Dr Patel on the Evolving Use of Neoadjuvant PD-1 Inhibitors in CSCC
Source: OncLive, April 2024
Vishal Patel, MD, FAAD, FACMS, associate professor, Dermatology, George Washington (GW) School of Medicine & Health Sciences; director, Cutaneous Oncology Program, GW Cancer Center, discusses the evolving use of PD-1 inhibitors for patients with cutaneous squamous cell carcinoma (CSCC) in the neoadjuvant and adjuvant setting.
The use of PD-1 inhibition for patients with non-melanoma skin cancers such as CSCC has evolved significantly, taking cues from successful strategies in melanoma, Patel begins. These data have shown that patients with certain risk factors achieve better responses when treated with anti–PD-1 therapy earlier on in the disease course, he states. Initially, PD-1 therapy was used in cases of advanced, unresectable, metastatic disease. However, recent trials have explored the efficacy of this approach in earlier stages of disease, such as lymph node disease that is surgically resectable or primary tumors without distant metastases or lymph node metastases, Patel explains.
Trials evaluating PD-1 inhibitors in CSCC such as cemiplimab (Libtayo) alone or in combinations in the neoadjuvant space have demonstrated robust response rates and complete tumor responses, Patel reports. Although surgery remains integral to management strategies in this space, the efficacy of neoadjuvant PD-1 inhibition is changing the landscape by potentially reducing the extent of treatment needed for long-term cures after initial systemic immunotherapy followed by surgery. These outcomes have been observed across the spectrum of melanoma and non-melanoma skin cancers, and clinical trials are planned to expand these approaches into the basal cell carcinoma space, Patel says.