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- Presentation
Adjuvant Immunotherapy for High-Risk Cutaneous Squamous Cell Carcinoma
Description
The discussion centers around adjuvant immunotherapy for high-risk cutaneous squamous cell carcinoma (CSCC), highlighting the contrasting results from two significant clinical trials involving pembrolizumab from Merck and simliflumab from Regeneron. The Merck trial did not demonstrate significant improvement in recurrence-free survival, whereas Regeneron reported marked improvement with a hazard ratio of 0.32. Despite the promise of simliflumab, concerns about increased grade 3 adverse events arose, suggesting the treatment comes with toxicity risks. The need for careful monitoring of adverse effects is emphasized. Clinical management of patients with varying risk profiles was then examined through case discussions involving factors like perineural invasion and post-operative radiation decisions. The complexities of treating high-risk cases, including careful consideration of immunosuppressed renal transplant patients, were explored. Options like cetuximab or intralesional therapies were considered, alongside findings from recent studies that suggest mTOR inhibitors may mitigate risks of allograft rejection while allowing effective immunotherapy. The conversation underscored the collaborative approach required in managing these challenging cases, balancing treatment efficacy against potential risks. Overall, there is a call for patience as the outcomes from ongoing studies and more comprehensive data emerge.
View moreConclusions
- Adjuvant immunotherapy using cemiplimab shows significant improvement in disease-free survival in high-risk cutaneous squamous cell carcinoma compared to placebo.
- Merck's pembrolizumab did not demonstrate statistical significance in improving recurrence-free survival in similar patient populations.
- Cemiplimab has a remarkably low hazard ratio for disease-free survival, indicating a 68% reduction in recurrence or death events compared to placebo.
- Safety profiles indicate a higher incidence of treatment-emergent adverse events in the cemiplimab group, including more severe grade 3 adverse events and treatment discontinuations due to adverse effects.
- A multidisciplinary approach is crucial for managing patients with high-risk skin cancers, especially in immunocompromised individuals like transplant recipients.
- Standardized immunosuppression regimens that incorporate mTOR inhibitors appear to reduce the risk of organ rejection while allowing for effective responses to immune checkpoint inhibitors in kidney transplant recipients.
- Use of mTOR inhibitors can provide protection against allograft rejection in patients undergoing immune checkpoint inhibitor therapy.
- Toxicity considerations, including potential serious adverse events such as anaphylaxis, must be carefully monitored when administering combined immunotherapy and transplant medications.
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