies in both malignancies.
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Affiliation(s)
- Priyanka Reddy
- Department of Hematology and Oncology, Department of Radiation Oncology, Case Comprehensive Cancer Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Min Yao
- Department of Radiation Oncology, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Monaliben Patel
- Department of Oncology, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
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15
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Lin C, Ballah T, Nottage M, Hay K, Chua B, Kenny L, Thomas P, Teng M, Keller J, Le T, Edmunds J, Hughes B. A prospective study investigating the efficacy and toxicity of definitive ChemoRadiation and ImmunOtherapy (CRIO) in locally and/or regionally advanced unresectable cutaneous squamous cell carcinoma. Radiat Oncol 2021; 16:69. [PMID: 33836800 PMCID: PMC8033693 DOI: 10.1186/s13014-021-01795-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 03/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with unresectable advanced cutaneous squamous cell carcinoma (cSCC) are generally treated with palliative intent. Immune checkpoint blockade has significant activity in the palliative setting in patients with recurrent or metastatic cSCC. This single arm phase 2 prospective study aims to investigate the combination of curative intent chemoradiation and durvalumab (anti-PD-L1 checkpoint inhibitor) for this patient cohort. METHODS Patients with unresectable locally and or regionally advanced pathologically confirmed cSCC (stage III-IVa) deemed fit for CRIO by consensus of the Multidisciplinary meeting will be eligible. In the first stage of a two-stage minimax design, we aim to recruit a total of 15 patients. If fewer than 7 patients achieved a complete response in the first stage, we will conclude the treatment is not more effective than standard treatment. The co-primary endpoints of CRIO are the safety of treatment (acute and late toxicities) and the rate of complete response. Secondary endpoints would include overall survival, progression free survival, and locoregional control. Translational research endpoints including biomarkers (CD73, CD39, PD-1, PD-L1) will also be explored utilising multiplex immunohistochemistry on tumour biopsy samples obtained prior to commencing treatment and during treatment (week 2). In addition, the utility of CXCR-4 PET/CT scan will be explored. DISCUSSION CRIO is a novel trial evaluating the combination of curative intent chemoradiotherapy with concurrent and adjuvant durvalumab for patients with unresectable stage III-IVa cSCC. TRIAL REGISTRATION Trial registered with the Australian New Zealand Clinical Trial Registry (ACTRN12618001573246).
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Affiliation(s)
- Charles Lin
- Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia.
- Faculty of Medicine, University of Queensland, St. Lucia, QLD, Australia.
| | - Trishna Ballah
- Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia
- Faculty of Medicine, University of Queensland, St. Lucia, QLD, Australia
| | - Michelle Nottage
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia
- Faculty of Medicine, University of Queensland, St. Lucia, QLD, Australia
| | - Karen Hay
- Queensland Institute of Medical Research, Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Benjamin Chua
- Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia
- Faculty of Medicine, University of Queensland, St. Lucia, QLD, Australia
| | - Lizbeth Kenny
- Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia
- Faculty of Medicine, University of Queensland, St. Lucia, QLD, Australia
| | - Paul Thomas
- Department of Nuclear Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Faculty of Medicine, University of Queensland, St. Lucia, QLD, Australia
| | - Michele Teng
- Queensland Institute of Medical Research, Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Jacqui Keller
- Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia
| | - Trang Le
- Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia
| | - Jennifer Edmunds
- Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia
| | - Brett Hughes
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia
- Faculty of Medicine, University of Queensland, St. Lucia, QLD, Australia
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16
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Monroe M, Kakarala K. Management of Advanced Basal Cell Carcinoma of the Head and Neck. Otolaryngol Clin North Am 2021; 54:271-280. [PMID: 33743886 DOI: 10.1016/j.otc.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Basal cell carcinoma is the most common human malignancy, with an incidence exceeding all other cancers combined. Advanced basal cell cancer requires a multidisciplinary approach to management. The mainstay of treatment remains surgical excision with appropriate reconstruction. Some advanced tumors may require radical resections; however, extensive, high-risk surgery may be justified by the indolent biology of the disease and the likelihood of cure. Other options, such as radiation or systemic targeted therapy, may be considered in selected patients who either refuse or are not candidates for surgery. The focus of this article is primarily on management of these high-risk cases.
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Affiliation(s)
- Marcus Monroe
- Head and Neck Surgery, Head and Neck Clinical Trials Program, Head and Neck Disease-Oriented Team, Huntsman Cancer Institute, University of Utah School of Medicine, 2000 Circle of Hope Drive, Salt Lake City, UT 84132, USA.
| | - Kiran Kakarala
- Head and Neck Surgery and Microvascular Reconstruction, Head and Neck Fellowship, Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; Department of Health Policy and Management, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
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17
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McMullen CP, Ow TJ. The Role of Systemic Therapy in Advanced Cutaneous Squamous Cell Carcinoma. Otolaryngol Clin North Am 2021; 54:343-355. [PMID: 33583597 DOI: 10.1016/j.otc.2020.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Systemic therapy for patients with head and neck cutaneous squamous cell carcinoma (HNCSCC) generally is used for patients with advanced disease and most often employed for patients in the palliative setting when disease is unresectable and/or widely metastatic. Cytotoxic agents and epidermal growth factor receptor pathway targeted therapy have been utilized most commonly, with few clinical data to support their efficacy. Adjuvant postoperative chemoradiation with platinum has been called into question based on recent data. Programmed cell death protein 1 receptor immune checkpoint inhibitors have demonstrated profound activity in HNCSCC, and cemiplimab and pembrolizumab now are approved for use for unresectable/metastatic disease.
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Affiliation(s)
- Caitlin P McMullen
- Department of Head and Neck - Endocrine Oncology Program, Moffit Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA.
| | - Thomas J Ow
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 3400 Bainbridge Avenue, 3rd Floor Medical Arts Pavilion, Bronx, NY 10467, USA; Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, 3400 Bainbridge Avenue, 3rd Floor Medical Arts Pavilion, Bronx, NY 10467, USA
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18
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Asahina Y, Nakamura Y, Tanese K, Hirai I, Fukuda K, Amagai M, Funakoshi T. Metastatic Cutaneous Squamous Cell Carcinoma in Liver Successfully Treated With Partial Hepatectomy and Adjuvant Irinotecan Chemotherapy. In Vivo 2020; 34:825-828. [PMID: 32111790 DOI: 10.21873/invivo.11844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND The management of distant metastatic cutaneous squamous cell carcinoma (cSCC) relies mainly on chemotherapies and radiotherapy. Management of patients with cSCC with surgically resectable distant metastatic lesions is not clear. CASE REPORT A 59-year-old male had 4×10 cm-sized cSCC on the perianal skin with inguinal lymph node metastasis. Surgical resection was performed followed by radiation and adjuvant carboplatin and farmorubicin combination therapy. Six months later, 25 mm-sized solitary metastatic nodule arose on the liver. Base on his favorable overall condition fulfilling the criteria of tumor resectability for the treatment of tumors in liver and having good performance status, laparoscopic partial hepatectomy and six courses of adjuvant irinotecan therapy were performed. The surgical margin was negative and the patient has maintained complete remission for over 3 years. CONCLUSION The clinical course of the present case suggests that surgical approaches should also be considered as candidate additional therapy for resectable distant metastatic cSCC.
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Affiliation(s)
- Yasuhiko Asahina
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshio Nakamura
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keiji Tanese
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Hirai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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19
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Keeping S, Xu Y, Chen CI, Cope S, Mojebi A, Kuznik A, Konidaris G, Ayers D, Sasane M, Allen R, Huynh TMT, Popoff E, Freeman M, Andria ML, Fury MG, Singh K, Stockfleth E, Challapalli A, Schmults CD. Comparative efficacy of cemiplimab versus other systemic treatments for advanced cutaneous squamous cell carcinoma. Future Oncol 2020; 17:611-627. [PMID: 33052055 DOI: 10.2217/fon-2020-0823] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: To estimate the comparative efficacy of cemiplimab, a programmed cell death protein 1 inhibitor, versus EGFR inhibitors, pembrolizumab and platinum-based chemotherapy in terms of overall survival (OS) and progression-free survival. Patients & methods: We performed an indirect treatment comparison of cemiplimab and other available systemic therapies for patients with advanced cutaneous squamous cell carcinoma. Results: Cemiplimab was associated with benefits in OS (hazard ratios range: 0.07-0.52) and progression-free survival (hazard ratios range: 0.30-0.67) versus EGFR inhibitors and pembrolizumab (data from KEYNOTE-629). Cemiplimab was more efficacious versus platinum-based chemotherapy in terms of OS. Conclusion: Cemiplimab may offer improvements in survival for advanced cutaneous squamous cell carcinoma patients compared with existing systemic therapies.
