Response of advanced cutaneous squamous cell carcinoma to immunotherapy: case report.

Q1 Biochemistry, Genetics and Molecular Biology
Stem cell investigation Pub Date : 2021-09-06 eCollection Date: 2021-01-01 DOI:10.21037/sci-2020-071
Sara Ashraf, Mohamed Alsharedi
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引用次数: 3

Abstract

The most common cancer in the United States is non-melanoma skin cancer. Cutaneous squamous cell carcinoma (cSCC) is the second most common non-melanoma skin cancer after basal cell carcinoma. It develops in the middle and outer layers of the skin. Its precursor is actinic keratosis, which can progress to squamous cell carcinoma in situ, invasive cSCC, and finally metastatic cSCC. About 20% of non-melanoma skin cancers are squamous cell and the remaining 80% are basal cell. Unlike basal cell, squamous cell carcinoma has the propensity to metastasize. This commonly occurs with squamous cell carcinoma (SCC) thicker than 2 millimeters. The risk of metastasis and local recurrence increases with 6 mm thickness and desmoplasia. The risk factors are excessive sun or ultraviolet light (tanning beds) exposure, immunosuppression (either having a weakened immune system or taking immunosuppressive therapy) and fair skin. Therefore, it most commonly affects skin in the head and neck area such as scalp, ears, lips, face, neck or the back of the hands. The treatment for local cutaneous squamous cell cancer is mainly surgery; excisional surgery, Moh's surgery, cryosurgery, curettage and electrodessication, laser surgery or radiation therapy, photodynamic therapy or topical agents such as fluorouracil or imiquimod. However, cSCC that is locally advanced, such as involvement of regional lymph nodes, or has metastasized to distant organs or tissue, is not amenable to surgery or radiation alone. Immunotherapy with cemiplimab, a programmed cell death 1 (PD-1) inhibitor, is a US Food and Drug Administration (FDA) approved therapeutic option for locally advanced and metastatic cSCC for patients who are not candidates for or whose disease is not susceptible to curative surgery or radiation therapy. Cemiplimab is a humanized recombinant immunoglobulin monoclonal antibody that binds to and blocks PD-1 receptor found on T cells inhibiting T-cell proliferation and cytokine production. We present a case of locally advanced cSCC with regional lymph nodes metastases, which achieved clinical remission, utilizing a unique approach of therapy combining a checkpoint inhibitor, Cemiplimab and radiotherapy.

Abstract Image

晚期皮肤鳞状细胞癌对免疫治疗的反应:1例报告。
美国最常见的癌症是非黑色素瘤皮肤癌。皮肤鳞状细胞癌(cSCC)是仅次于基底细胞癌的第二常见的非黑色素瘤皮肤癌。它发生在皮肤的中间层和外层。其前体为光化性角化病,可发展为原位鳞状细胞癌、侵袭性cSCC,最后发展为转移性cSCC。约20%的非黑色素瘤皮肤癌是鳞状细胞癌,其余80%是基底细胞癌。与基底细胞癌不同,鳞状细胞癌有转移倾向。这种情况常见于厚度大于2毫米的鳞状细胞癌(SCC)。6毫米厚度和结缔组织增生增加了转移和局部复发的风险。风险因素是过度暴露在阳光下或紫外线下(晒黑床),免疫抑制(免疫系统较弱或接受免疫抑制治疗)和皮肤白皙。因此,它最常影响头颈部的皮肤,如头皮、耳朵、嘴唇、面部、颈部或手背。局部皮肤鳞状细胞癌的治疗以手术为主;切除手术、莫氏手术、冷冻手术、刮除和电干燥、激光手术或放射治疗、光动力治疗或局部用药,如氟尿嘧啶或咪喹莫特。然而,局部进展的cSCC,如累及区域淋巴结,或转移到远处的器官或组织,不适合单纯手术或放疗。应用程序性细胞死亡1 (PD-1)抑制剂cemiplimab进行免疫治疗是美国食品和药物管理局(FDA)批准的一种局部晚期和转移性cSCC的治疗选择,用于不适合或疾病不易接受根治性手术或放疗的患者。Cemiplimab是一种人源化重组免疫球蛋白单克隆抗体,结合并阻断T细胞上发现的PD-1受体,抑制T细胞增殖和细胞因子的产生。我们报告了一例局部晚期cSCC伴区域淋巴结转移的病例,该病例采用检查点抑制剂、Cemiplimab和放疗相结合的独特治疗方法,获得了临床缓解。
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来源期刊
Stem cell investigation
Stem cell investigation Biochemistry, Genetics and Molecular Biology-Developmental Biology
CiteScore
5.80
自引率
0.00%
发文量
9
期刊介绍: The Stem Cell Investigation (SCI; Stem Cell Investig; Online ISSN: 2313-0792) is a free access, peer-reviewed online journal covering basic, translational, and clinical research on all aspects of stem cells. It publishes original research articles and reviews on embryonic stem cells, induced pluripotent stem cells, adult tissue-specific stem/progenitor cells, cancer stem like cells, stem cell niche, stem cell technology, stem cell based drug discovery, and regenerative medicine. Stem Cell Investigation is indexed in PubMed/PMC since April, 2016.
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