Complete Resolution of a Large, Locally-advanced Cutaneous Squamous Cell Carcinoma with the Immune-modulating PD-1 Inhibitor Pembrolizumab

Cristancho, Cagney; Riano, Ivy; Guareras-Paredes, Daniel; Park, Robin; Seetharaman, Kala

doi:10.7759/cureus.8072

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…Auch bei der Behandlung des lokal fortgeschrittenen cSCC scheint Pembrolizumab wirksam zu sein, wie die im Folgenden beschriebenen drei Fallberichte zeigen. Cristancho et al berichteten über einen Patienten mit inoperablem, lokal fortgeschrittenen cSCC, der Pembrolizumab 200 mg alle 3 Wochen erhielt und eine Vollremission CR erreichte, die mindestens 1 Jahr anhielt [80]. Unerwünschte Ereignisse wurden nicht beobachtet.…”

Section: Icb Bei Cscc: Wie Ist Die Derzeitige Evidenzlage?unclassified

Immun-Checkpoint-Blockade bei fortgeschrittenem kutanen Plattenepithelkarzinom: Was wissen wir derzeit im Jahr 2020?

et al. 2021

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Das kutane Plattenepithelkarzinom (cSCC) ist der zweithäufigste Hautkrebs und entsteht vor allem in chronisch sonnengeschädigter Haut. Nachgewiesene Hauptrisikofaktoren sind Immunsuppression, genetische Störungen wie Xeroderma pigmentosum (XP), Exposition gegenüber bestimmten Medikamenten und Umweltnoxen. Therapie der Wahl bei cSCC ist die chirurgische Entfernung, die im Frühstadium meist kurativ erfolgt. Einige wenige Patienten entwickeln jedoch lokal fortgeschrittene Tumoren oder Fernmetastasen, die nach wie vor schwierig zu behandeln sind. Die auf CTLA-4, PD-L1 und PD-1 ausgerichtete Immun-Checkpoint-Blockade (ICB) hat die onkologische Therapie und insbesondere die Behandlung von Hautkrebserkrankungen als Tumoren mit hoher Mutationslast sehr stark verändert. In der vorliegenden Übersichtsarbeit liegt der Fokus auf den Unterschieden zwischen dem kutanen Plattenepithelkarzinom und dem kutanen Melanom (CM) sowie den damit verbundenen Implikationen für die Therapie. Darüber hinaus werden die aktuelle Evidenzlage zur ICB für die Behandlung des fortgeschrittenem cSCC zusammengefasst und die Chancen und Risiken dieser therapeutischen Option für diese Krebsentität erörtert. Ferner richten wir das Augenmerk auf spezielle interessierende Subgruppen von Patienten wie etwa Organtransplantatempfänger, Patienten mit malignen hämatologischen Erkrankungen, XP und Feldkanzerisierung.

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Section: Icb Bei Cscc: Wie Ist Die Derzeitige Evidenzlage?unclassified

Immun-Checkpoint-Blockade bei fortgeschrittenem kutanen Plattenepithelkarzinom: Was wissen wir derzeit im Jahr 2020?

et al. 2021

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“…Pembrolizumab also seems to be effective for the treatment of locally advanced cSCC as demonstrated by the following three case reports. Cristancho et al reported the case of a patient with unresectable, locally advanced cSCC who received pembrolizumab 200 mg Q3W and achieved a CR for at least 1 year [80]. No AEs were observed.…”

Section: Pembrolizumabmentioning

confidence: 99%

Immune Checkpoint Blockade in Advanced Cutaneous Squamous Cell Carcinoma: What Do We Currently Know in 2020?

