1
|
Hamdan D, Gardair C, Pamoukdjian F, Peraldi Gardin MN, Nakouri I, Leboeuf C, Janin A, Lebbé C, Battistella M, Bousquet G. A Sub-Group of Kidney-Transplant Recipients with Highly Aggressive Squamous Cell Carcinoma Expressing Phosphorylated Serine392p53. Int J Mol Sci 2024; 25:1147. [PMID: 38256221 PMCID: PMC10816400 DOI: 10.3390/ijms25021147] [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: 11/28/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Cutaneous squamous cell carcinomas in kidney-transplant recipients are frequent, with an increasing incidence linked to long immunosuppression durations and exposure to ultraviolet radiation. p53 is at the cornerstone of ultraviolet-induced DNA damage, but the role of p53 post-translational modifications in this context is not yet deciphered. Here, we investigated the phosphorylation status of p53 at Serine 392 in 25 cutaneous squamous cell carcinomas in kidney-transplant recipients, compared with 22 non-transplanted patients. Cutaneous squamous cell carcinomas in transplanted patients occurred after a median period of 19 years of immunosuppression, with a median number of 15 cutaneous squamous cell carcinomas and more aggressive histological and clinical characteristics. There was no significant difference between Ki67, p53, and pSer392p53 expression in the two groups. Using principal component analysis, we identified a cluster of exclusively transplanted patients with a median of 23 years of immunosuppression duration, significantly more aggressive biological characteristics, and higher pSer392p53 expression. pSer392p53 was expressed in the whole tumor, suggesting an early carcinogenic event in the course of prolonged immunosuppression. This high, diffuse pSer392p53 expression, corresponding to a high level of DNA damage, might be useful to identify aggressive cutaneous squamous cell carcinomas in kidney-transplant recipients to treat them more aggressively.
Collapse
Affiliation(s)
- Diaddin Hamdan
- Faculté de Santé, Site Lariboisière, Institut National de la Santé et de la Recherche Médicale INSERM, Unité Mixte de Recherche UMR_S942 MASCOT, Université Paris-Cité, F-75006 Paris, France
- Medical Oncology Department, Hôpital La Porte Verte, F-78000 Versailles, France
| | - Charlotte Gardair
- Faculté de Santé, Site Lariboisière, Institut National de la Santé et de la Recherche Médicale INSERM, Unité Mixte de Recherche UMR_S942 MASCOT, Université Paris-Cité, F-75006 Paris, France
| | - Frédéric Pamoukdjian
- Faculté de Santé, Site Lariboisière, Institut National de la Santé et de la Recherche Médicale INSERM, Unité Mixte de Recherche UMR_S942 MASCOT, Université Paris-Cité, F-75006 Paris, France
- UFR Santé Médecine et Biologie Humaine, Campus Bobigny, Université Sorbonne Paris Nord, F-93439 Villetaneuse, France
- Geriatric Medicine Department, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, F-93000 Bobigny, France
| | - Marie-Noëlle Peraldi Gardin
- Nephrology-Renal Transplantation Department, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, F-75015 Paris, France
| | - Inès Nakouri
- Faculté de Santé, Assistance Publique-Hôpitaux de Paris Dermato-Oncology, Cancer Institute APHP. Nord Paris Cité, Institut National de la Santé et de la Recherche Médicale INSERM Unité U976, Saint Louis Hospital, Université Paris-Cite, F-75010 Paris, France
| | - Christophe Leboeuf
- Faculté de Santé, Site Lariboisière, Institut National de la Santé et de la Recherche Médicale INSERM, Unité Mixte de Recherche UMR_S942 MASCOT, Université Paris-Cité, F-75006 Paris, France
| | - Anne Janin
- Faculté de Santé, Site Lariboisière, Institut National de la Santé et de la Recherche Médicale INSERM, Unité Mixte de Recherche UMR_S942 MASCOT, Université Paris-Cité, F-75006 Paris, France
| | - Céleste Lebbé
- Faculté de Santé, Assistance Publique-Hôpitaux de Paris Dermato-Oncology, Cancer Institute APHP. Nord Paris Cité, Institut National de la Santé et de la Recherche Médicale INSERM Unité U976, Saint Louis Hospital, Université Paris-Cite, F-75010 Paris, France
| | - Maxime Battistella
- Department of Pathology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Faculté de Santé, Cancer Institute APHP. Nord Paris Cité, Institut National de la Santé et de la Recherche Médicale INSERM Unité U976, Université Paris-Cite, F-75010 Paris, France
| | - Guilhem Bousquet
- Faculté de Santé, Site Lariboisière, Institut National de la Santé et de la Recherche Médicale INSERM, Unité Mixte de Recherche UMR_S942 MASCOT, Université Paris-Cité, F-75006 Paris, France
- UFR Santé Médecine et Biologie Humaine, Campus Bobigny, Université Sorbonne Paris Nord, F-93439 Villetaneuse, France
- Medical Oncology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, F-93000 Bobigny, France
| |
Collapse
|
2
|
Pham JP, Rodrigues A, Goldinger SM, Sim HW, Liu J. Epidermal growth factor receptor inhibitors in advanced cutaneous squamous cell carcinoma: A systematic review and meta-analysis. Exp Dermatol 2024; 33:e14978. [PMID: 37971204 DOI: 10.1111/exd.14978] [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: 06/13/2023] [Revised: 10/01/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023]
Abstract
Patients with advanced cutaneous squamous cell carcinoma (cSCC) who are not eligible for or who fail to respond to anti-PD1 immunotherapy have few treatment options. Epidermal growth factor receptor (EGFR) inhibitors have been investigated as a therapeutic option for advanced cSCC; however, data are limited to small single-arm trials or retrospective studies. A systematic review and meta-analysis was conducted to PRISMA guidelines (CRD42023394300). Studies reporting on outcomes of EGFR inhibition in advanced cSCC were identified. Objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and adverse event (AE) rate were pooled using a random effects model and the inverse variance method. Twelve studies (six prospective, six retrospective) were identified, representing 324 patients. Pooled ORR was 26% (95% confidence interval [CI] 18-36), median PFS was 4.8 months (95% CI 3.9-6.6) and median OS was 11.7 months (95% CI 9.2-14.1). Any grade AEs occurred in 93% of patients (95% CI 85-97) while grade 3 and higher AEs occurred in 30% (95% CI 14-54). These results were similar between anti-EGFR monoclonal antibodies (MAbs) and tyrosine kinase inhibitors (TKIs). EGFR inhibitors can be considered in patients with advanced cSCC who are contraindicated for or progress on first-line anti-PD1 immunotherapy. Future studies should evaluate their activity and safety following anti-PD1, identify predictive biomarkers for their efficacy and explore combination approaches.