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Affiliation(s)
- Sam Keeping
- Precision HEOR, Vancouver, BC V6H 3Y4, Canada
| | - Yingxin Xu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Chieh-I Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | | | - Ali Mojebi
- Precision HEOR, Vancouver, BC V6H 3Y4, Canada
| | - Andreas Kuznik
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | | | | | | | | | | | - Evan Popoff
- Precision HEOR, Vancouver, BC V6H 3Y4, Canada
| | | | | | - Matthew G Fury
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | | | - Eggert Stockfleth
- Department of Dermatology, University of Bochum, 44801 Bochum, Germany
| | - Amarnath Challapalli
- Bristol Cancer Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8ED, UK
| | - Chrysalyne D Schmults
- Brigham & Women's/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
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20
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Brancaccio G, Moscarella E, Briatico G, Verolino P, Alfano R, Argenziano G. Challenges and new perspectives in the treatment of advanced cutaneous squamous cell carcinoma. Minerva Med 2020; 111:589-600. [PMID: 32955822 DOI: 10.23736/s0026-4806.20.06821-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite the overall excellent survival rates in patients affected by early cutaneous squamous cell carcinoma (CSCC), advanced forms of CSCC are associated with high patient mortality. To date, only limited therapeutic modalities have been implemented, including chemotherapy and radiotherapy. Systemic therapy was enriched by the addition of epidermal growth factor receptor inhibitors (EGFRi) in the last years. Unfortunately, the overall outcome of all these therapeutic strategies remains poor, therefore important unmet clinical needs persist. Thanks to a better understanding of the biology of advanced CSCC, new treatment options are now available. This article presents the current definition of advanced CSCC along with actual therapeutic options and discusses the strengths and limitations of a new promising systemic approach, which involves the use of immune checkpoint inhibitors.
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Affiliation(s)
| | - Elvira Moscarella
- Dermatology Unit, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Giulia Briatico
- Dermatology Unit, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Pasquale Verolino
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Roberto Alfano
- Department of Anesthesiology, Surgery and Emergency, Luigi Vanvitelli University of Campania, Naples, Italy
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21
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Leiter U, Gutzmer R, Alter M, Ulrich C, Meiwes A, Heppt MV, Steeb T, Berking C, Lonsdorf AS, Sachse MM, Garbe C, Hillen U. [Cutaneous squamous cell carcinoma]. Hautarzt 2020; 71:597-606. [PMID: 32583034 DOI: 10.1007/s00105-020-04620-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers of the Caucasian population and accounts for 20% of all skin tumours. An S3 guideline of the German Guideline Program in Oncology has been available since 2019. The diagnosis is based on the clinical examination. Excision and histological confirmation is required for all clinically suspicious lesions to allow prognostic assessment and correct treatment. The therapy of first choice is complete excision with histological control of the surgical margin. In cSCC with risk factors such as tumor thickness >6 mm, sentinel lymph node biopsy may be discussed, but there is currently no clear evidence of its prognostic and therapeutic relevance. Adjuvant radiation therapy may be considered in cases of high risk of recurrence and should be tested in cases of inoperable tumors. The indication for electrochemotherapy should also be considered in the treatment of local or locoregional recurrence. The immune checkpoint inhibitor cemiplimab is approved for the treatment of inoperable or metastasized cSCC. In case of contraindications, chemotherapeutic agents, epidermal growth factor receptor (EGFR) inhibitors or palliative radiotherapy can be used. Since the evidence is low in these cases, a systemic therapy should be used preferentially within clinical studies. Follow-up care should be risk-adapted and includes a dermatological control, supplemented by ultrasound examinations in high-risk patients.
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Affiliation(s)
- U Leiter
- Zentrum für Dermato-Onkologie, Südwestdeutsches Tumorzentrum, Universitäts-Hautklinik, Eberhard-Karls-Universität, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
| | - R Gutzmer
- Hauttumorzentrum Hannover, Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - M Alter
- Universitätshautklinik, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - C Ulrich
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - A Meiwes
- Zentrum für Dermato-Onkologie, Südwestdeutsches Tumorzentrum, Universitäts-Hautklinik, Eberhard-Karls-Universität, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - M V Heppt
- Hautklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - T Steeb
- Hautklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - C Berking
- Hautklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - A S Lonsdorf
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
| | - M M Sachse
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven, Bremerhaven, Deutschland
| | - C Garbe
- Zentrum für Dermato-Onkologie, Südwestdeutsches Tumorzentrum, Universitäts-Hautklinik, Eberhard-Karls-Universität, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - U Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
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22
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Gellrich FF, Hüning S, Beissert S, Eigentler T, Stockfleth E, Gutzmer R, Meier F. Medical treatment of advanced cutaneous squamous-cell carcinoma. J Eur Acad Dermatol Venereol 2020; 33 Suppl 8:38-43. [PMID: 31833610 DOI: 10.1111/jdv.16024] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/21/2019] [Indexed: 01/23/2023]
Abstract
Considering the rising incidence, cutaneous squamous-cell carcinoma (cSCC) has a high clinical relevance. In patients with localized cSCC, complete surgical resection is indicated. Radiotherapy should be performed in patients with non-resectable tumours or in patients who are not suitable for surgery. Systemic therapy is reserved for cSCC that are neither surgically nor radiotherapeutically curable due to their extensive local spread and/or local or distant metastasis. In the absence of prospective randomized phase 3 trials to evaluate and compare the efficacy and safety of chemotherapeutics, epidermal growth factor receptor (EGFR) inhibitors and anti-PD-1 antibodies, no final recommendation for systemic therapy can be given for patients with locally advanced or metastatic cSCC. Anti-PD-1 antibodies currently show promising results with response rates of up to 50% in both locally advanced and metastatic cSCC. Anti-PD-1 antibodies appear to achieve higher response rates compared with EGFR inhibitors, and the duration of response appears to be superior to both chemotherapy and EGFR inhibitors. Compared with chemotherapy, the side effect profile of anti-PD-1 antibodies appears to be favourable. Altogether, PD-1 inhibitors are expected to become the new standard of care for patients with locally advanced and metastatic cSCC. Currently, placebo-controlled clinical trials are investigating the adjuvant use of cemiplimab and pembrolizumab in patients undergoing resection and radiotherapy of high-risk cSCC. Patients not eligible for anti-PD-1 treatment, e.g. in organ transplant recipients, or in patients refractory to anti-PD-1 may be offered EGFR inhibitors and/or chemotherapies. Chemotherapies appear to be superior to EGFR inhibitors in terms of response rates, whereas EGFR inhibitors have a more favourable toxicity profile. EGFR inhibitors are therefore more suitable for multimorbid and/or frail elderly patients. By combining EGFR inhibitors with local therapy such as surgery or radiotherapy, response rates and duration of response may be improved.
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Affiliation(s)
- F F Gellrich
- Dermatology, National Center for Tumor Diseases, University Hospital Carl Gustav Carus, Dresden, Germany
| | - S Hüning
- Dermatology, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - S Beissert
- Dermatology, National Center for Tumor Diseases, University Hospital Carl Gustav Carus, Dresden, Germany
| | - T Eigentler
- Dermatology, Universitätsklinikum Tübingen, Tübingen, Germany
| | - E Stockfleth
- Dermatology and Allergology, University of Bochum, Bochum, Germany
| | - R Gutzmer
- Department of Dermatology and Allergy, Skin Cancer Center, Hannover Medical School, Hannover, Germany
| | - F Meier
- Dermatology, National Center for Tumor Diseases, University Hospital Carl Gustav Carus, Dresden, Germany
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23
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Advanced cutaneous squamous cell carcinoma: how is it defined and what new therapeutic approaches are available? Curr Opin Oncol 2020; 31:461-468. [PMID: 31394558 DOI: 10.1097/cco.0000000000000566] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Despite the overall excellent survival rates in patients with cutaneous squamous cell carcinoma (cSCC), advanced cutaneous SCCs are associated with high patient morbidity and mortality. Therefore, important unmet clinical needs persist: identifying high risk patients and choosing optimal treatment approaches. RECENT FINDINGS In recent years, a better understanding of the biology of cSCC and its clinical progression have led to improved staging systems and new promising treatments for advanced disease. Such treatments include PD1 inhibitors, such as cemiplimab, which was recently approved for the treatment of cutaneous SCC, and pembrolizumab whose efficacy in the treatment cSCC is still being investigated. Other treatments, such as epidermal growth factor receptor inhibitors have also been used in the treatment of cSCC with moderate success. Several clinical and histological risk factors are considered key in estimating the risk or recurrence or metastasis in cSCCs and, therefore, influence the appropriate treatment choice and patient monitoring. SUMMARY The present study reviews the current definition of advanced cSCC and discusses the new systemic approaches, including checkpoint inhibitors.
