PD-1 inhibition therapy for advanced cutaneous squamous cell carcinoma: a retrospective analysis from the University of
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ORIGINAL ARTICLE – CLINICAL ONCOLOGY
PD‑1 inhibition therapy for advanced cutaneous squamous cell carcinoma: a retrospective analysis from the University of Southern California Gino K. In1,2,3 · Poorva Vaidya3 · Alexandra Filkins3 · David J. Hermel4 · Kevin G. King5 · Omar Ragab6 · William W. Tseng7 · Mark Swanson8 · Niels Kokot8 · Julie E. Lang7 · Lawrence Menendez9 · Brittney DeClerck2,10 · Gene Kim2,10 · Jenny C. Hu2 · Alicia Terando7 · Hossein Jadvar5 · Charité Ricker1 · Kimberly A. Miller2,11 · David H. Peng2 · Ashley Wysong12 Received: 26 August 2020 / Accepted: 6 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Approximately 5% of patients with cutaneous squamous cell carcinoma (CSCC) may develop recurrent or metastatic disease. The management of such cases is challenging and requires multi-disciplinary care. Immunotherapy using PD-1 inhibition was approved to treat unresectable or metastatic CSCC in 2018. Given limited data regarding clinical outcomes outside of published trials, we describe our experience using this therapy. Methods We retrospectively reviewed all patients treated with PD-1 inhibition as therapy for locally advanced, regionally metastatic or distant metastatic CSCC at the University of Southern California. Clinicopathological characteristics, treatment data using PD-1 inhibitors, and outcomes were assessed. Results Among 26 patients treated with PD-1 inhibition, the objective response rate was 42.3%, with 19.2% of patients having partial response and 23.1% having complete response to therapy. The median progression-free survival was 5.4 months. Median tumor mutational burden (TMB) was higher among responders compared to non-responders (60 vs. 9 Mut/Mb, p = 0.04). Primary CSCC tumor location on the head/neck was also associated with response to PD-1 inhibition (p = 0.04). Two patients with mutations affecting mismatch repair deficiency were noted to have complete response to treatment. No other variables were associated with treatment outcomes. Conclusion PD-1 inhibition produces durable responses among patients with advanced or metastatic CSCC. PD-1 inhibition therapy is well tolerated, but patients should be monitored closely for immune-related adverse events, particularly frail or immune-suppressed patients. Further investigation of potential biomarkers to help identify patients who will derive the most benefit from this therapeutic option is needed. Keywords Cutaneous squamous cell carcinoma · PD-1 · Skin cancer · Immunotherapy · Checkpoint blockade
Introduction Cutaneous squamous cell carcinoma (CSCC), also known as squamous cell skin cancer, is the second most common malignancy found in the United States, with over 1 million cases treated annually and rising (Lomas et al. 2012; Rogers et al. 2015). Risk factors for CSCC include advanced age, fair skin, extensive history of UV exposure, and a history * Gino K. In [email protected] Extended author information available on the last page of the article
of immune suppression (e.g., co
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