Collapse
Affiliation(s)
- James P Pham
- Department of Medical Oncology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Clinical Campus, Darlinghurst, New South Wales, Australia
| | - Anthony Rodrigues
- Department of Medical Oncology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Clinical Campus, Darlinghurst, New South Wales, Australia
| | - Simone M Goldinger
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Hao-Wen Sim
- Department of Medical Oncology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Clinical Campus, Darlinghurst, New South Wales, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Jia Liu
- Department of Medical Oncology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Clinical Campus, Darlinghurst, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Soria Rivas A, Bea-Ardebol S, Vida Navas E, Muñoz-Arrones ÓM, Cabañas-Montero LJ, Mena-Mateos A, López-Campos F, Corral Moreno S, Pérez-Muñoz I, González Lizan F, Sanz Pascual M, Serrano Domingo JJ. Treatment of metastatic squamous cell carcinoma arising in sacrococcygeal pilonidal sinus: a case report series. Front Med (Lausanne) 2023; 10:1248894. [PMID: 37780565 PMCID: PMC10534040 DOI: 10.3389/fmed.2023.1248894] [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: 06/27/2023] [Accepted: 08/14/2023] [Indexed: 10/03/2023] Open
Abstract
Background Squamous cell carcinoma (SCC) arising in a sacrococcygeal pilonidal sinus is rare, with cases of metastatic disease being even rarer. Among published cases, almost none have reported on systemic treatment. Objective This disease has a poorer prognosis than other forms of cutaneous SCC; therefore, our objective is to shed some light on the treatment of metastatic disease. Methods We present a series of nine cases treated at a single center, four of whom received systemic treatment. Additionally, other previously reported cases of metastatic disease are included in an attempt to draw stronger conclusions. Results Four patients were treated under several treatment regimens, with a median progression-free survival of only 2 months and two instances of partial response (18%). The best result was achieved with cemiplimab. Across all the cases, there was a trend toward a benefit of the use of systemic treatment (HR 0.41, 95% CI 0.15-1.12, p = 0.083; median overall survival 13 vs. 8 months). Limitations Limitations include the significant lack of information on previously published cases and the extremely heterogeneous nature of the existing information. Conclusion The initial systemic treatment should be an anti-PD-1, as with other SCCs. After progression on anti-PD-1, there is no strong evidence to support the recommendation of a specific treatment or sequence: options include cetuximab and/or chemotherapy (platinum, paclitaxel, 5-fluorouracyl).
Collapse
Affiliation(s)
- Ainara Soria Rivas
- Medical Oncology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Sonia Bea-Ardebol
- Dermatology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Elena Vida Navas
- Medical Oncology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | | | | | | | | | | | - Israel Pérez-Muñoz
- Orthopedics and Orthopedic Surgery Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Fausto González Lizan
- Orthopedics and Orthopedic Surgery Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - María Sanz Pascual
- Orthopedics and Orthopedic Surgery Department, Ramon y Cajal University Hospital, Madrid, Spain
| | | |
Collapse
|
5
|
Ferrándiz-Pulido C, Leiter U, Harwood C, Proby CM, Guthoff M, Scheel CH, Westhoff TH, Bouwes Bavinck JN, Meyer T, Nägeli MC, Del Marmol V, Lebbé C, Geusau A. Immune Checkpoint Inhibitors in Solid Organ Transplant Recipients With Advanced Skin Cancers-Emerging Strategies for Clinical Management. Transplantation 2023; 107:1452-1462. [PMID: 36706163 DOI: 10.1097/tp.0000000000004459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Use of immune checkpoint inhibitors (ICIs) in solid organ transplant recipients (SOTRs) with advanced skin cancers presents a significant clinical management dilemma. SOTRs and other immunosuppressed patients have been routinely excluded from ICI clinical trials with good reason: immune checkpoints play an important role in self- and allograft-tolerance and risk of acute allograft rejection reported in retrospective studies affects 10% to 65% of cases. These reports also confirm that cutaneous squamous cell carcinoma and melanoma respond to ICI therapy, although response rates are generally lower than those observed in immunocompetent populations. Prospective trials are now of critical importance in further establishing ICI efficacy and safety. However, based on current knowledge, we recommend that ICIs should be offered to kidney transplant recipients with advanced cutaneous squamous cell carcinoma, melanoma, or Merkel cell carcinoma if surgery and/or radiotherapy have failed. For kidney transplant recipients, this should be first line ahead of chemotherapy and targeted therapies. In SOTRs, the use of ICIs should be carefully considered with the benefits of ICIs versus risks of allograft rejection weighed up on a case-by-case basis as part of shared decision-making with patients. In all cases, parallel management of immunosuppression may be key to ICI responsiveness. We recommend maintaining immunosuppression before ICI initiation with a dual immunosuppressive regimen combining mammalian target of rapamycin inhibitors and either corticosteroids or calcineurin inhibitors. Such modification of immunosuppression must be considered in the context of allograft risk (both rejection and also its subsequent treatment) and risk of tumor progression. Ultimately, a multidisciplinary approach should underpin all clinical decision-making in this challenging scenario.
Collapse
Affiliation(s)
- Carla Ferrándiz-Pulido
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ulrike Leiter
- Department of Dermatology, Eberhard-Karls University of Tuebingen, Tuebingen, Germany
| | - Catherine 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, United Kingdom
| | - Charlotte M Proby
- Department of Dermatology, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Martina Guthoff
- Department of Diabetology, Endocrinology, Nephrology, Section of Nephrology and Hypertension, Eberhard-Karls-University, Tuebingen, Germany
| | - Christina H Scheel
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Timm H Westhoff
- Medical Department I, University Hospital Marien Hospital Herne, Ruhr-University Bochum, Bochum, Germany
| | | | - Thomas Meyer
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Mirjam C Nägeli
- Department of Dermatology, University Hospital of Zurich, Switzerland
| | - Veronique Del Marmol
- Service de Dermatologie, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Celeste Lebbé
- Dermato-Oncology Department, Université Paris Cite, AP-HP Hôpital Saint Louis, Cancer Institute APHP. Nord-Université Paris CiteINSERM U976, HIPI, Paris, France
| | - Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
6
|
Petzold A, Steeb T, Wessely A, Schatton T, Berking C, Heppt MV. Comparative efficacy analysis identifies immune checkpoint blockade as a new survival benchmark in advanced cutaneous squamous cell carcinoma. Eur J Cancer 2022; 170:42-53. [PMID: 35594611 DOI: 10.1016/j.ejca.2022.03.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/01/2022] [Accepted: 03/28/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma is a common type of skin cancer that may progress to locally advanced or metastatic disease. Both disease stages are managed by a variety of treatment options, including immune checkpoint blockade (ICB), targeted therapy to epidermal growth factor, chemotherapy or treatment combinations. However, the comparative efficacy of such treatments is unclear. METHODS We performed a systematic literature search of Medline, Embase and Central to identify eligible studies reporting Kaplan-Meier curves or individual patient data for overall survival (OS) or progression-free survival (PFS). Kaplan-Meier curves were digitised using the "'WebPlotDigitizer" program. Individual patient data was subsequently remodelled and pooled for distinct treatment groups. RESULTS Overall, 22 independent studies were included of which n = 927 patients were evaluable for PFS and n = 1054 for OS. ICB showed the highest median PFS (mPFS 9.9 months (95% CI: 8.1-19.9)) and median OS (mOS not reached (95% CI: 31.5 months-not reached)) compared to chemotherapy (mPFS 3.0 months (95% CI: 2.2-4.8), mOS 12.6 months (95% CI: 9.6-15.8)), targeted therapy to epidermal growth factor (mPFS 4.9 months (95% CI: 4.4-5.6), mOS 12.7 months (95% CI: 11.9-14.9)) and combination therapies without ICB (mPFS 9.1 months (95% CI: 8.0-12.1), mOS 18.1 months (95% CI: 16.3-22.8)). The survival benchmark with ICB after 26 months for metastatic squamous cell carcinoma was 70.8% (95% CI: 61.5%-81.5%) versus 37.9% (95% CI: 29.5%-48.8%) for the combination group and 17.1% (95% CI: 9.5%-30.8%) for chemotherapy. CONCLUSION ICB is superior to other systemic treatments and sets a novel survival benchmark for advanced cutaneous squamous cell carcinoma.