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24
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Okamoto M, Kan T, Murakami E, Numata T, Otsuka R, Sueoka M, Moriwaki M, Takahagi S, Tanaka A, Kawai M, Mizuno H, Hide M. Three cases of advanced cutaneous squamous cell carcinoma treated with a combination of carboplatin and epirubicin. Eur J Hosp Pharm 2020; 27:128. [PMID: 32133145 DOI: 10.1136/ejhpharm-2019-002123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Mayumi Okamoto
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takanobu Kan
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Emi Murakami
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomofumi Numata
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Risa Otsuka
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Manami Sueoka
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masaya Moriwaki
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shunsuke Takahagi
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akio Tanaka
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mikio Kawai
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hayato Mizuno
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Michihiro Hide
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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25
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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, Bataille V, Bastholt L, Dreno B, Concetta Fargnoli M, Forsea AM, Frenard C, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NWJ, Malvehy J, Del Marmol V, Middleton MR, Moreno-Ramirez D, Pellecani G, Peris K, Saiag P, van den Beuken-van Everdingen MHJ, Vieira R, Zalaudek I, Eggermont AMM, Grob JJ. European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 2. Treatment. Eur J Cancer 2020; 128:83-102. [PMID: 32113942 DOI: 10.1016/j.ejca.2020.01.008] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 01/11/2023]
Abstract
In order to update recommendations on treatment, supportive care, education and follow-up of patients with invasive cutaneous squamous cell carcinoma (cSCC), a multidisciplinary panel of experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer was formed. Recommendations were based on evidence-based literature review, guidelines and expert consensus. Treatment recommendations are presented for common primary cSCC (low risk, high risk), locally advanced cSCC, regional metastatic cSCC (operable or inoperable) and distant metastatic cSCC. For common primary cSCC (the most frequent cSCC type), first-line treatment is surgical excision with postoperative margin assessment or microscopically controlled sugery. Safety margins containing clinical normal-appearing tissue around the tumour during surgical excision and negative margins as reported in the pathology report are necessary to minimise the risk of local recurrence and metastasis. In case of positive margins, a re-excision shall be done, for operable cases. Lymph node dissection is recommended for cSCC with cytologically or histologically confirmed regional nodal involvement. Radiotherapy should be considered as curative treatment for inoperable cSCC, or for non-surgical candidates. Anti-PD-1 antibodies are the first-line systemic treatment for patients with metastatic or locally advanced cSCC who are not candidates for curative surgery or radiation, with cemiplimab being the first approved systemic agent for advanced cSCC by the Food and Drug Administration/European Medicines Agency. Second-line systemic treatments for advanced cSCC include epidermal growth factor receptor inhibitors (cetuximab) combined with chemotherapy or radiation therapy. Multidisciplinary board decisions are mandatory for all patients with advanced disease who require more than surgery. Patients should be engaged with informed decisions on management and be provided with best supportive care to optimise symptom management and improve quality of life. Frequency of follow-up visits and investigations for subsequent new cSCC depend on underlying risk characteristics.
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Affiliation(s)
- Alexander J Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Clio Dessinioti
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Celeste Lebbe
- Université de Paris, INSERM U976, AP-HP, Dermatology Department, Saint Louis Hospital, Paris, France
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Brigitte Dreno
- Dermatology Department, CHU Nantes, Université Nantes, CIC 1413, CRCINA Inserm U1232, Nantes, France
| | - Maria Concetta Fargnoli
- Dermatology - Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana M Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Department of Oncologic Dermatology, Elias University Hospital Bucharest, Romania
| | - Cecille Frenard
- Dermatology Department, CHU Nantes, Université Nantes, CIC 1413, CRCINA Inserm U1232, Nantes, France
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | | | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole W J Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Centre+, GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, Spain
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Belgium
| | - Mark R Middleton
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - David Moreno-Ramirez
- Department of Medical-&-Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ketty Peris
- Institute of Dermatology, Università Cattolica, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré Hospital, APHP, EA 4340 'Biomarkers in Cancerology and Hemato-oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Marieke H J van den Beuken-van Everdingen
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre+, GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Ricardo Vieira
- Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Italy
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26
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Ogata D, Namikawa K, Otsuka M, Asai J, Kato H, Yasuda M, Maekawa T, Fujimura T, Kato J, Takenouchi T, Nagase K, Kawaguchi M, Kaji T, Kuwatsuka Y, Shibayama Y, Takai T, Okumura M, Kambayashi Y, Yoshikawa S, Yamazaki N, Tsuchida T. Systemic treatment of patients with advanced cutaneous squamous cell carcinoma: response rates and outcomes of the regimes used. Eur J Cancer 2020; 127:108-117. [PMID: 32004792 DOI: 10.1016/j.ejca.2019.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/26/2019] [Accepted: 12/17/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) is the second most common type of skin cancer. Few patients with cSCC experience metastases, but the prognosis of advanced cSCC (acSCC) is dismal. Evidence regarding systemic therapy for acSCC is limited. Therefore, we aimed to determine the most effective systemic treatment for acSCC. PATIENTS AND METHODS This retrospective study involved 16 Japanese institutions. We documented patient and tumour characteristics and disease course of patients with acSCC who received systemic therapy between 1st January 2006 and 31st December 2015. We compared the overall survival (OS) and progression-free survival (PFS) for (1) platinum versus non-platinum groups, (2) radiation plus chemotherapy first-line therapy (RCT) versus non-RCT groups and (3) platinum-based RCT versus non-platinum-based RCT groups. RESULTS Although the use of platinum-based systemic therapy was not associated with statistically significant improvements in PFS and OS, there were significant differences between the RCT and non-RCT groups (PFS: p < 0.001, OS: p = 0.003). In the subgroup analysis, RCT significantly prolonged PFS and OS in the nodal SCC (nSCC) group. For the RCT and non-RCT groups, the median OS was 110 and 14 months, respectively, and the 5-year OS rate was 54% and 21%, respectively. CONCLUSION RCT could improve OS in patients with nSCC. However, further multicenter prospective studies are needed to establish evidence for superiority of RCT.
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Affiliation(s)
- Dai Ogata
- Department of Dermatology, Saitama Medical University, 38, Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan; Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 1040045, Japan.