Wessely

Steeb

Leiter

et al. 2020

IJMS

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Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer that predominantly arises in chronically sun-damaged skin. Immunosuppression, genetic disorders such as xeroderma pigmentosum (XP), exposure to certain drugs and environmental noxae have been identified as major risk factors. Surgical removal of cSCC is the therapy of choice and mostly curative in early stages. However, a minority of patients develop locally advanced tumors or distant metastases that are still challenging to treat. Immune checkpoint blockade (ICB) targeting CTLA-4, PD-L1 and PD-1 has tremendously changed the field of oncological therapy and especially the treatment of skin cancers as tumors with a high mutational burden. In this review, we focus on the differences between cSCC and cutaneous melanoma (CM) and their implications on therapy, summarize the current evidence on ICB for the treatment of advanced cSCC and discuss the chances and pitfalls of this therapy option for this cancer entity. Furthermore, we focus on special subgroups of interest such as organ transplant recipients, patients with hematologic malignancies, XP and field cancerization.

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“…Cutaneous squamous cell carcinoma (CSCC) is a highly incident skin cancer that is often characterised by multifocal presentation and high rates of local recurrence after surgical excision. Advanced CSCCs include a small number of metastatic patients and more frequent cases of locally advanced disease unfit for both surgery and radiotherapy, which can only be treated by systemic therapy (2,3). Immunotherapy with antiprogrammed death ligand-1 (PD-1) agents is the gold standard in all current guidelines, and cemiplimab is the only recently approved anti-PD-1 antibody in Italy (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Case Report: Autoimmune Pemphigus Vulgaris in a Patient Treated With Cemiplimab for Multiple Locally Advanced Cutaneous Squamous Cell Carcinoma

et al. 2021

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BackgroundPemphigus vulgaris (PV) is a rare and severe autoimmune blistering disorder affecting the skin and mucous membranes, characterized by the production of autoantibodies against two desmosomal adhesion proteins, desmoglein 1 and 3. In patients with advanced squamous cell carcinoma of the skin unfit for surgery and radiotherapy, immune check-point inhibitors, including the anti-Programmed Death-1 (PD-1) agent cemiplimab have been successfully employed proving relevant clinical outcomes. Cemiplimab is a monoclonal antibody capable of inhibiting PD-1 signalling that has recently been approved for the treatment of patients with metastatic or locally advanced cutaneous squamous cell carcinoma. Although the peculiar setting of advanced CSCC involving elderly patients, rare and unusual skin immune-related adverse events such as PV could be observed in cemiplimab treated patients.Case ReportA 95-year-old man without a history of autoimmune disease was treated with cemiplimab for multiple and advanced squamous cell carcinomas of the head obtaining a complete response to therapy. After seven cycles of cemiplimab administered every 21 days, the patient developed a mucocutaneous blistering eruption. Clinical diagnosis of PV was suspected on the basis of the diffuse involvement of trunk and extremities with large blisters and necrotic eschar. It was carried out an ELISA test, that showed high level of circulating antibodies against desmoglein 1, thus confirming the diagnosis of PV. For this reason, cemiplimab infusion was discontinued and complete resolution of skin lesions was obtained using oral prednisone 0,8 mg/kg/daily for four weeks. Once remission was achieved, a maintenance dose of 10 mg/day was administered, observing a good control of bullous disease and low value of desmoglein 1. Response to CSCC persisted also during cemiplimab discontinuation, until obtaining a complete remission still persisting at 9 months after the last cycle of therapy.ConclusionThe case we observed is the first description of PV revealed from cemiplimab therapy, thus suggesting that cemiplimab could allow the arise of underlying autoimmune PV, through a mechanism both T and B-cell-mediated.

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Complete Resolution of a Large, Locally-advanced Cutaneous Squamous Cell Carcinoma with the Immune-modulating PD-1 Inhibitor Pembrolizumab

Cited by 4 publications

References 15 publications

Immun-Checkpoint-Blockade bei fortgeschrittenem kutanen Plattenepithelkarzinom: Was wissen wir derzeit im Jahr 2020?

Immun-Checkpoint-Blockade bei fortgeschrittenem kutanen Plattenepithelkarzinom: Was wissen wir derzeit im Jahr 2020?

Immune Checkpoint Blockade in Advanced Cutaneous Squamous Cell Carcinoma: What Do We Currently Know in 2020?

Case Report: Autoimmune Pemphigus Vulgaris in a Patient Treated With Cemiplimab for Multiple Locally Advanced Cutaneous Squamous Cell Carcinoma

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