Collapse
Affiliation(s)
- Anne Petzold
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN) and Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Theresa Steeb
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN) and Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Anja Wessely
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN) and Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Tobias Schatton
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carola Berking
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN) and Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Markus V Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN) and Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany; Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
7
|
Abstract
We present the update of the recommendations of the French society of oncological radiotherapy on radiotherapy of cutaneous cancers. The indications of radiotherapy for skin cancers are not clearly defined because of the lack of randomized trials or prospective studies. For basal cell carcinomas, radiotherapy frequently offers a good local control, but a randomized trial showed that surgery is more efficient and less toxic. Indications of radiotherapy are contra-indications of surgery for patients older than 60, non-sclerodermiform histology and located in non-sensitive areas. Adjuvant radiotherapy could be proposed to squamous cell carcinomas, in case of poor prognostic factors. Dose of 60 to 70Gy are usually required, and must be modulated to the size of the lesions. Adjuvant radiotherapy seems beneficial for desmoplastic melanomas but not for the other histological types. Prophylactic nodal irradiation (45 to 50Gy), for locally advanced tumors (massive nodal involvement), decreases the locoregional failure rate but do not increase survival. Adjuvant radio- therapy (50 to 56Gy) for Merkel cell carcinomas increases also the local control rate, as demonstrated by meta-analysis and a large epidemiological study. Nodal areas must be included, if there is no surgical exploration (sentinel lymph node dissection). Kaposi sarcomas are radiosensitive and could be treated with relatively low doses (24 to 30Gy). Also, cutaneous lymphomas are good indications for radiotherapy: B lymphomas are electively treated with limited fields. The role of total skin electron therapy for T-lymphomas is still discussed; but palliative radiotherapy is very efficient in case of cutaneous nodules.
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Non-Surgical Treatments for Keratinocyte Carcinomas. Adv Ther 2021; 38:5635-5648. [PMID: 34652721 DOI: 10.1007/s12325-021-01916-2] [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] [Received: 08/06/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
Skin cancer is the most common malignancy worldwide, comprising approximately 30% of all human tumors. In recent decades, the incidence of keratinocyte carcinomas, which include basal cell carcinoma and cutaneous squamous cell carcinoma, has been steadily increasing globally (Rogers et al. in JAMA Dermatol 151(10):1081-1086. https://doi.org/10.1001/jamadermatol.2015.1187 , 2015; Nehal and Bichakjian in N Engl J Med 379(4):363-374. https://doi.org/10.1056/nejmra1708701 , 2018). Most tumors are cured with surgical excision; however, some tumors are best treated with non-surgical approaches. Superficial tumors can often be cured with non-surgical methods whereas more advanced stage tumors may not be amenable to surgery. Additionally, surgical treatment may not be available for all populations depending on geographic location and accessibility to care. This article reviews commonly utilized nonsurgical options such as cryotherapy, photodynamic therapy, topical treatments, and radiation as well as systemic treatments including immunotherapies and chemotherapies.
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Ansai SI, Umebayashi Y, Katsumata N, Kato H, Kadono T, Takai T, Namiki T, Nakagawa M, Soejima T, Koga H, Sugaya M. Japanese Dermatological Association Guidelines: Outlines of Guidelines for Cutaneous Squamous Cell Carcinoma 2020. J Dermatol 2021; 48:e288-e311. [PMID: 33963604 DOI: 10.1111/1346-8138.15889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 01/04/2023]
Abstract
In consideration of the development of treatment options for squamous cell carcinoma (SCC), the Japanese Skin Cancer Society issued the first guidelines of SCC in 2007 and revised them in 2015. Here, we report the English version of the 2020 edition of the Japanese SCC guidelines. The first half of this article is an overview of SCC including actinic keratosis and Bowen's disease, and the second half discusses three clinical questions: (i) treatment of actinic keratosis; (ii) determination of the resection margin of the primary lesion; and (iii) treatment of radically incurable cases, as contemporary problems encountered in treating SCC. In these evaluations, all processes were implemented according to the Grading of Recommendations, Assessment, Development, Evaluation system. Also, items of recommendation concerning each clinical question were determined by a multidisciplinary expert panel consisting of dermatologists, plastic/reconstructive surgeons, radiologists, and oncologists through a comprehensive literature search and systematic reviews.
Collapse
Affiliation(s)
- Shin-Ichi Ansai
- Division of Dermatology and Dermatopathology, Nippon Medical School Musashi Kosugi-Hospital, Kawasaki, Japan
| | - Yoshihiro Umebayashi
- Department of Dermatology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Noriyuki Katsumata
- Department of Medical Oncology, Nippon Medical School Musashi Kosugi-Hospital, Kawasaki, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takafumi Kadono
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toshihiro Takai
- Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
| | - Takeshi Namiki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Nakagawa
- Department of Plastic and Reconstructive Surgery, Shizuoka Prefectural Cancer Center, Nagaizumi, Japan
| | | | - Hiroshi Koga
- Department of Dermatology, Shinshu University, Matsumoto, Japan
| | - Makoto Sugaya
- Department of Dermatology, International University of Health and Welfare, Narita, Japan
| | | |
Collapse
|
12
|
Zelin E, Zalaudek I, Agozzino M, Dianzani C, Dri A, Di Meo N, Giuffrida R, Marangi GF, Neagu N, Persichetti P, Toffoli L, Conforti C. Neoadjuvant Therapy for Non-melanoma Skin Cancer: Updated Therapeutic Approaches for Basal, Squamous, and Merkel Cell Carcinoma. Curr Treat Options Oncol 2021; 22:35. [PMID: 33725197 PMCID: PMC7966643 DOI: 10.1007/s11864-021-00826-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/17/2022]
Abstract
OPINION STATEMENT Recently introduced systemic therapies for locally advanced and metastatic non-melanoma skin cancers (NMSCs) are paving the way for neoadjuvant approach. Although none of the therapeutic options has currently gained indication in this setting, neoadjuvant approach for NMSCs is an open field and we are likely to see huge developments in the near future. Targeted therapy with sonic hedgehog pathway inhibitors is very effective in locally advanced or multiple basal cell carcinomas while immunotherapy with immune checkpoint inhibitors appears to be promising for advanced cutaneous squamous cell carcinoma and Merkel cell carcinoma. To date, targeted therapy and immunotherapy represent the frontiers in NMSC therapeutic management and, according to recent studies, good results can be achieved.
Collapse
Affiliation(s)
- Enrico Zelin
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy.
