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Published on: April 22, 2019
Immune Checkpoint Blockade in Advanced Cutaneous Squamous Cell Carcinoma: What Do We Currently Know in 2020?
Anja Wessely1,2, Theresa Steeb1,2, Ulrike Leiter3
1Department of Dermatology, Deutsches Zentrum Immuntherapie (DZI), Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany.
Abstract:
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.
Insights
Cutaneous squamous cell carcinoma (cSCC) is a common skin cancer. Immune checkpoint blockade (ICB) shows promise for advanced cSCC, but its efficacy varies across patient subgroups.
Area of Science:
- Oncology
- Dermatology
- Immunotherapy
Background:
- Cutaneous squamous cell carcinoma (cSCC) is the second most frequent skin cancer, often linked to sun exposure.
- While surgery is curative for early stages, advanced cSCC and metastases pose treatment challenges.
- Risk factors include immunosuppression, genetic disorders like xeroderma pigmentosum (XP), and environmental exposures.
Purpose of the Study:
- To review the therapeutic landscape of advanced cSCC.
- To compare cSCC with cutaneous melanoma (CM) regarding treatment implications.
- To summarize evidence and discuss the potential and limitations of immune checkpoint blockade (ICB) for cSCC.
Main Methods:
- Literature review focusing on advanced cSCC and ICB therapies.
- Comparative analysis of cSCC and CM in the context of immunotherapy.
- Discussion of ICB in specific patient populations.
Main Results:
- ICB targeting CTLA-4, PD-L1, and PD-1 has transformed cancer therapy, including skin cancers.
- cSCC, like other high mutational burden tumors, is a candidate for ICB.
- The review examines ICB's effectiveness and challenges in advanced cSCC.
Conclusions:
- ICB represents a significant advancement in treating advanced cSCC.
- Understanding differences between cSCC and CM is crucial for therapeutic strategies.
- Further research is needed to optimize ICB for special patient subgroups, including those with XP and field cancerization.
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