Systemic Treatment of Metastatic Cutaneous Squamous Cell Carcinoma - Episode 3

Multidisciplinary Assessment of Advanced CSCC

Michael R. Migden, MD:The primary goal of therapy is to cure the patient of their disease, to get a complete response that is durable. Of course, with life-threatening disease, it’s nearly as important in just holding patients from progressing, because progression leads to death in a large percentage of these cases. That would be in the form of disease control, so that would be your complete responders, your partial responders, and those patients who have stable disease, but they’re not progressing. Having a disease control rate that is significant and especially a durable disease control rate—one that keeps them that way for some period of time—is a big thing for these patients. Especially in the setting of having other systemic therapy, other than immunotherapy, where the ability for the patient to stay on therapy is lower due to adverse reactions, tolerability. Having immunotherapy where the commonplace is good and having the ability to hold people with disease control, those are the treatment goals.

On to multidisciplinary evaluation and management of patients, I can’t stress enough how important multidisciplinary evaluation and management is. We know that these nonmelanoma skin cancers—basal cell and squamous cell carcinomas—are primary cancers of the skin. So, anybody who thinks that dermatology, of which I am a dermatologist; Mohs surgery, of which I am a surgeon; or dermatologic oncology, of which I am an oncologist, is not appropriate for management of these patients is, in my opinion, quite wrong.

After all, this is a primary cancer of the skin. We’re talking about the spectrum of disease, from the small “n” all the way up to the large “N.” That’s all squarely within the dermatology purview. But dermatology alone isn’t the best thing for the patient because some of these tumors extend very deeply, and they would benefit from evaluation from head and neck surgery, about larger surgery potential, radiation therapy for possible adjuvant radiation therapy, medical oncology for the purpose of systemic therapy and co-managing patients. So, whether the prescriber is a dermatologist or a medical oncologist, it’s still important to have the other specialty involved. I know the skin very well being a Mohs surgeon and dermatologic oncologist, and my assessment of lesions, I believe, has a lot of expertise based on my experience and my background. I don’t do some of the things that medical oncologists do, but medical oncologists don’t know the skin as well as I know the skin and even the subcutaneous structures. So it’s actually the best case scenario for the patient to have these multidisciplinary evaluations and management.

Transcript edited for clarity.