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Marina Agozzino
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Caterina Dianzani
- Plastic and Reconstructive Surgery Department, Campus Biomedico University, Rome, Italy
| | - Arianna Dri
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Nicola Di Meo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology Section, University of Messina, Messina, Italy
| | | | - Nicoleta Neagu
- Dermatology Clinic, Mures Country Hospital, Tirgu Mures, Romania
| | - Paolo Persichetti
- Plastic and Reconstructive Surgery Department, Campus Biomedico University, Rome, Italy
| | - Ludovica Toffoli
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Claudio Conforti
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| |
Collapse
|
13
|
Bourhis J, Stein A, Paul de Boer J, Van Den Eynde M, Gold KA, Stintzing S, Becker JC, Moran M, Schroeder A, Pennock G, Salmio S, Esser R, Ciardiello F. Avelumab and cetuximab as a therapeutic combination: An overview of scientific rationale and current clinical trials in cancer. Cancer Treat Rev 2021; 97:102172. [PMID: 33989949 DOI: 10.1016/j.ctrv.2021.102172] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 01/09/2023]
Abstract
Treatment outcomes have improved with the advent of immune checkpoint inhibitors and small molecule inhibitors. However, many patients do not respond with single agents. Consequently, ongoing research is focused on the use of combination therapies to increase clinical efficacy by potential synergistic effects. Here, we outline ongoing trials and review the rationale and evidence for the combination of avelumab, an anti-programmed death ligand 1 (PD-L1) immunoglobulin G1 (IgG1) monoclonal antibody (mAb), with cetuximab, an anti-epidermal growth factor receptor (EGFR) IgG1 mAb. Avelumab is approved as a monotherapy for the treatment of Merkel cell carcinoma and urothelial carcinoma, and in combination with axitinib for renal cell carcinoma; cetuximab is approved in combination with chemotherapy for the treatment of squamous cell carcinoma of the head and neck (SCCHN) and RAS wild-type metastatic colorectal cancer, and in combination with radiation therapy for SCCHN. Avelumab binds to PD-L1 expressed on tumor cells and immune regulatory cells, thus blocking its interaction with programmed death 1 and reventing T-cell suppression; cetuximab inhibits the EGFR signaling pathway, inhibiting proliferation and inducing apoptosis. Both therapies have complementary mechanisms of action and may also activate the immune system to induce innate effector function through the binding of their Fc regions to natural killer (NK) cells. Furthermore, cetuximab combined with chemotherapy has been shown to induce immunogenic cell death and leads to an increase in tumor-infiltrating CD8+ T and NK cells, which should synergize with the immunostimulatory effects of avelumab. Prospective studies will investigate this combination and inform future treatment strategies.
Collapse
Affiliation(s)
- Jean Bourhis
- Centre Hospitalier Universitaire Vaudois, Service de Radio-oncologie, Lausanne, Switzerland.
| | - Alexander Stein
- Hematology-Oncology Practice Hamburg (HOPE), University Cancer Center Hamburg, Hamburg, Germany
| | - Jan Paul de Boer
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marc Van Den Eynde
- Cliniques universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, Brussels, Belgium
| | - Kathryn A Gold
- Department of Medicine, Division of Hematology-Oncology, University of California, San Diego, La Jolla, CA, USA
| | - Sebastian Stintzing
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen C Becker
- Department of Translational Skin Cancer Research, German Cancer Consortium (DKTK), Essen University Hospital, Essen, Germany, and German Cancer Research Institute (DKFZ), Heidelberg, Germany
| | | | | | - Gregory Pennock
- EMD Serono Research & Development Institute, Inc., Billerica, MA, USA(2)
| | | | | | - Fortunato Ciardiello
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| |
Collapse
|
14
|
Ritter A, Badir S, Mansour M, Segal Z, Ad-El D, Bachar G, Shpitzer T, Popovtzer A, Mizrachi A. Solid organ transplantation worsens the prognosis of patients with cutaneous squamous cell carcinoma of the head and neck region-Comparison between solid organ transplant recipients and immunocompetent patients. Head Neck 2020; 43:884-894. [PMID: 33247523 DOI: 10.1002/hed.26546] [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] [Received: 06/21/2020] [Revised: 10/25/2020] [Accepted: 11/09/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cutaneous squamous cell carcinoma of the head and neck (CSCC-HN) appears to behave more aggressively in immunosuppressed patients. We aimed to investigate this hypothesis by comparing solid organ transplant recipients (SOTR) with CSCC-HN to immunocompetent patients. METHODS A retrospective comparative study was conducted for SOTR and immunocompetent patients who were treated for CSCC-HN. RESULTS A total of 177 SOTR and 157 immunocompetent patients with CSCC-HN were included. Lymph node metastases were more common in the SOTR group (9% vs 3%), and distant metastases occurred only in SOTR (3% of patients). SOTR had a higher rate of recurrences (19% vs 10%), which were mostly regional (7%) and distant (3%). The 2-year disease-specific survival of SOTR was lower (93% vs 100%). CONCLUSIONS SOTR with CSCC-HN has significantly worse outcomes compared to immunocompetent patients. Solid-organ transplantation should be regarded as a negative prognostic factor in patients with CSCC-HN.
Collapse
Affiliation(s)
- Amit Ritter
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samih Badir
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Muhammad Mansour
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Plastic Surgery and Burns, Rabin Medical Center, Petah Tikva, Israel
| | - Zvi Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Plastic Surgery and Burns, Rabin Medical Center, Petah Tikva, Israel
| | - Dean Ad-El
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Plastic Surgery and Burns, Rabin Medical Center, Petah Tikva, Israel
| | - Gideon Bachar
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Thomas Shpitzer
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aron Popovtzer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Aviram Mizrachi
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
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.
Collapse
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
| | | |
Collapse
|
17
|
Hourbeigt K, Ehret M, Visseaux L, Durlach A, Petit A, Sanchez J, Grange‐Prunier A, Barbe C, Servagi‐Vernat S, Grange F. Efficacy and safety of panitumumab alone or in association with radiotherapy in unresectable cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol 2020; 34:2789-2794. [DOI: 10.1111/jdv.16465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/27/2020] [Indexed: 12/27/2022]
Affiliation(s)
- K. Hourbeigt
- Department of Oncodermatology Reims University Hospital Reims France
| | - M. Ehret
- Department of Oncodermatology Reims University Hospital Reims France
| | - L. Visseaux
- Department of Oncodermatology Reims University Hospital Reims France
| | - A. Durlach
- Department of Biopathology Reims University Hospital Reims France
| | - A. Petit
- Department of Oncodermatology Reims University Hospital Reims France
| | - J. Sanchez
- Department of Oncodermatology Reims University Hospital Reims France
| | - A. Grange‐Prunier
- Department of Oncodermatology Reims University Hospital Reims France
| | - C. Barbe
- Methodological Support Unit Reims University Hospital Reims France
| | | | - F. Grange
- Department of Oncodermatology Reims University Hospital Reims France
| |
Collapse
|
18
|
Deciphering the Molecular Landscape of Cutaneous Squamous Cell Carcinoma for Better Diagnosis and Treatment. J Clin Med 2020; 9:jcm9072228. [PMID: 32674318 PMCID: PMC7408826 DOI: 10.3390/jcm9072228] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is a common type of neoplasia, representing a terrible burden on patients' life and clinical management. Although it seldom metastasizes, and most cases can be effectively treated with surgical intervention, once metastatic cSCC displays considerable aggressiveness leading to the death of affected individuals. No consensus has been reached as to which features better characterize the aggressive behavior of cSCC, an achievement hindered by the high mutational burden caused by chronic ultraviolet light exposure. Even though some subtypes have been recognized as high risk variants, depending on certain tumor features, cSCC that are normally thought of as low risk could pose an increased danger to the patients. In light of this, specific genetic and epigenetic markers for cutaneous SCC, which could serve as reliable diagnostic markers and possible targets for novel treatment development, have been searched for. This review aims to give an overview of the mutational landscape of cSCC, pointing out established biomarkers, as well as novel candidates, and future possible molecular therapies for cSCC.
