Advances in Cutaneous Squamous Cell Carcinoma Management

Abstract

cSCC is increasing in prevalence due to increased lifespans and improvements in survival for conditions that increase the risk of cSCC. The absolute mortality of cSCC exceeds melanoma in the United States and approaches that of melanoma worldwide. This review presents significant changes in the management of cSCC, focusing on improvements in risk stratification, new treatment options, optimization of existing treatments, and prevention strategies. One major breakthrough in cSCC treatment is the advent of immune checkpoint inhibitors (ICIs) targeting programmed cell death protein 1 (PD-1) and programmed death-ligand 1 (PD-L1), which have ushered in a renaissance in the treatment of patients with locally advanced and metastatic disease. These agents have offered patients with advanced disease decreased therapeutic toxicity compared to traditional chemotherapy agents, a more durable response after discontinuation, and improved survival. cSCC is an active field of research, and this review will highlight some of the novel and more developed clinical trials that are likely to impact cSCC management in the near future.

Recent Advances in Immunotherapy for Patients with Head and Neck Cutaneous Squamous Cell Carcinoma

“…The first immunotherapy drug used for the treatment of CSCC was intralesional interferon [ 48 ]. Over the past 3 decades, there has been increased knowledge regarding the immune system’s key role in CSCC pathogenesis [ 49 ].…”

The Prognostic Value and Clinical Utility of the 40-Gene Expression Profile (40-GEP) Test in Cutaneous Squamous Cell Carcinoma: Systematic Review and Meta-Analysis

“…Farberg et al have suggested intensifying management in high-risk groups and incorporating 40-GEP within NCCN guideline recommendations [16]. Despite the reported incremental improvements in the prognostic and clinical usefulness of 40-GEP, it has not yet been integrated into the guidelines of the NCCN nor the American Academy of Dermatology [4, 24,25].…”

Immune checkpoint inhibitors in kidney transplantation

“…The cancer types that are approved for treatment with ICIs continue to increase every year, and at present, 22 types of cancer are included in the approval list [26,29,36]. The introduction of ICIs has ushered a new age in treating advanced and metastatic malignancies, as they are better tolerated and often more effective compared with chemotherapy and radiotherapy [10 ▪ ].…”

“…Surgical resection alone is seldom sufficient in cancer treatment. A more recent option for the treatment of cancer is immunotherapy, particularly with immune checkpoint inhibitors (ICIs), which have been shown to be well tolerated compared with chemotherapy or radiotherapy [10 ▪ ]. However, the use of immunotherapy in SOTRs, in whom immunosuppression is the key strategy for preventing allograft rejection, is considered risky, as it could broadly unleash the immune system response, including against the transplanted organ.…”

“…However, immunosuppression use is associated with many adverse effects in solid organ transplant recipients (SOTRs), including a higher risk of infections and malignancies. The incidence of cancer in SOTRs is three to five-fold higher than the general population [1][2][3], and is a leading cause of mortality in SOTRs [4,5…”