| | - Kenjiro Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 1040045, Japan
| | - Masaki Otsuka
- Department of Dermatology, Shizuoka Cancer Center. 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan
| | - Jun Asai
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Hisoshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku Nagoya 467-8601, Japan
| | - Masahito Yasuda
- Department of Dermatology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Takeo Maekawa
- Department of Dermatology, Faculty of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Taku Fujimura
- Department of Dermatology, Tohoku University Graduate School of Medicine, Seiryo-machi 1-1, Aoba-ku, Sendai, 980-8574, Japan
| | - Junji Kato
- Department of Dermatology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan
| | - Tatsuya Takenouchi
- Department of Dermatology, Niigata Cancer Center Hospital, 2 Kawagishichou, Niigata 951-8566, Japan
| | - Kotaro Nagase
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga 849-8501, Japan
| | - Masakazu Kawaguchi
- Department of Dermatology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
| | - Tatsuya Kaji
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2 -5 -1 Shikata -cho, Kita -ku, Okayama, 700- 8558, Japan
| | - Yutaka Kuwatsuka
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Yoshitsugu Shibayama
- Department of Dermatology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 810-0180, Japan
| | - Toshihiro Takai
- Department of Dermatology, Hyogo Prefectural Cancer Center, 13-30 Kitaoji, Akashi, Hyogo 673-8558, Japan
| | - Mao Okumura
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 1040045, Japan
| | - Yumi Kambayashi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Seiryo-machi 1-1, Aoba-ku, Sendai, 980-8574, Japan
| | - Syusuke Yoshikawa
- Department of Dermatology, Shizuoka Cancer Center. 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 1040045, Japan
| | - Tetsuya Tsuchida
- Department of Dermatology, Saitama Medical University, 38, Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
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27
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Cetuximab is efficient and safe in patients with advanced cutaneous squamous cell carcinoma: a retrospective, multicentre study. Oncotarget 2020; 11:378-385. [PMID: 32064041 PMCID: PMC6996917 DOI: 10.18632/oncotarget.27434] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/13/2019] [Indexed: 02/02/2023] Open
Abstract
There is no standard of care for unresectable cutaneous squamous cell carcinoma (cSCC). Chemotherapy, alone or combined with radiotherapy, is commonly used mostly as palliative treatment; moreover, its poor safety profile limits its use most of the time, especially in elderly patients. Thus, alternative options are needed. Targeted molecular inhibitors, such as the epidermal growth factor receptor inhibitor cetuximab, seem promising, but data are limited. We retrospectively evaluated clinical outcomes of cetuximab as a single agent in this indication. The primary endpoint was the Disease Control Rate (DCR) at 6 weeks according to RECIST criteria. Secondary endpoints included DCR at 12 weeks, objective response rate (ORR) at 6 and 12 weeks, progression-free-survival (PFS), overall survival (OS), and safety profile. Fifty-eight patients received cetuximab as monotherapy. The median age was 83.2 (range, 47.4 to 96.1). The majority of patients was chemotherapy naïve. The median follow-up was 11.7 months (95% CI: 9.6-30.1). The DCR at 6 and 12 weeks was 87% and 70%, respectively. The ORR was 53% and 42%, respectively, at 6 and 12 weeks. The median PFS and OS were 9.7 months (95% CI: 4.8-43.4) and 17.5 months (95% CI: 9.4-43.1), respectively. Fifty-one patients (88%) experienced toxicity, and 67 adverse events related to cetuximab occurred. Most of them (84%) were grade 1 to 2. Our study shows that cetuximab is safe and efficient for the treatment of patients, even elderly ones, with advanced cSCC. These results indicate that cetuximab is a promising agent to test in new combinations, especially with immune checkpoint inhibitors such as anti-PD-1 agents.
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28
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Immunotherapy and other systemic therapies for cutaneous SCC. Oral Oncol 2019; 99:104459. [PMID: 31715538 DOI: 10.1016/j.oraloncology.2019.104459] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/22/2019] [Indexed: 12/21/2022]
Abstract
Contrary to the impression that non-melanoma skin cancer is a banal and relatively trivial malignancy it causes about 1% of all cancer deaths. Cutaneous Squamous Cell carcinoma (CuSCC) make up a significant part of these deaths either from incurable loco-regional disease or metastatic disease. As is typical of the disease itself, these patients are often of advanced age, but the immunocompromised from organ transplantation or haematological malignancy are important populations. Systemic therapies have a long history in palliative therapy for CuSCC, but not a particularly extensively studied one. Cytotoxic chemotherapy is active with response rates derived from multiple small studies of 17-85%; as is often the case in solid tumour oncology responses are rarely durable. The Epidermal Growth Factor Receptor has been targeted with both small molecular inhibitors and monoclonal antibodies. Disease control rates of the order of 50-70% were seen but again durability remains an issue. Immunotherapy using interferon with retinoids also showed significant response rates in very small trials. The high rates of mutation seen in CuSCC and relationship with immunosuppression suggested that checkpoint inhibitors might be active. Checkpoint inhibition immunotherapy with PD-1 antibodies like cemiplimab have demonstrated response rates of the order of 40% and durability is encouraging: response duration was over a year in 75% of responders in the initial trial. We review the latest data with current immunotherapy drugs and consider the future directions such therapy may take us as well as the role of these therapies in special populations.
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29
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Amaral T, Osewold M, Presser D, Meiwes A, Garbe C, Leiter U. Advanced cutaneous squamous cell carcinoma: real world data of patient profiles and treatment patterns. J Eur Acad Dermatol Venereol 2019; 33 Suppl 8:44-51. [PMID: 31658392 DOI: 10.1111/jdv.15845] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/25/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) is one of the most common types of cancer in the Caucasian population, with an increasing incidence. cSCC is mostly a local invasive disease that can be treated surgically in the majority of the cases. However, in the case of advanced cSCC (acSCC), a multimodality approach also involving systemic therapies needs to be considered. METHODS One hundred and ninety-five patients diagnosed with acSCC (stages III and IV) treated in our centre between 2011 and 2018 were included. Patient and tumour characteristics along with treatment patterns were documented and analyzed. Descriptive analysis was performed and survival rates were estimated according to Kaplan-Meier and compared with the Log-rank test. Follow-up was defined as the time between diagnosis of advanced disease and last contact or death. All causes of death were considered as events. RESULTS The median follow-up was 21 months [IQR = (10.0; 21.0)]. The median age at time of advanced disease diagnosis was 78 years [IQR = (72; 84)], with 40.5% of the patients in stage III and 59.5% in stage IV. One hundred and forty-five patients had resectable tumours. In this group the median overall survival (mOS) was 59 months (95% CI: 28.2-89.8), significantly higher than the mOS in patients with inoperable tumour [n = 50; mOS: 19 months (96% CI: 7-31, P <0.0001)]. Patients receiving immunotherapy (n = 20) showed a statistically significant better survival compared to those treated with other systemic therapies (n = 37; mOS not reached vs. mOS: 22 months (95% CI: 6.5-43.5), P = 0.034). For patients without systemic therapy, a combination of surgery and radiotherapy provided better outcomes compared to radiotherapy alone or best supportive care (P <0.001). CONCLUSION Surgical complete resection should be the first therapeutic option for patients with acSCC. For patients with inoperable tumour, first-line immunotherapy should be preferably considered.
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Affiliation(s)
- T Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Portuguese Air Force, Health Care Direction, Lisbon, Portugal
| | - M Osewold
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - D Presser
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - A Meiwes
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - C Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - U Leiter
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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30
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Chapalain M, Baroudjian B, Dupont A, Lhote R, Lambert J, Bagot M, Lebbe C, Basset-Seguin N. Stage IV cutaneous squamous cell carcinoma: treatment outcomes in a series of 42 patients. J Eur Acad Dermatol Venereol 2019; 34:1202-1209. [PMID: 31587382 DOI: 10.1111/jdv.16007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/28/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND The prevalence and incidence of cutaneous squamous cell carcinoma (cSCC) are increasing due to the ageing of the population and sun exposure. Advanced cSCC forms (locally advanced and/or locoregional metastatic and/or distant metastatic) account for approximately 3% of cSCC and can result in death. OBJECTIVE Analysis of the clinical characteristics and treatment outcomes in stage IV cSCC with unresectable locoregional extension and/or the presence of metastases. METHODS A retrospective study was conducted at a single-centre university hospital for stage IV cSCC patients followed between 1 January 2008 and 31 December 2015. Descriptive analyses (demographic, anatomo-clinical characteristics, treatment sequences, response to treatment and survival analysis) were performed. RESULTS The study included 42 patients (median age = 75.5 years) with a diagnosis of stage IV cSCC who were treated with at least one line of chemotherapy and/or cetuximab. At the time of diagnosis, 85.7% of the patients had locoregional extension (19% of locally advanced and 67% of locoregional metastatic) and 14.3% had distant metastatic disease. Regarding treatment, 40% and 36% of patients received no more than 1 and 2 systemic treatment lines, respectively. The 4-year overall survival was 6%, and the median follow-up was 18.6 months. The objective response rate was 55% after the first line of treatment with a median progression-free survival (PFS) of 6.18 months and 12% after the second line with a median PFS of 6.51 months. Grade 3 and 4 adverse events were observed for 33% of patients. CONCLUSION Our study confirms a very poor prognosis of stage IV cSCC and a poor response to conventional therapies, indicating that the stage IV cSCC patient population remains with unmet medical needs.