Collapse
|
19
|
Girbardt C, Mößner A, Wiedemann P, Grunewald S. Therapiealternativen zur chirurgischen Versorgung maligner Lidtumoren und deren Vorläuferstufen. Ophthalmologe 2020; 117:478-483. [DOI: 10.1007/s00347-020-01072-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
20
|
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.
Collapse
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
| | | | | | | |
Collapse
|
21
|
de Lima PO, Joseph S, Panizza B, Simpson F. Epidermal Growth Factor Receptor's Function in Cutaneous Squamous Cell Carcinoma and Its Role as a Therapeutic Target in the Age of Immunotherapies. Curr Treat Options Oncol 2020; 21:9. [PMID: 32016630 DOI: 10.1007/s11864-019-0697-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OPINION STATEMENT Recent studies have evidenced the potential of combining anti-EGFR therapies with anti-PD-1/PD-L1 checkpoint therapies. Both anti-EGFR and anti-PD-1/PD-L1 have been separately tested in the treatment of cutaneous SCC (cSCC). Here, we review recent data on EGFR in the context of cancer progression, as a prognostic and as a therapeutic target in cSCC. Anti-EGFR/checkpoint immunotherapy and other combination therapy approaches are discussed. With the advent of immunotherapy, EGFR is still a valid cSCC target.
Collapse
Affiliation(s)
- Priscila Oliveira de Lima
- The University of Queensland Diamantina Institute, University of Queensland, Woolloongabba, Queensland, Australia
| | - Shannon Joseph
- The University of Queensland Diamantina Institute, University of Queensland, Woolloongabba, Queensland, Australia
| | - Benedict Panizza
- Faculty of Medicine, University of Queensland, Woolloongabba, Queensland, Australia.,Otolaryngology-Head and Neck Surgery Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Fiona Simpson
- The University of Queensland Diamantina Institute, University of Queensland, Woolloongabba, Queensland, Australia.
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
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.
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
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]
|
26
|
Joseph K, Alkaabi K, Warkentin H, Ghosh S, Jha N, Smylie M, Walker J. Cetuximab-radiotherapy combination in the management of locally advanced cutaneous squamous cell carcinoma. J Med Imaging Radiat Oncol 2018; 63:257-263. [PMID: 30549229 DOI: 10.1111/1754-9485.12842] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/18/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION We report the outcomes of using a combination of cetuximab with radiation therapy (Cetux-RT) to treat a selected group of patients with locally advanced (unresectable) cutaneous squamous cell carcinoma (LA-cSCC). This study presents two-year efficacy and safety data for 8 patients with LA-cSCC treated within a single institution. METHODS Between 2014 and 2017 a total of eight patients (seven males, one female) with LA-cSCC received curative intent treatment with Cetux-RT. All patients received an initial loading dose of cetuximab at 400 mg/m2 seven days prior to radiotherapy, followed by weekly treatment with 250 mg/m2 , continuing through the end of radiotherapy. Radiation doses were 6600 cGy/30 fr (n = 2), 6300 cGy/30fr (n = 2) and 5500 cGy/22 fr (n = 4). RESULTS The median age was 81 years (range, 55-87). The ECOG performance status of all patients was between 0 and 2. With a median duration of follow-up of 25 months (range 10-48 months), five patients remain in a complete response. After a partial response, another patient has relapsed and is receiving palliative chemotherapy, while two patients have died during the period of follow up (one of whom died following progression of disease, the other of an unrelated cause). Treatment in this group of patients was well tolerated, with most toxicities ≤ grade 2, and no toxicities of grade 4/5 reported. CONCLUSIONS Cetux-RT was well tolerated and provided durable disease control within this patient sample. Our data support the use of the Cetux-RT regimen for selected patients with inoperable LA-cSCC and adequate performance status.
Collapse
Affiliation(s)
- Kurian Joseph
- Division of Radiation Oncology, Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Khalifa Alkaabi
- Division of Radiation Oncology, Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Heather Warkentin
- Division of Medical Physics, Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Sunita Ghosh
- Division of Medical Oncology, Department of Oncology, University of Alberta, and Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Naresh Jha
- Division of Radiation Oncology, Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Michael Smylie
- Division of Medical Oncology, Department of Oncology, University of Alberta, and Cross Cancer Institute, Edmonton, Alberta, Canada
| | - John Walker
- Division of Medical Oncology, Department of Oncology, University of Alberta, and Cross Cancer Institute, Edmonton, Alberta, Canada
| |
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Tchernev G, Lotti T, Lozev I, Maximov GK, Wollina U. Peri - and Intraocular Mutilating Advanced Squamous Cell Carcinoma: "Monsters Inside Your Body"? Open Access Maced J Med Sci 2018; 6:132-133. [PMID: 29484009 PMCID: PMC5816283 DOI: 10.3889/oamjms.2018.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 11/24/2022] Open
Abstract
Periocular malignancies represent between 5% and 10% of all types of skin cancers. The incidence of eyelid (but also the periocular located) malignancies seems to differ in distribution across the continents. The incidence of eyelid tumours (but also the periocular located tumours) in a predominantly white population determined that BCC is the most common malignant periocular eyelid tumour in whites. This finding has been replicated consistently throughout the literature, with BCC representing 85–95% of all eyelid malignancies, SCC representing 3.4 - 12.6%, Seb Ca representing 0.6 - 10.2%, and both melanoma and Merkel cell carcinoma representing less than 1%. Most periocular skin cancers are associated with ultraviolet radiation (UVR) exposure. Ultraviolet radiation causes local immune suppression, which, coupled with DNA abnormalities in tumour suppressor genes and oncogenes, leads to the development of skin cancers. We are presenting a 62 - year - old patient with a small nodule about 2 cm away from the lower lid of his left eye. A tumour was surgically treated. Several years later there was a tumour relapse, treated with radiotherapy and subsequent chemotherapy with Endoxan and Cisplatin. After the second relapse, he was treated surgically in general anaesthesia by orbital exenteration, removal of the orbital floor and resection of zygomatic bone and the maxillary sinus. A couple of months later, he developed a tumour relapse in the scars and the area of a primary tumour with tumour progression. A possible therapy with Cetuximab or radiation therapy was discussed as a possible treatment option.
