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- Presentation
Peri-Operative Management of High-Risk CSCC
Description
The session focuses on the peri-operative management of high-risk cutaneous squamous cell carcinoma (CSCC), featuring an interactive element to engage participants in recent trends and practices. The speaker presents a case study of an elderly male with a poorly differentiated CSCC lesion, emphasizing the importance of imaging and sentinel lymph node biopsies in identifying disease extent and appropriate management pathways. The National Comprehensive Cancer Network (NCCN) guidelines are referenced, highlighting the recommendation of neoadjuvant therapy, particularly anti-PD-1 treatments, for certain high-risk cases. New data indicate significant response rates, with many patients showing major or complete pathological responses and long-term remission. The speaker discusses the evolving landscape of adjuvant treatments, including the role of radiation therapy, and presents recent clinical trial results that contrast outcomes of different therapies. Despite the promising efficacy of pre-operative immunotherapy, the optimal timing and approach remains uncertain, with ongoing research needed to clarify best practices. The session concludes by reiterating key take-home points regarding imaging, lymph node evaluation, and the rapid evolution of management for cutaneous malignancies.
View moreConclusions
- Neoadjuvant therapy with anti-PD-1 has shown promising results in preoperative management of high-risk CSCC, resulting in high rates of pathological complete response.
- NCCN guidelines suggest considering neoadjuvant immune checkpoint inhibitors for tumors with rapid growth, in-transit metastasis, or those that may lead to significant functional limitations after surgery.
- Imaging and lymph node evaluation are critical in assessing high-risk CSCC to determine appropriate treatment strategies.
- The risk of metastasis for high-risk CSCC can be significant, necessitating careful stratification and management based on clinical and histological findings.
- Postoperative management guidelines indicate that radiotherapy may improve outcomes for patients with specific high-risk features, but the role of systemic therapy remains unclear.
- Recent studies have highlighted the potential cardiovascular risks associated with immune checkpoint inhibitors in older, comorbid populations, necessitating rigorous patient selection.
- Adjuvant therapy with cemiplimab showed a significant reduction in disease recurrence or death in high-risk patients compared to traditional therapies.
- Both pre- and postoperative immunotherapy approaches are evolving and require ongoing assessment to optimize patient outcomes.
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