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Affiliation(s)
- M Chapalain
- Dermatology Department, Hôpital Saint-Louis, AP-HP, Paris, France.,Inserm Unité 976, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France
| | - B Baroudjian
- Dermatology Department, Hôpital Saint-Louis, AP-HP, Paris, France.,Inserm Unité 976, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France
| | - A Dupont
- Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France.,Department of Biostatistics, Hôpital Saint-Louis, AP-HP, Paris, France
| | - R Lhote
- Dermatology Department, Hôpital Saint-Louis, AP-HP, Paris, France.,Inserm Unité 976, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France
| | - J Lambert
- Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France.,Department of Biostatistics, Hôpital Saint-Louis, AP-HP, Paris, France
| | - M Bagot
- Dermatology Department, Hôpital Saint-Louis, AP-HP, Paris, France.,Inserm Unité 976, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France
| | - C Lebbe
- Dermatology Department, Hôpital Saint-Louis, AP-HP, Paris, France.,Inserm Unité 976, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France
| | - N Basset-Seguin
- Dermatology Department, Hôpital Saint-Louis, AP-HP, Paris, France.,Inserm Unité 976, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France
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31
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Lee AY, Berman RS. The Landmark Series: Non-melanoma Skin Cancers. Ann Surg Oncol 2019; 27:22-27. [PMID: 31549317 DOI: 10.1245/s10434-019-07831-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Indexed: 11/18/2022]
Abstract
Surgery with or without radiation has always been the mainstay of treatment for patients with non-melanoma skin cancers, including basal cell carcinoma, squamous cell carcinoma, and Merkel cell carcinoma. Until recently, there were no effective systemic therapies for patients with advanced disease. This review will focus on the landmark clinical trials that led to Food and Drug Administration (FDA) approval of Vismodegib for advanced basal cell carcinoma (ERIVANCE BCC) and pembrolizumab for advanced Merkel cell carcinoma (KEYNOTE-017). These trials have not only changed the landscape for patients with metastatic disease but also notably for patients with locally advanced disease that is either unresectable or resectable with high morbidity. Additional mention is made for the clinical trial that led to FDA approval of cemiplimab for advanced cutaneous squamous cell carcinoma (EMPOWER-CSCC-1), which is already changing practice patterns, but for which longer-term data are still needed.
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Affiliation(s)
- Ann Y Lee
- Department of Surgery, NYU Langone Health, New York, NY, USA.
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Evolving Role of Systemic Therapies in Non-melanoma Skin Cancer. Clin Oncol (R Coll Radiol) 2019; 31:759-768. [PMID: 31522944 DOI: 10.1016/j.clon.2019.08.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/16/2019] [Accepted: 08/28/2019] [Indexed: 02/07/2023]
Abstract
Keratinocyte cancers - basal and cutaneous squamous cell carcinoma (BCC, cSCC) - are the most common forms of non-melanoma skin cancer (NMSC) and there has been a significant increase in their incidence globally in recent decades. Although the majority of BCC and cSCC are cured with conventional surgery or radiotherapy, certain tumour or patient-determined factors may result in these modalities being inadequate or inappropriate, for example, locally advanced or metastatic disease, high tumour multiplicity, patient comorbidities and patient preferences. In these clinical circumstances, systemic treatment may be indicated, and over the past 10 years a number of new systemic agents have been approved. Nonetheless, effective systemic therapy for keratinocyte cancers remains an area of significant unmet clinical need. Improved understanding of the molecular and immune pathogenesis underlying tumour growth and development is critical for driving future advances and is a research priority. The aim of this review is to provide clinicians with an overview of systemic treatments for BCC and cSCC and will focus on current evidence for conventional chemotherapy, targeted therapies, immunotherapy, adjuvant and neoadjuvant therapy, chemoprevention and future prospects for novel systemic treatment approaches.
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Petersen ET, Ahmed SR, Chen L, Silapunt S, Migden MR. Review of systemic agents in the treatment of advanced cutaneous squamous cell carcinoma. Future Oncol 2019; 15:3171-3184. [PMID: 31382778 DOI: 10.2217/fon-2019-0158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Advanced cutaneous squamous cell carcinoma (cSCC) accounts for only 5% of all cases of cSCC but up to 60% of disease related deaths. Historically, this disease has lacked effective treatment options due to a combination of poor response rate, poor response durability and significant treatment-associated morbidity. Autumn of 2018 marked the first time ever that an agent received US FDA approval for advanced cSCC and the future is looking much brighter for this previously neglected patient population. The purpose of this article is to review the various systemic treatment options for advanced cSCC moving from the past to the present, highlighting their relative merits and shortcomings, and to briefly speculate on future developments in the field of advanced cSCC.
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Affiliation(s)
- Erik T Petersen
- University of Texas MD Anderson Cancer Center, Department of Dermatology, Mohs and Dermasurgery Unit, Houston, TX 77030, USA
| | - Saqib R Ahmed
- University of Texas MD Anderson Cancer Center, Department of Dermatology, Mohs and Dermasurgery Unit, Houston, TX 77030, USA
| | - Leon Chen
- University of Texas McGovern Medical School Department of Dermatology, Houston, TX 77030, USA
| | - Sirunya Silapunt
- University of Texas McGovern Medical School Department of Dermatology, Houston, TX 77030, USA
| | - Michael R Migden
- University of Texas MD Anderson Cancer Center, Department of Dermatology, Mohs and Dermasurgery Unit, Houston, TX 77030, USA.,University of Texas MD Anderson Cancer Center Department of Head & Neck Surgery, Houston, TX 77030, USA
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34
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Basal cell carcinoma: Contemporary approaches to diagnosis, treatment, and prevention. J Am Acad Dermatol 2019; 80:321-339. [PMID: 29782901 DOI: 10.1016/j.jaad.2018.02.083] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 12/21/2022]
Abstract
As the most common human cancer worldwide and continuing to increase in incidence, basal cell carcinoma is associated with significant morbidity and cost. Continued advances in research have refined both our insight and approach to this seemingly ubiquitous disease. This 2-part continuing medical education series provides a comprehensive and contemporary review of basal cell carcinoma. The second article in this series will present both the current standard of care and newly developed approaches to diagnosis, treatment, and prevention of this disease.
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35
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Cetuximab as a Component of Multimodality Treatment of High-Risk Cutaneous Squamous Cell Carcinoma: A Retrospective Analysis From a Single Tertiary Academic Medical Center. Dermatol Surg 2019; 45:254-267. [DOI: 10.1097/dss.0000000000001755] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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36
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Nakamura Y, Tanese K, Hirai I, Kawakami Y, Funakoshi T. Carboplatin and epirubicin combination therapy for advanced malignant epithelial skin tumors: Retrospective study of six patients. J Dermatol 2018; 45:874-875. [PMID: 29971836 DOI: 10.1111/1346-8138.14328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/06/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Yoshio Nakamura
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keiji Tanese
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Hirai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Kawakami
- Division of Cellular Signaling for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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37
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Peris K, Alaibac M, Argenziano G, Di Stefani A, Fargnoli MC, Frascione P, Gualdi G, Longo C, Moscarella E, Naldi L, Pellacani G, Pimpinelli N, Quaglino P, Salgarello M, Sollena P, Valentini V, Zalaudek I, Calzavara-Pinton PG. Cutaneous squamous cell carcinoma. Italian Guidelines by SIDeMaST adapted to and updating EADO/EDF/EORTC guidelines. GIORN ITAL DERMAT V 2018; 153:747-762. [DOI: 10.23736/s0392-0488.18.06093-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Yu SL, Lee DC, Baek SW, Cho DY, Choi JG, Kang J. Identification of mTOR inhibitor-resistant genes in cutaneous squamous cell carcinoma. Cancer Manag Res 2018; 10:6379-6389. [PMID: 30568499 PMCID: PMC6267733 DOI: 10.2147/cmar.s174966] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose The PI3K/AKT/mTOR pathway is frequently activated in various squamous cell carcinomas (SCCs). Although mTOR inhibitors are suggested as effective treatments in immunosuppressed patients with metastatic SCC, they are still not proven to be favorable in treating skin SCC patients not undergoing immunosuppressive therapy. Moreover, the exact mechanism of the mTOR signaling pathway in SCC has not yet been identified. In this study, we aimed to determine the genes associated with mTOR inhibitors in skin SCC. Materials and methods The identification of cell viability according to concentration of everolimus and Western blot was done. To analyze the global gene expression profiles, A431 and HSC-1 cells were treated with dimethyl sulfoxide (DMSO) or 100 nM of everolimus for 72 hours. Furthermore, differentially expressed genes (DEGs) were identified using Affymetrix analysis. To identify the gene network associated with everolimus resistance in SCC cells, pathway analysis was performed using the Ingenuity Pathway Analysis (IPA) tool. Results The effects of cell death with respect to the mTOR inhibitor concentration were observed in the HSC-1 cell line; however, the mTOR inhibitor did not show effective cytotoxic activity in the A431 cell line. p-mTOR concentration also diminished with respect to everolimus concentrations in the HSC-1 cell line. Moreover, the microarray results showed that the MYC/CCND1/TP73/NUPR1/SBD/ERBB2/CDKN2B genes were related to mTOR inhibitor resistance. However, CCND1 gene overexpression was most closely related to mTOR inhibitor resistance. Conclusion We identified mTOR inhibitor resistance genes, and our findings may help select therapeutic targets in skin SCC.