Collapse
Affiliation(s)
- Georgi Tchernev
- Medical Institute of Ministry of Interior Department of General, Vascular and Abdominal Surgery, Sofia, Bulgaria.,"Onkoderma"- Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - Torello Lotti
- University G. Marconi of Rome - Dermatology and Venereology, Rome, Italy
| | - Ilia Lozev
- Medical Institute of Ministry of Interior Department of General, Vascular and Abdominal Surgery, Sofia, Bulgaria
| | | | - Uwe Wollina
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| |
Collapse
|
29
|
Mittal A, Colegio OR. Skin Cancers in Organ Transplant Recipients. Am J Transplant 2017; 17:2509-2530. [PMID: 28556451 DOI: 10.1111/ajt.14382] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 05/05/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023]
Abstract
Long-term utilization of immunosuppression in organ transplant recipients (OTRs) leads to decreased immune-mediated tumor surveillance and development of malignant tumors. A delicate balance needs to be maintained in the intensity of immunosuppression to keep the risk of malignancy low without jeopardizing life-saving graft function. OTRs are prone to developing skin cancers that exhibit unique epidemiologic, pathophysiologic, and prognostic characteristics. In this review, we discuss the most commonly reported skin cancers in OTRs: squamous cell carcinoma (SCC), basal cell carcinoma (BCC), Kaposi sarcoma, Merkel cell carcinoma, and malignant melanoma (MM). Tumors in this high-risk population are aggressive and may respond poorly to standard therapies; however, new targeted therapies are promising. Checkpoint inhibitor antibodies have been used for treatment of cutaneous SCC, Merkel cell carcinoma, and MM; epidermal growth factor receptor inhibitors have been used for cutaneous SCC; hedgehog pathway inhibitors have been used for BCC; and BRAF and MEK inhibitors are being used increasingly in the management of MM. Guidelines for dermatologic screening are variable and primarily based on expert opinion. Prospective evidence-based trials by multidisciplinary groups are needed to better define surveillance schedules for pre- and posttransplant cutaneous malignancies.
Collapse
Affiliation(s)
- A Mittal
- Departments of Dermatology, Yale University School of Medicine, New Haven, CT
| | - O R Colegio
- Departments of Dermatology, Yale University School of Medicine, New Haven, CT.,Departments of Pathology, Yale University School of Medicine, New Haven, CT.,Departments of Surgery, Yale University School of Medicine, New Haven, CT.,Yale Cancer Center, Yale University School of Medicine, New Haven, CT.,Yale-New Haven Transplantation Center, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
30
|
Abstract
PURPOSE OF REVIEW There are few randomized controlled studies to guide the treatment of advanced cutaneous squamous cell carcinoma. The existing treatments are mostly based on case reports and small case series. Here we review recently available insights concerning the treatment of locally advanced and metastatic squamous cell carcinoma, with a special emphasis on novel targeted therapy and immunotherapy. RECENT FINDINGS Surgery and combination of chemotherapy and radiation therapy have been long considered the gold standard options for advanced squamous cell carcinoma. The detection of clinically relevant driver mutations has opened the door to the use of novel targeted therapies. Recent studies have shown that aggressive cutaneous squamous cell carcinoma is characterized by a very high mutational background. Furthermore, the importance of the defective immunosurveillance in the growth of cutaneous squamous cell carcinoma and the critical role of programed cell death protein 1 and programmed death-ligand 1 interaction in skin tumor development provides a rationale for the use of immune checkpoint inhibitors. SUMMARY Epidermal growth factor receptor inhibitors have shown to have satisfactory antitumor activity with acceptable side-effect profile. However, their place in management of advanced cutaneous squamous cell carcinoma alone or in combination with either radiation therapy and/or chemotherapy needs to be better characterized. The available preliminary findings suggest that immune checkpoint inhibitors represent a potentially valuable alternative in cutaneous aggressive squamous cell carcinoma, promising a further expansion of their indication spectrum. Randomized controlled studies will allow us to better characterize their practical value.
Collapse
|
31
|
Dereure O, Missan H, Girard C, Costes V, Guillot B. Efficacy and Tolerance of Cetuximab Alone or Combined with Chemotherapy in Locally Advanced or Metastatic Cutaneous Squamous Cell Carcinoma: An Open Study of 14 Patients. Dermatology 2017; 232:721-730. [DOI: 10.1159/000461578] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/31/2017] [Indexed: 12/18/2022] Open
|
32
|
Strom TJ, Caudell JJ, Harrison LB. Management of BCC and SCC of the Head and Neck. Cancer Control 2016; 23:220-7. [DOI: 10.1177/107327481602300305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background For decades radiotherapy (RT) has been shown to treat skin cancers; however, the indications, delivery methods, and techniques for RT continue to evolve. Methods Relevant prospective and retrospective reports were reviewed that addressed outcomes with, indications for, and delivery techniques used with RT for the management of cutaneous basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the head and neck. Results Rates of local control higher than 90% are typically achievable for early-stage BCC and SCC of the head and neck. RT is often recommended for tumors located in cosmetically or functionally sensitive areas of the face, for patients who cannot tolerate anesthesia, for those taking anticoagulants, or for patients who prefer RT to other treatment options. A wide range of radiation doses, daily fractionation schedules, and radiation techniques have been shown to be effective for management. In general, postoperative local radiation is recommended following excision for patients with high-risk factors, including those whose tumors have close or positive margins, perineural invasion, invasion of the bone or nerves, or those with recurrent disease. Conclusions RT plays an integral role in the treatment of primary and postoperative cutaneous BCC and SCC of the head and neck. Prospective trials are in progress to address the roles of concurrent systemic therapy and RT for both cutaneous BCC and SCC.
Collapse
Affiliation(s)
- Tobin J. Strom
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Jimmy J. Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Louis B. Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| |
Collapse
|
33
|
Della Vittoria Scarpati G, Perri F, Pisconti S, Costa G, Ricciardiello F, Del Prete S, Napolitano A, Carraturo M, Mazzone S, Addeo R. Concomitant cetuximab and radiation therapy: A possible promising strategy for locally advanced inoperable non-melanoma skin carcinomas. Mol Clin Oncol 2016; 4:467-471. [PMID: 27073643 DOI: 10.3892/mco.2016.746] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/17/2015] [Indexed: 12/20/2022] Open
Abstract
Non-melanoma skin cancers (NMSCs) include a heterogeneous group of malignancies arising from the epidermis, comprising squamous cell carcinoma (SCC), basal cell carcinoma (BCC), Merkel cell carcinoma and more rare entities, including malignant pilomatrixoma and sebaceous gland tumours. The treatment of early disease depends primarily on surgery. In addition, certain patients present with extensive local invasion or metastasis, which renders these tumours surgically unresectable. Improving the outcome of radiotherapy through the use of concurrent systemic therapy has been demonstrated in several locally advanced cancer-treatment paradigms. Recently, agents targeting the human epidermal growth factor receptor (EGFR) have exhibited a consolidated activity in phase II clinical trials and case series reports. Cetuximab is a monoclonal antibody that binds to and completely inhibits the EGFR, which has been revealed to be up-regulated in a variety of SCCs, including NMSCs. The present review aimed to summarize the role of anti-EGFR agents in the predominant types of NMSC, including SCC and BCC, and focuses on the cetuximab-based studies, highlighting the biological rationale of this therapeutic option. In addition, the importance of the association between cetuximab and radiotherapy for locally advanced NMSC is discussed.
