Systemic Chemotherapy of Non-Melanoma Skin Cancer
Chemotherapy for non-melanoma skin cancer is rarely used since most tumors are curable in the early stage. There is limited experience with chemotherapy regimens including platinum compounds and taxanes. Overall response rate for metastatic squamous cell
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Systemic Chemotherapy of Non-Melanoma Skin Cancer Robert Gniadecki
Key Points
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Chemotherapy for non-melanoma skin cancer is rarely used since most tumors are curable in the early stage. There is limited experience with chemotherapy regimens including platinum compounds and taxanes. Overall response rate for metastatic squamous cell carcinoma is in the range of 25–75%. Epidermal growth factor receptor antagonists and bortezomib are emerging for the treatment of metastatic squamous cell carcinoma. Chemotherapeutic regimens can be used in adjuvant and neoadjuvant setting together with surgery or radiation.
Chemotherapy is defined as the treatment of disease with chemical agents that have a specific, toxic effect upon cancer cells and selectively destroy cancerous tissue. Chemotherapeutic agents can be used alone, but the efficacy of the treatment is often enhanced when the drugs are used in combination (combination chemotherapy). The ultimate goal of chemotherapy, a complete destruction of cancerous tissue, is not always achievable. However, in many instances, even the best available
R. Gniadecki University of Copenhagen, Department of Dermatology, Bispebjerg Hospital, Bispebjerg bake 23, 2400 Copenhagen, Denmark e-mail: [email protected]
chemotherapy does not provide complete, unsupported remissions, but rather partial remissions or stabilization of the disease. In these cases, chemotherapy can still be very useful as a palliative treatment providing symptomatic relief. Chemotherapy can also be employed in an adjuvant or neoadjuvant setting. In adjuvant chemotherapy, the drug is given to augment or stimulate some other form of treatment such as surgery or radiation therapy. Neoadjuvant chemotherapy is a preliminary cancer chemotherapy that precedes a necessary second modality of treatment, such as surgery or radiation.
9.1 Overview of Chemotherapeutic Drugs Most chemotherapy protocols for non-melanoma skin cancer (NMSC) employ combination chemotherapy. Many different regimens have been proposed and Table 9.1 summarizes the characteristics of the drugs that have been repetitively employed in NMSC chemotherapy.
9.2 Chemotherapy Regimens 9.2.1 Cisplatin Combination Regimens Cisplatin is the most constant ingredient of chemotherapy regimens used for NMSC. The central role of cisplatin stems from the positive experience with head and neck carcinomas, the biology and histogenesis of which resemble that of squamous cell carcinoma of the skin. Cisplatin-based combination therapies have been
G. B. E. Jemec et al. (eds.), Non-Surgical Treatment of Keratinocyte Skin Cancer, DOI: 10.1007/978-3-540-79341-0_9, © Springer-Verlag Berlin Heidelberg 2010
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Table 9.1 Approved chemotherapeutic agents used in the treatment of NMSC Drug Usual dose Mechanism of action Cisplatin
Doxorubicin
Paclitaxel
50–100 mg/m2 i.v. once or 15–20 mg/m2 daily for 5 days, repeated every 3rd–4th week Depends on the combination chemotherapy protocol, usually approximately 50–75 mg/m2 100–175 mg/m2 i.v., repeated
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