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Affiliation(s)
- Seong-Lan Yu
- Myunggok Medical Research Institute, College of Medicine, Konyang University, Daejeon, Republic of Korea,
| | - Dong Chul Lee
- Biotherapeutics Translational Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
| | - Seung Woo Baek
- Department of Oncology-Hematology, Konyang University Hospital, Daejeon, Republic of Korea,
| | - Do Yeun Cho
- Department of Oncology-Hematology, Konyang University Hospital, Daejeon, Republic of Korea,
| | - Jong Gwon Choi
- Department of Oncology-Hematology, Konyang University Hospital, Daejeon, Republic of Korea,
| | - JaeKu Kang
- Myunggok Medical Research Institute, College of Medicine, Konyang University, Daejeon, Republic of Korea,
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Nation-wide survey of advanced non-melanoma skin cancers treated at dermatology departments in Japan. J Dermatol Sci 2018; 92:230-236. [PMID: 30527378 DOI: 10.1016/j.jdermsci.2018.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/25/2018] [Accepted: 10/30/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are limited treatment options for advanced non-melanoma skin cancers (NMSCs). To overcome this issue, we need to conduct clinical studies, however, there is a lack of information on how many patients with advanced NMSCs are treated annually in Japan. OBJECTIVE To investigate the actual number of advanced NMSC patients in Japan. METHODS A questionnaire survey was sent to 668 institutes to educe information on: 1) the numbers of patients with squamous cell carcinoma (SCC), extramammary Paget disease (EMPD), other skin origin carcinomas, and cutaneous angiosarcoma (CAS) admitted in 2016 and 2017; 2) the preferred first- and second-line chemotherapies; and 3) the anticipated for future development. RESULTS Questionnaires were returned from 383 (57.3%) institutes. They reported a total of 1765 patients over the 2 years. The annual number patients with SCC, EMPD, other skin carcinomas, and CAS was 323.5, 192.5, 126, and 240.5, respectively. We estimated the annual number of patients for all 668 institutes to be 1255.6. Current first- and second-line treatment for NMSCs were chemotherapy regimens, but immune checkpoint inhibitors were the most anticipated new drugs for SCC and CAS, while chemotherapy was still the most anticipated treatment for EMPD. CONCLUSION Considering that during 2017, the number of deaths in Japan due to NMSC was reported to be 948, our estimated annual number of patients with NMSCs, 1255.6 seems to be an accurate estimation. As most of the treatment options for advanced NMSCs are outdated, the results of this study should be used to propose clinical studies.
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40
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Cavalieri S, Perrone F, Miceli R, Ascierto PA, Locati LD, Bergamini C, Granata R, Alfieri S, Resteghini C, Galbiati D, Busico A, Paielli N, Patuzzo R, Maurichi A, Gallino G, Ruggeri R, Mariani L, Palla M, Licitra L, Bossi P. Efficacy and safety of single-agent pan-human epidermal growth factor receptor (HER) inhibitor dacomitinib in locally advanced unresectable or metastatic skin squamous cell cancer. Eur J Cancer 2018; 97:7-15. [PMID: 29734047 DOI: 10.1016/j.ejca.2018.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/07/2017] [Accepted: 04/05/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND In recurrent or metastatic (R/M) skin squamous cell cancer (sSCC) not amenable to radiotherapy (RT) or surgery, chemotherapy (CT) has a palliative intent and limited clinical responses. The role of oral pan-HER inhibitor dacomitinib in this setting was investigated within a clinical trial. METHODS Patients with diagnosis of R/M sSCC were treated. Dacomitinib was started at a dose of 30 mg daily (QD) for 15 d, followed by 45 mg QD. Primary end-point was response rate (RR). Tumour samples were analysed through next-generation sequencing using a custom panel targeting 36 genes associated with sSCC. RESULTS Forty-two patients (33 men; median age 77 years) were treated. Most (86%) received previous treatments consisting in surgery (86%), RT (50%) and CT (14%). RR was 28% (2% complete response; 26% partial response), disease control rate was 86%. Median progression-free survival and overall survival were 6 and 11 months, respectively. Most patients (93%) experienced at least one adverse event (AE): diarrhoea, skin rash (71% each), fatigue (36%) and mucositis (31%); AEs grade 3-4 occurred in 36% of pts. In 16% of cases, treatment was discontinued because of drug-related toxicity. TP53, NOTCH1/2, KMT2C/D, FAT1 and HER4 were the most frequently mutated genes. BRAF, NRAS and HRAS mutations were more frequent in non-responders, and KMT2C and CASP8 mutations were restricted to this subgroup. CONCLUSIONS In sSCC, dacomitinib showed activity similar to what was observed with anti-epidermal growth factor receptor agents, and durable clinical benefit was observed. Safety profile was comparable to previous experiences in other cancers. Molecular pt selection could improve therapeutic ratio.
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Affiliation(s)
- S Cavalieri
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Medical Oncology/Head and Neck Unit, Milan, Italy
| | - F Perrone
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Department of Pathology, Unit of Experimental Molecular Pathology, Milan, Italy
| | - R Miceli
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Clinical Epidemiology and Trial Organization, Milan, Italy
| | - P A Ascierto
- Istituto Nazionale Tumori Fondazione "G. Pascale", Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, Naples, Italy
| | - L D Locati
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Medical Oncology/Head and Neck Unit, Milan, Italy
| | - C Bergamini
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Medical Oncology/Head and Neck Unit, Milan, Italy
| | - R Granata
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Medical Oncology/Head and Neck Unit, Milan, Italy
| | - S Alfieri
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Medical Oncology/Head and Neck Unit, Milan, Italy
| | - C Resteghini
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Medical Oncology/Head and Neck Unit, Milan, Italy
| | - D Galbiati
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Medical Oncology/Head and Neck Unit, Milan, Italy
| | - A Busico
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Department of Pathology, Unit of Experimental Molecular Pathology, Milan, Italy
| | - N Paielli
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Department of Pathology, Unit of Experimental Molecular Pathology, Milan, Italy
| | - R Patuzzo
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Melanoma and Sarcoma Surgery Unit, Milan, Italy
| | - A Maurichi
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Melanoma and Sarcoma Surgery Unit, Milan, Italy
| | - G Gallino
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Melanoma and Sarcoma Surgery Unit, Milan, Italy
| | - R Ruggeri
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Melanoma and Sarcoma Surgery Unit, Milan, Italy
| | - L Mariani
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Clinical Epidemiology and Trial Organization, Milan, Italy
| | - M Palla
- Istituto Nazionale Tumori Fondazione "G. Pascale", Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, Naples, Italy
| | - L Licitra
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Medical Oncology/Head and Neck Unit, Milan, Italy; Università Degli Studi di Milano, Medical Oncology Department, Milan, Italy
| | - P Bossi
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Medical Oncology/Head and Neck Unit, Milan, Italy.
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Hillen U, Leiter U, Haase S, Kaufmann R, Becker J, Gutzmer R, Terheyden P, Krause-Bergmann A, Schulze HJ, Hassel J, Lahner N, Wollina U, Ziller F, Utikal J, Hafner C, Ulrich J, Machens HG, Weishaupt C, Hauschild A, Mohr P, Pföhler C, Maurer J, Wolff P, Windemuth-Kieselbach C, Schadendorf D, Livingstone E. Advanced cutaneous squamous cell carcinoma: A retrospective analysis of patient profiles and treatment patterns-Results of a non-interventional study of the DeCOG. Eur J Cancer 2018; 96:34-43. [PMID: 29665511 DOI: 10.1016/j.ejca.2018.01.075] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/15/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Advanced cutaneous squamous cell carcinoma (aSCC) is an area of unmet medical need and no treatment standards are established. Recently, an anti-PD-1 inhibitor received FDA breakthrough therapy designation. The aim of the study was to describe the clinical course, therapeutic management and prognosis of aSCC under real-life conditions. PATIENTS AND METHODS In a retrospective study performed in 24 German and Austrian hospitals and doctor's offices, patient and tumour characteristics of patients diagnosed with aSCC between January 1, 2010 and December 31, 2011 and their disease course was documented. Advanced SCC comprised either locally advanced SCCs (laSCC) or metastatic SCCs (mSCC) with any kind of metastatic spread. RESULTS Data of 190 patients with aSCC were analysed. Median age at time of diagnosis of aSCC was 78 years. LaSCC was diagnosed in 76 patients (40%), 114 patients (60%) had mSCC. Once diagnosed with laSCC, most patients (59%) did not receive any therapy, whereas in 92% of mSCC patients at least one type of therapy was performed. Only 32 patients (29 mSCC, 3 laSCC) received systemic antitumour therapies, mostly EGFR inhibitor-based regimens. Mean duration of response was short (17-months laSCC patients, 3-months mSCC patients). Only 2 patients achieved a complete response, 27% had a partial response, 43% disease stabilisation. At diagnosis of aSCC, ECOG status was 0-1 in most patients. Non-malignant comorbidities influenced the decision on SCC-specific therapy in 39 patients (21%). CONCLUSIONS Our data show the high medical need for efficient and tolerable antitumour therapies and demonstrate that despite older age and comorbidities, most patients can be expected to be fit for treatment. This study provides a historical context for emerging aSCC treatments.