Collapse
Affiliation(s)
- Giuseppina Della Vittoria Scarpati
- D.A.I. Diagnostica Morfologica e Funzionale, Radioterapia e Medicina Legale, Università degli Studi di Napoli 'Ferderico II', I-80138 Napoli, Italy
| | - Francesco Perri
- Unità Operativa di Oncologia, Ospedale 'San Giuseppe Moscati' di Taranto, I-74100 Taranto, Italy
| | - Salvatore Pisconti
- Unità Operativa di Oncologia, Ospedale 'San Giuseppe Moscati' di Taranto, I-74100 Taranto, Italy
| | - Giuseppe Costa
- Dipartimento di Salute Mentale Fisica e Medicina Preventiva, SUN Napoli, I-80138 Napoli, Italy
| | | | - Salvatore Del Prete
- Oncology Unit, 'San Giovanni di Dio' Hospital, A.S.L. Napoli 2 Nord, I-80027 Frattamaggiore (NA), Italy
| | | | | | - Salvatore Mazzone
- Dipartimento di Salute Mentale Fisica e Medicina Preventiva, SUN Napoli, I-80138 Napoli, Italy
| | - Raffaele Addeo
- Oncology Unit, 'San Giovanni di Dio' Hospital, A.S.L. Napoli 2 Nord, I-80027 Frattamaggiore (NA), Italy
| |
Collapse
|
34
|
Borghi A, Gianesini S, Pedriali M, Stefanelli A, Mangiola G, Caneva PD, Lanza G, Virgili A, Zamboni P. An apparently untreatable ulcer of the face. Int Wound J 2016; 13:1084-6. [PMID: 26752070 DOI: 10.1111/iwj.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/02/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Alessandro Borghi
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di, Ferrara, Italy.
| | | | - Massimo Pedriali
- Section of Anatomy, Histology and Pathological Cytology, University of Ferrara, Ferrara, Italy
| | - Antonio Stefanelli
- Department of Radiation Oncology, University Hospital SS. Anna, Ferrara, Italy
| | | | | | - Giovanni Lanza
- Section of Anatomy, Histology and Pathological Cytology, University of Ferrara, Ferrara, Italy
| | - Annarosa Virgili
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di, Ferrara, Italy
| | - Paolo Zamboni
- Vascular Disease Center, University of Ferrara, Ferrara, Italy
| |
Collapse
|
35
|
Reigneau M, Robert C, Routier E, Mamelle G, Moya‐Plana A, Tomasic G, Mateus C. Efficacy of neoadjuvant cetuximab alone or with platinum salt for the treatment of unresectable advanced nonmetastatic cutaneous squamous cell carcinomas. Br J Dermatol 2015; 173:527-34. [DOI: 10.1111/bjd.13741] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2015] [Indexed: 11/30/2022]
Affiliation(s)
- M. Reigneau
- Dermatology Unit Department of Medical Oncology Gustave Roussy 114 rue Edouard Vaillant 94800 Villejuif France
| | - C. Robert
- Dermatology Unit Department of Medical Oncology Gustave Roussy 114 rue Edouard Vaillant 94800 Villejuif France
| | - E. Routier
- Dermatology Unit Department of Medical Oncology Gustave Roussy 114 rue Edouard Vaillant 94800 Villejuif France
| | - G. Mamelle
- Department of Surgery Gustave Roussy 114 rue Edouard Vaillant 94800 Villejuif France
| | - A. Moya‐Plana
- Department of Surgery Gustave Roussy 114 rue Edouard Vaillant 94800 Villejuif France
| | - G. Tomasic
- Department of Pathology Gustave Roussy 114 rue Edouard Vaillant 94800 Villejuif France
| | - C. Mateus
- Dermatology Unit Department of Medical Oncology Gustave Roussy 114 rue Edouard Vaillant 94800 Villejuif France
| |
Collapse
|
36
|
|
37
|
Bloy N, Pol J, Manic G, Vitale I, Eggermont A, Galon J, Tartour E, Zitvogel L, Kroemer G, Galluzzi L. Trial Watch: Radioimmunotherapy for oncological indications. Oncoimmunology 2014; 3:e954929. [PMID: 25941606 DOI: 10.4161/21624011.2014.954929] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 07/18/2014] [Indexed: 02/06/2023] Open
Abstract
During the past two decades, it has become increasingly clear that the antineoplastic effects of radiation therapy do not simply reflect the ability of X-, β- and γ-rays to damage transformed cells and directly cause their permanent proliferative arrest or demise, but also involve cancer cell-extrinsic mechanisms. Indeed, among other activities, radiotherapy has been shown to favor the establishment of tumor-specific immune responses that operate systemically, underpinning the so-called 'out-of-field' or 'abscopal' effect. Thus, ionizing rays appear to elicit immunogenic cell death, a functionally peculiar variant of apoptosis associated with the emission of a particularly immunostimulatory combination of damage-associated molecular patterns. In line with this notion, radiation therapy fosters, and thus exacerbates, the antineoplastic effects of various treatment modalities, including surgery, chemotherapy and various immunotherapeutic agents. Here, we summarize recent advances in the use of ionizing rays as a means to induce or potentiate therapeutically relevant anticancer immune responses. In addition, we present clinical trials initiated during the past 12 months to test the actual benefit of radioimmunotherapy in cancer patients.
Collapse
Affiliation(s)
- Norma Bloy
- Gustave Roussy Cancer Campus ; Villejuif, France ; INSERM, U1138 ; Paris, France ; Equipe 11 labellisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers ; Paris, France ; Université Paris-Sud/Paris XI ; Paris, France
| | - Jonathan Pol
- Gustave Roussy Cancer Campus ; Villejuif, France ; INSERM, U1138 ; Paris, France ; Equipe 11 labellisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers ; Paris, France
| | - Gwenola Manic
- Regina Elena National Cancer Institute ; Rome, Italy
| | - Ilio Vitale
- Regina Elena National Cancer Institute ; Rome, Italy
| | | | - Jérôme Galon
- INSERM, U1138 ; Paris, France ; Université Paris Descartes/Paris V; Sorbonne Paris Cité ; Paris, France ; Université Pierre et Marie Curie/Paris VI ; Paris, France ; Laboratory of Integrative Cancer Immunology, Centre de Recherche des Cordeliers ; Paris, France
| | - Eric Tartour
- Université Paris Descartes/Paris V; Sorbonne Paris Cité ; Paris, France ; INSERM, U970 ; Paris, France ; Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP ; Paris, France
| | - Laurence Zitvogel
- Gustave Roussy Cancer Campus ; Villejuif, France ; INSERM, U1015; CICBT507 ; Villejuif, France
| | - Guido Kroemer
- INSERM, U1138 ; Paris, France ; Equipe 11 labellisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers ; Paris, France ; Université Paris Descartes/Paris V; Sorbonne Paris Cité ; Paris, France ; Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP ; Paris, France ; Metabolomics and Cell Biology Platforms; Gustave Roussy Cancer Campus ; Villejuif, France
| | - Lorenzo Galluzzi
- Gustave Roussy Cancer Campus ; Villejuif, France ; Equipe 11 labellisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers ; Paris, France ; Université Paris Descartes/Paris V; Sorbonne Paris Cité ; Paris, France
| |
Collapse
|
38
|
Falivene S, Giugliano FM, Grimaldi AM, Di Franco R, Toledo D, Muto M, Cammarota F, Borzillo V, Ascierto PA, Muto P. Tomotherapy concomitant with cetuximab, followed by cetuximab as single-agent therapy for unresectable squamous cell carcinoma of the skin: a case report. BMC DERMATOLOGY 2014; 14:15. [PMID: 25270710 PMCID: PMC4186952 DOI: 10.1186/1471-5945-14-15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/24/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (SCC) is the second most frequency of all skin tumors. Incidence of SCC has risen significantly due to an increased sun exposure and the number of immunodeficient patients. Cutaneous SCC is characterized by high Epidermal growth factor receptor (EGFR) expression with low frequency of RAS mutations. Generally, locoregional surgery is curative and systemic therapy is not indicated. We evaluated the activity and toxicity profile of tomotherapy concomitant with Cetuximab, followed by Cetuximab as single agent therapy in a patient affected by unresectable, locally advanced cutaneous SCC. CASE PRESENTATION At our institution, on March 2012 we treated a 45 years-old patient affected by locally advanced, unresectable G1 SCC of the lumbar region. At our first observation, the patient was asthenic, with severe pain and functional limitations. There was also a superinfection due to Pseudomonas Aeruginosa resistant to antibiotics, and a G3 anemia secondary to the bleeding lesion. ECOG Performance Status was 2. Tomotherapy has been performed concomitant with the Cetuximab (400 mg/m2, followed by weekly doses of 250 mg/m2) at the total dose of 60 Gy (2 Gy/fx), followed by Cetuximab monotherapy.The lesion reduced progressively until disappear even after the suspension of the treatment and the patient achieved complete response. Toxicity resulted in G1 cutaneous rash and G2 toxicity to the nails, appeared after 5 months of treatment, typical toxicity profile of the anti-EGFR therapies. After one month of therapy the Pseudomonas Aeruginosa superinfection totally disappeared. Quality of life resulted significantly improved with reduction until discontinuation of the anti-pain drugs, and progressive increase of the hemoglobin levels. At follow up of 15 months there was no evidence of active disease and the ECOG Performance Status was 0 (zero). CONCLUSION The treatment was effective and feasible. Considering these excellent results, further studies about concomitant tomotherapy with Cetuximab for advanced/inoperable SCC of the skin are needed.
