Uncommon Presentation of Metastatic Squamous Cell Carcinoma of the Skin and Treatment Challenges

Abstract

Patient: Female, 80Final Diagnosis: Metastatic squamous cell carcinoma of skinSymptoms: Back pain • leg swelling • utiMedication: —Clinical Procedure: ImmunotherapySpecialty: OncologyObjective:Unusual clinical courseBackground:Squamous cell carcinoma is one of the most common keratinocytic skin cancers, the other being basal cell carcinoma. It is the second most common skin cancer after melanoma. Cutaneous squamous cell carcinoma is mostly a localized disease. The metastatic presentation is rare even in the presence of invasive disease. The metastatic potential depends on the presence of high-risk features at the time of diagnosis. Lung, liver, and bone are the frequent sites of metastasis. Local and locoregional disease undergoes excision with or without adjuvant radiation. However, we lack proper treatment paradigms for this metastatic disease.Case Report:We are reporting a case of an elderly female with a history of high-risk localized cutaneous squamous cell carcinoma treated with complete local excision and radiation presenting 5 years later with extensive disease to the lung and liver, abdominal nodes, and spinal fracture. The patient was not a candidate for chemotherapy due to kidney failure. On the basis of ongoing separate trials on different immunotherapies, she was started on nivolumab.Conclusions:Treating metastatic cutaneous squamous cell carcinoma is a challenge considering the absence of phase III trials due to the rarity of this disease. Historically, platinum with or without 5-FU (fluorouracil), bleomycin, doxorubicin, and retinoic acid were used with variable responses. Data on epidermal growth factor receptor (EGFR) inhibitors on EGFR expressing tumors are available. However, even with the most recent reports on immunotherapy in patients with high programmed death-1 expression or high mutation burden, it is difficult to achieve good response.

Multiparametric analysis of the effectiveness of cisplatin on cutaneous squamous carcinoma cells using two different types of adjuvants

“…The high potential of cisPt as a chemotherapy agent against cSCC with respect to 5-fluorouracil has already been described [7]. Some other studies also suggested platinum compounds as an alternative treatment to inoperable cSCC [25]. Going one step further, the results obtained in this work showed that cisPt 3.5 μM diluted in tricine 50 mM was the most effective strategy to significantly decrease (up to~40%) cSCC cell survival with only one application.…”

Tumor-Infiltrating Immunosuppressive Cells in Cancer-Cell Plasticity, Tumor Progression and Therapy Response

“…Recently, FDA has approved a PD-1 blockade treatment for unresectable locally advanced and metastatic cutaneous SCCs with Cemiplimab [134]. However, most patients' clinical response was partial or short-lived, and a considerable percentage of patients suffered disease progression [135]. Checkpoint inhibitors that target PD-L1 have also been approved by FDA for the treatment of metastatic NSCLC, urothelial [136,137], Merkel-cell carcinoma and advanced bladder cancer [138][139][140].…”

Nivolumab for Metastatic Cutaneous Squamous Cell Carcinoma

“…At present, advanced or metastatic cSCC portend a poor prognosis, with few available treatment options. Most of the literature is based on platinum therapy or cetuximab, with low overall response rates and high toxicity [6].…”