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Affiliation(s)
- Uwe Hillen
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; Department of Dermatology and Venerology, Vivantes Klinikum Neukölln, 12351 Berlin, Germany.
| | - Ulrike Leiter
- Department of Dermatology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Sylvie Haase
- Department of Dermatology, University Hospital Frankfurt, 60590 Frankfurt, Germany; Hautärzte in Konstanz, 78462 Konstanz, Germany
| | - Roland Kaufmann
- Department of Dermatology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Jürgen Becker
- Department of Dermatology, University Hospital Graz, 8036 Graz, Austria; Translational Skin Cancer Research, German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ralf Gutzmer
- Skin Cancer Center, Department of Dermatology and Allergy, Hannover Medical School, 30625 Hannover, Germany
| | - Patrick Terheyden
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
| | | | | | - Jessica Hassel
- Department of Dermatology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Nina Lahner
- Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Uwe Wollina
- Department of Dermatology, University Hospital Dresden, 01067 Dresden, Germany
| | - Fabian Ziller
- Department of Dermatology, DRK Krankenhaus Rabenstein, 09117 Chemnitz, Germany
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Christine Hafner
- Dept. of Dermatology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, 3500 St. Pölten, Austria; Karl Landsteiner Institute of Dermatological Research, Karl Landsteiner Gesellschaft, 3500 St. Pölten, Austria
| | - Jens Ulrich
- Department of Dermatology, Harzklinikum Dorothea Christiane Erxleben, 06484 Quedlinburg, Germany
| | - Hans-Günther Machens
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital Münster, 48149 Münster, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe-Kliniken, 21614 Buxtehude, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical School, 66421 Homburg/Saar, Germany
| | - Jan Maurer
- Department of ENT, Katholisches Klinikum Marienhof, 56073 Koblenz, Germany
| | - Patrick Wolff
- Alcedis GmbH, Medical Research Institute, 35394 Gießen, Germany
| | | | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; Translational Skin Cancer Research, German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
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Potenza C, Bernardini N, Balduzzi V, Losco L, Mambrin A, Marchesiello A, Tolino E, Zuber S, Skroza N, Proietti I. A Review of the Literature of Surgical and Nonsurgical Treatments of Invasive Squamous Cells Carcinoma. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9489163. [PMID: 29808169 PMCID: PMC5902082 DOI: 10.1155/2018/9489163] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/12/2017] [Accepted: 02/18/2018] [Indexed: 01/11/2023]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is an increasing public health problem. It is a primary malignant skin tumor with Malpighian differentiation and together with basal cell carcinoma is classified among nonmelanoma skin cancers (NMSCs). cSCC usually occurs on photoexposed areas, such as the head, the neck, and the extremities, and its incidence increases with age. Invasive forms of this skin tumor tend to be more aggressive showing a higher metastatic potential, usually regarding regional lymph nodes. Treatment options for invasive cSCCs include both surgical and nonsurgical options. The therapeutic choice depends on several factors, such as anatomic location, risk factors for tumor recurrence, age, and health status of the patient. This review aims to provide an overview of the current evidence on therapeutic surgical and nonsurgical management of invasive cSCC.
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Affiliation(s)
- Concetta Potenza
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Rome, Italy
| | - Nicoletta Bernardini
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Rome, Italy
| | - Veronica Balduzzi
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Rome, Italy
| | - Luigi Losco
- Plastic Surgery Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Alessandra Mambrin
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Rome, Italy
| | - Anna Marchesiello
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Rome, Italy
| | - Ersilia Tolino
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Rome, Italy
| | - Sara Zuber
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Rome, Italy
| | - Nevena Skroza
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Rome, Italy
| | - Ilaria Proietti
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Rome, Italy
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Wenande E, Tam J, Bhayana B, Schlosser SK, Ishak E, Farinelli WA, Chlopik A, Hoang MP, Pinkhasov OR, Caravan P, Rox Anderson R, Haedersdal M. Laser-assisted delivery of synergistic combination chemotherapy in in vivo skin. J Control Release 2018; 275:242-253. [PMID: 29454062 DOI: 10.1016/j.jconrel.2018.02.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 12/13/2022]
Abstract
The effectiveness of topical drugs for treatment of non-melanoma skin cancer is greatly reduced by insufficient penetration to deep skin layers. Ablative fractional lasers (AFLs) are known to enhance topical drug uptake by generating narrow microchannels through the skin, but information on AFL-drug delivery in in vivo conditions is limited. In this study, we examined pharmacokinetics, biodistribution and toxicity of two synergistic chemotherapy agents, cisplatin and 5-fluorouracil (5-FU), following AFL-assisted delivery alone or in combination in in vivo porcine skin. Detected at 0-120 h using mass spectrometry techniques, we demonstrated that fractional CO2 laser pretreatment (196 microchannels/cm2, 852 μm ablation depth) leads to rapid drug uptake in 1500 μm deep skin layers, with a sixfold enhancement in peak cisplatin concentrations versus non-laser-treated controls (5 h, P = 0.005). Similarly, maximum 5-FU deposition was measured within an hour of AFL-delivery, and exceeded peak deposition in non-laser-exposed skin that had undergone topical drug exposure for 5 days. Overall, this accelerated and deeper cutaneous drug uptake resulted in significantly increased inflammatory and histopathological effects. Based on clinical scores and transepidermal water loss measurement, AFL intensified local toxic responses to drugs delivered alone and in combination, while systemic drug exposure remained undetectable. Quantitative histopathologic analyses correspondingly revealed significantly reduced epidermal proliferation and greater cellular apoptosis after AFL-drug delivery; particularly after combined cisplatin + 5-FU exposure. In sum, by overcoming the primary limitation of topical drug penetration and providing accelerated, enhanced and deeper delivery, AFL-assisted combination chemotherapy may represent a promising treatment strategy for non-melanoma skin cancer.
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Yanagi T, Kitamura S, Hata H. Novel Therapeutic Targets in Cutaneous Squamous Cell Carcinoma. Front Oncol 2018; 8:79. [PMID: 29629337 PMCID: PMC5876309 DOI: 10.3389/fonc.2018.00079] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/08/2018] [Indexed: 12/23/2022] Open
Abstract
Cutaneous squamous cell carcinoma (SCC) is one of the common cancers in Caucasians, accounting for 20–30% of cutaneous malignancies. The risk of metastasis is low in most patients; however, aggressive SCC is associated with very high mortality and morbidity. Although cutaneous SCC can be treated with surgical removal, radiation and chemotherapy singly or in combination, the prognosis of patients with metastatic SCC is poor. Recently, the usage of immune checkpoint blockades has come under consideration. To develop effective therapies that are less toxic than existing ones, it is crucial to achieve a detailed characterization of the molecular mechanisms that are involved in cutaneous SCC pathogenesis and to identify new drug targets. Recent studies have identified novel molecules that are associated with SCC carcinogenesis and progression. This review focuses on recent advances in molecular studies involving SCC tumor development, as well as in new therapeutics that have become available to clinicians.