Collapse
Affiliation(s)
- Sara Falivene
- Dipartimento di diagnostica per immagini e Radioterapia – Seconda Università degli studi di Napoli, Piazza Miraglia, 80131 Naples, Italy
| | - Francesca Maria Giugliano
- UOC Radioterapia -– Istituto Nazionale per lo studio e la cura dei tumori “Fondazione Giovanni Pascale” – IRCCS, Via Mariano Semmola 80131 Naples, Italy
| | - Antonio Maria Grimaldi
- SC Oncologia Medica Melanoma Immunoterapia Oncologica e Terapie Innovative – Istituto Nazionale per lo studio e la cura dei tumori “Fondazione Giovanni Pascale” – IRCCS, Via Mariano Semmola 80131 Naples, Italy
| | - Rossella Di Franco
- Dipartimento di diagnostica per immagini e Radioterapia – Seconda Università degli studi di Napoli, Piazza Miraglia, 80131 Naples, Italy
| | - Diego Toledo
- EuropeanMedicalImaging - Fondazione Muto-onlus, Napoli, Italia, Via Taverna Rossa, 169, 80020 Casavatore, Naples, Italy
| | - Matteo Muto
- EuropeanMedicalImaging - Fondazione Muto-onlus, Napoli, Italia, Via Taverna Rossa, 169, 80020 Casavatore, Naples, Italy
| | - Fabrizio Cammarota
- UOC Radioterapia -– Istituto Nazionale per lo studio e la cura dei tumori “Fondazione Giovanni Pascale” – IRCCS, Via Mariano Semmola 80131 Naples, Italy
| | - Valentina Borzillo
- UOC Radioterapia -– Istituto Nazionale per lo studio e la cura dei tumori “Fondazione Giovanni Pascale” – IRCCS, Via Mariano Semmola 80131 Naples, Italy
| | - Paolo Antonio Ascierto
- SC Oncologia Medica Melanoma Immunoterapia Oncologica e Terapie Innovative – Istituto Nazionale per lo studio e la cura dei tumori “Fondazione Giovanni Pascale” – IRCCS, Via Mariano Semmola 80131 Naples, Italy
| | - Paolo Muto
- UOC Radioterapia -– Istituto Nazionale per lo studio e la cura dei tumori “Fondazione Giovanni Pascale” – IRCCS, Via Mariano Semmola 80131 Naples, Italy
| |
Collapse
|
39
|
Samstein RM, Ho AL, Lee NY, Barker CA. Locally advanced and unresectable cutaneous squamous cell carcinoma: outcomes of concurrent cetuximab and radiotherapy. J Skin Cancer 2014; 2014:284582. [PMID: 25136458 PMCID: PMC4129159 DOI: 10.1155/2014/284582] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 07/02/2014] [Indexed: 02/06/2023] Open
Abstract
Background. Advanced age and immune dysfunction are risk factors for cutaneous squamous cell carcinoma (cSCC) and often render patients with locally-advanced disease medically inoperable or surgically unresectable, but potentially curable with radiotherapy. Concurrent chemotherapy and radiotherapy may not be well tolerated in this population, but another systemic therapy may improve disease control. Objective. Determine the tolerance and efficacy of concurrent cetuximab and radiotherapy (CRT) for patients with locally advanced and unresectable cSCC. Methods. Retrospective analysis of 12 patients treated with CRT for locally advanced and unresectable cSCC. Results. Patients were elderly and 75% had moderate-to-severe comorbidities, while 42% had immune dysfunction. Grades 3-4 adverse events were noted in 83% of patients; 67% required hospital admission for adverse events. Complete and partial response was noted in 36% and 27% (response rate, 64%). Stable and progressive disease was noted in 3 and 1 patients, respectively (disease control rate, 91%). Median progression-free and overall survival were 6.4 and 8.0 months, respectively. Limitations. Retrospective small-cohort, single-institution analysis. Conclusion. Patients selected for CRT were elderly, with comorbidities and immune dysfunction, but treatment responses were observed. Patients selected for this treatment approach have a poor prognosis with limited capacity for therapy; more effective treatment is needed.
Collapse
Affiliation(s)
- Robert M. Samstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 22, New York, NY 10065, USA
| | - Alan L. Ho
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Nancy Y. Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 22, New York, NY 10065, USA
| | - Christopher A. Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 22, New York, NY 10065, USA
| |
Collapse
|
40
|
Nguyen BM, Schmults CD. Update on Evaluation and Management of High-Risk Squamous Cell Carcinomas. CURRENT DERMATOLOGY REPORTS 2014. [DOI: 10.1007/s13671-014-0078-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
41
|
Duperret EK, Ridky TW. Focal adhesion complex proteins in epidermis and squamous cell carcinoma. Cell Cycle 2013; 12:3272-85. [PMID: 24036537 DOI: 10.4161/cc.26385] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Focal adhesions (FAs) are large, integrin-containing, multi-protein assemblies spanning the plasma membrane that link the cellular cytoskeleton to surrounding extracellular matrix. They play critical roles in adhesion and cell signaling and are major regulators of epithelial homeostasis, tissue response to injury, and tumorigenesis. Most integrin subunits and their associated FA proteins are expressed in skin, and murine genetic models have provided insight into the functional roles of FAs in normal and neoplastic epidermis. Here, we discuss the roles of these proteins in normal epidermal proliferation, adhesion, wound healing, and cancer. While many downstream signaling mechanisms remain unclear, the critically important roles of FAs are highlighted by the development of therapeutics targeting FAs for human cancer.
Collapse
|
42
|
Boyd K, Shea SM, Patterson J. Cetuximab for treatment of advanced squamous cell carcinoma in solid organ transplant recipients. Wien Med Wochenschr 2013; 163:372-5. [DOI: 10.1007/s10354-013-0213-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/10/2013] [Indexed: 01/27/2023]
|