Important developments in the treatment of SCC

Until recently, patients with non-melanoma skin cancers have had limited treatment options available, and efficacy levels have been relatively low. However, recent clinical advancements have opened the door to therapeutic options that demonstrate positive results.

During a session at the Fall Clinical Dermatology Conference on Friday, October 18, Scott Dinehart, M.D., a dermatologist with Arkansas Dermatology in Little Rock, Ark., discussed two new methods for attacking non-melanoma skin cancer, particularly squamous cell carcinoma. These developments are critical, he says, because many patients end up dying from the disease.

“In the past, we’ve really had nothing but surgery and radiation to help them, and that hasn’t worked very well for these patients,” he says. “We’ve never had an FDA-approved drug for this condition before, so this immunotherapy is a God-send. For the first time, we’re able to influence the disease.”

The medication, called cemiplimab (Libtayo, Sanofi Regeneron), is considered a first-line response to squamous cell carcinoma. As a a PD-1 inhibitor that restores the anti-tumor T-cell response, it prompts a rapid response in patients - results can be seen in less than two months. Patients typically receive 350 mg intravenous infusions every three weeks.

While dermatologists don’t administer the medication themselves, they are responsible for identifying these patients and working closely with oncologists. So far, Dr. Dinehart has already had five patients from his practice treated successfully with cemiplimab.

“I can see just from my patients alone that this is a superior treatment,” he says. “And, when you look at the oncology studies, there are three now with this therapy for squamous cell carcinoma. You can see objective responses that you’ve never seen before.”

Overall, patients tolerate cemiplimab well, he says. The most common side effects include fatigue, joint pain, rash, diarrhea, and nausea. Only 5% of patients experienced adverse events significant enough to abandon treatment.

Unfortunately, though, Dr. Dinehart says this immunotherapy cannot be used in patients who have received lung, heart, or liver transplants because it would cause the body to reject the transplanted organ, endangering the patient’s life. These patients account for roughly half of individuals with locally advanced or metastatic squamous cell carcinoma.

“We still have work to do,” he says. “We still need better therapies because those patients, right now, are left out of these benefits.”

The drug is, however, safe for patients who have had a kidney transplant.

Dr. Dinehart also points to sequential therapy as an effective immunotherapy strategy for combatting squamous cell carcinoma, indicating dermatologists are already equipped to begin this treatment.

“This is something dermatologists should start doing in their offices Monday morning,” he says. “It’s something they can do, should do, and will do,” he says.

With this therapy, providers should recommend patients use a topical steroid for two weeks, such as clobetasol twice daily, following it with imiquimod, a cream already used to treat rough skin patches and basal cell carcinoma. The steroids strip away the fork-head box P3 (Foxp3) Treg cells that work as stop signs to protect the tumor, allowing the imiquimod to penetrate and destroy it.

“It’s like the Death Star from Star Wars. With the Death Star’s shield up, you can’t kill it,” Dr. Dinehart says. “And, the shield is the Foxp3 cells. If you chase those off with the steroid cream, you can more easily destroy the Death Star, which is the cancer.”

Sequential therapy is not yet in widespread use, he says, but he anticipates that will change quickly as this is a treatment option that dermatologists can implement on their own.

“It’s something they can do in their practice and something that will benefit their patients,” he says. “It is also something that will introduce them to another subset of immunology that’s going to be important in the future.”