Managing Patients on Immunotherapy in CSCC

Anna C. Pavlick, DO:Now that cemiplimab is approved, the FDA has not placed widespread restrictions on its use. It can be used in patients with autoimmune diseases. It can be used in patients who have chronic lymphocytic leukemia. Practitioners who use these medicines need to be astutely aware of the potential complications that these drugs can provide in patients who have had transplants. Having cemiplimab available to us has really impacted the lives and the survival of our locally advanced and metastatic squamous cell patients who are not transplant patients as well.

Unfortunately, not everybody responds to cemiplimab. It has a 50% response rate. If this lady did not respond to cemiplimab, she would certainly be a candidate for cetuximab or platinum-based chemotherapy. However, I would strongly encourage her to consider participating in a clinical trial that looks at how we make immunotherapy-refractory or immunotherapy-resistant patients sensitive and get them to respond.

Unfortunately, because of her underlying autoimmune disease, she’s probably going to be excluded from all of those trials. She’s going to have very limited options, other than the standard options. If she responds to those standard options, she would then, at least in my book, be offered resection to try to give her durable control of this cancer.

Transcript edited for clarity.

A 64-Year-Old Woman With Very Large Ocular CSCC Tumor

• History
  • A 64-year-old woman was referred for a left lower eyelid lesion that was rapidly increasing in size. She complained of intermittent twitching and numbness in the area. She reported that the lesion started on the lower eyelid.
  • PMH: stent placed 10 years ago; hyperlipidemia, well controlled on simvastatin; hypertension, well controlled on metoprolol; rheumatoid arthritis
• PE
  • Ulcerated lesion, approximately 8-mm in diameter
  • ECOG PS 1
• Imaging confirmed perineural, vascular, and bone invasion
• Biopsy confirmed cutaneous squamous cell carcinoma, poorly-differentiated, Clark level V, perineural invasion, vascular invasion
• Stage: T3N0M0