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Affiliation(s)
- Teruki Yanagi
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shinya Kitamura
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroo Hata
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Kanzaki A, Ansai SI, Ueno T, Kawana S, Shimizu A, Naito Z, Saeki H. A Case of Metastatic Basal Cell Carcinoma Treated with Cisplatin and Adriamycin. J NIPPON MED SCH 2018; 84:286-290. [PMID: 29279559 DOI: 10.1272/jnms.84.286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 72-year-old man was referred to our hospital for treatment of an ulcer that had been growing on his back for 10 years. Physical examination showed an ulcerated tumor from the neck to the back and swollen cervical lymph nodes. The tumor size was 12×9 cm. Histology of the biopsy showed a nodular and morpheic basal cell carcinoma (BCC). A chest computed tomography (CT) scan showed multiple lung tumors. CT-guided biopsy of the lung and the cervical lymph node revealed metastatic basal cell carcinoma (MBCC). The primary skin tumor was resected and a total of 10 courses of cisplatin (25 mg/m2/day×75%) and adriamycin (50 mg/m2×75%) were administered for metastatic basal cell carcinoma (MBCC). The patient died 5 years and 3 months after his first visit. Autopsy revealed MBCC in the lung, kidney, pancreas, several lymph nodes, liver and bone. A portion of the tumor cells were composed of squamoid cells with eosinophilic cytoplasm, large nuclei, lack of the characteristic peripheral palisading and retraction artifacts, and variable cytoplasmic keratinization. These pathological findings were compatible with basosquamous cell carcinoma. Chemotherapy was effective for MBCC in this patient.
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Affiliation(s)
| | - Shin-Ichi Ansai
- Division of Dermatology, Nippon Medical School Musashi Kosugi Hospital
| | - Takashi Ueno
- Department of Dermatology, Nippon Medical School
| | - Seiji Kawana
- Department of Dermatology, Nippon Medical School
| | - Akira Shimizu
- Division of Diagnostic Pathology, Nippon Medical School
| | - Zenya Naito
- Division of Diagnostic Pathology, Nippon Medical School
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46
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Cutaneous squamous cell carcinoma. J Am Acad Dermatol 2018; 78:249-261. [DOI: 10.1016/j.jaad.2017.08.058] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/23/2017] [Accepted: 08/17/2017] [Indexed: 11/19/2022]
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Kim JYS, Kozlow JH, Mittal B, Moyer J, Olenecki T, Rodgers P. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol 2018; 78:560-578. [PMID: 29331386 DOI: 10.1016/j.jaad.2017.10.007] [Citation(s) in RCA: 238] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common form of human cancer and has an increasing annual incidence. Although most cSCC is cured with office-based therapy, advanced cSCC poses a significant risk for morbidity, impact on quality of life, and death. This document provides evidence-based recommendations for the management of patients with cSCC. Topics addressed include biopsy techniques and histopathologic assessment, tumor staging, surgical and nonsurgical management, follow-up and prevention of recurrence, and management of advanced disease. The primary focus of these recommendations is on evaluation and management of primary cSCC and localized disease, but where relevant, applicability to recurrent cSCC is noted, as is general information on the management of patients with metastatic disease.
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Affiliation(s)
| | | | - John Y S Kim
- Department of Plastic and Reconstructive Surgery, Northwestern University, Chicago, Illinois
| | - Jeffrey H Kozlow
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, Michigan
| | - Bharat Mittal
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois
| | - Jeffrey Moyer
- Department of Otolaryngology, Plastic/Head/Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Thomas Olenecki
- Department of Internal Medicine, Ohio State University, Columbus, Ohio
| | - Phillip Rodgers
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
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Poirier E, Zumelzu C, Maubec E. Carcinome épidermoïde cutané : actualités sur la physiopathologie et les stratégies thérapeutiques. ONCOLOGIE 2018. [DOI: 10.3166/onco-2018-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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49
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Yang T, Wu Z, Wang P, Mu T, Qin H, Zhu Z, Wang J, Sui L. A large-inner-diameter multi-walled carbon nanotube-based dual-drug delivery system with pH-sensitive release properties. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:110. [PMID: 28589526 DOI: 10.1007/s10856-017-5920-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/16/2017] [Indexed: 06/07/2023]
Abstract
A novel dual-drug delivery system (DDDS) for cancer chemotherapy has been established by employing highly purified and mildly oxidized large-inner-diameter multi-walled carbon nanotubes (LID-MWCNTs) as the vector. The LID-MWCNTs were modified with the antitumor drugs, cisplatin (CDDP) and doxorubicin (DOX). CDDP was encapsulated inside the nanotube vectors by a wet-chemical approach while DOX was attached to the external surfaces through non-covalently interaction. The loading efficiencies of CDDP and DOX were as high as 84.56 and 192.67%, respectively. Notably, after CDDP was encapsulated inside the nanotubes, a three-level blocking strategy, which included polyethylene glycol, folic acid and DOX, was employed to block the CDDP exits at different levels. The pH-sensitive release profile of CDDP was demonstrated using a modified characterization method, as well as that of DOX. Finally, the anticancer activity of the DDDS on MCF-7 cells was tested and a synergistic effect was recorded. This work is part of our LID-MWCNTs based drug delivery system studies, and provides a basis for developing a novel comprehensive antitumor treatment that combines chemotherapy and photothermal therapy.
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Affiliation(s)
- Tao Yang
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, China No.14, 3rd Section of Ren Min Nan Rd., Chengdu, Sichuan, 610041, China
| | - Zhenzhen Wu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China No.14, 3rd Section of Ren Min Nan Rd., Chengdu, Sichuan, 610041, China
| | - Pingting Wang
- School of Stomatology, Tianjin Medical University, China No.12, Qixiangtai Rd. Heping District, Tianjin, 300070, China
| | - Tingting Mu
- School of Stomatology, Tianjin Medical University, China No.12, Qixiangtai Rd. Heping District, Tianjin, 300070, China
| | - Han Qin
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, China No.14, 3rd Section of Ren Min Nan Rd., Chengdu, Sichuan, 610041, China
| | - Zhimin Zhu
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, China No.14, 3rd Section of Ren Min Nan Rd., Chengdu, Sichuan, 610041, China
| | - Jian Wang
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, China No.14, 3rd Section of Ren Min Nan Rd., Chengdu, Sichuan, 610041, China
| | - Lei Sui
- School of Stomatology, Tianjin Medical University, China No.12, Qixiangtai Rd. Heping District, Tianjin, 300070, China.
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Campana LG, Marconato R, Valpione S, Galuppo S, Alaibac M, Rossi CR, Mocellin S. Basal cell carcinoma: 10-year experience with electrochemotherapy. J Transl Med 2017; 15:122. [PMID: 28569161 PMCID: PMC5452531 DOI: 10.1186/s12967-017-1225-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/27/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Electrochemotherapy (ECT), by combining manageable cytotoxic agents with short electric pulses, represents an effective palliative skin-directed therapy. The accumulated evidence indicates that ECT stands out as a safe and well-tolerated alternative treatment for patients with multiple or large basal cell carcinoma (BCC), who are not suitable for conventional treatments. However, long-term data and shared indications are lacking. METHODS In this observational study, we retrospectively analyzed 84 prospectively collected patients with multiple, recurrent or locally advanced BCC who were not candidate for standard therapies and received bleomycin-based ECT according to the European Standard Operative Procedures of ECT, from 2006 to 2016. RESULTS Disease extent was local, locally advanced and metastatic in 40 (48%), 41 (49%) and 3 (3%), respectively. Forty-four (52%) individuals had multiple BCCs. Grade 3 skin toxicity after ECT was observed in 6% of cases. Clearance rate was 50% (95% CI 39-61%). Primary presentation (p = 0.004), tumor size <3 cm (p < 0.001), well-defined borders (p = 0.021), absence of tumor ulceration (p = 0.001), non-aggressive BCC histology (p = 0.046) and age ≤69 years were associated with higher complete response rate. In patients with local BCC, the clearance rate was 72.5 and 85% after one or two ECT cycles, respectively. In the laBCC group, 32 patients (78%) achieved an objective response. Five-year recurrence rate for local and laBCC was 20 and 38%, respectively (p ≤ 0.001). CONCLUSIONS One or two ECT cycles with bleomycin may be a valuable palliative treatment in well-selected patients with multiple BCCs and favorable tumor features. Validation of predictive factors will be imperative to match patients with optimal ECT treatment modalities. Management of laBCC with ECT warrants further investigation. Trial registration ISRCTN14633165 Registered 24 March 2017 (retrospectively registered).
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Affiliation(s)
- Luca G Campana
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padua, Italy. .,Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128, Padua, Italy.
| | | | - Sara Valpione
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padua, Italy.,Christie NHS Foundation Trust, Manchester, M20 4BX, UK
| | - Sara Galuppo
- Radiotherapy Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Mauro Alaibac
- Dermatology Unit, University of Padova, Padua, Italy
| | - Carlo R Rossi
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padua, Italy.,Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128, Padua, Italy
| | - Simone Mocellin
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padua, Italy.,Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128, Padua, Italy
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