Clinical bottom line
Targeted therapies for advanced cutaneous squamous cell carcinoma (cSCC) have emerged as promising treatment options, particularly for patients who are not candidates for surgery or radiation. The introduction of immune checkpoint inhibitors, such as cemiplimab and pembrolizumab, has shown significant efficacy in treating advanced cases. These therapies offer a new avenue for managing a disease that traditionally had limited options once it reached an advanced stage.
What the evidence shows
Recent studies have demonstrated the efficacy of immune checkpoint inhibitors in advanced cSCC. Cemiplimab, a PD-1 inhibitor, was approved based on a pivotal phase II trial that showed a response rate of approximately 47% in patients with metastatic or locally advanced cSCC [1]. The trial highlighted durable responses, with some patients maintaining response for over a year.
Pembrolizumab, another PD-1 inhibitor, has also been evaluated in advanced cSCC. A study reported a response rate of approximately 34% with manageable safety profiles, reinforcing its potential as a treatment option [2]. These findings are supported by systematic reviews that consolidate evidence from multiple trials, underscoring the role of PD-1 inhibitors in this setting [3].
Caveats and uncertainty
While the efficacy of targeted therapies in advanced cSCC is promising, several caveats remain. The response rates, although significant, indicate that not all patients benefit from these treatments. Additionally, the long-term safety profile of these therapies is still being evaluated, with immune-related adverse events being a concern. The variability in response among different patient populations also suggests the need for biomarkers to predict which patients are most likely to benefit.
How this may change practice
The introduction of targeted therapies, particularly immune checkpoint inhibitors, is likely to change the management of advanced cSCC by providing effective options for patients who previously had limited treatment avenues. Clinicians may need to incorporate these therapies into treatment protocols, considering patient-specific factors such as comorbidities and previous treatment history. The potential for durable responses with these agents offers hope for improved outcomes and quality of life for patients with advanced cSCC.