scholarly journals Risk Factors and Diagnosis of Advanced Cutaneous Squamous Cell Carcinoma

2021 ◽  
Vol 11 (S2) ◽  
pp. e2021166S
Author(s):  
Gabriella Brancaccio ◽  
Maria Concetta Fargnoli ◽  
Giulia Briatico ◽  
Cristina Pellegrini ◽  
Tea Rocco ◽  
...  
Keyword(s):  
Risk Factors ◽  
Squamous Cell Carcinoma ◽  
Prognostic Factors ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Cutaneous Squamous Cell Carcinoma ◽  
Tumor Diameter ◽  
Locally Advanced Disease

Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer affecting humans. The combination of the increasing incidence and high mortality in advanced stages of the disease, defines cSCC as an emerging public health problem. Advanced disease includes metastatic and locally advanced cSCC. Metastatic disease refers to the presence of locoregional metastasis (in transit or to regional lymph nodes) or distant metastasis. Locally advanced disease has been defined as non-metastatic cSCC that is unlikely to be cured with surgery, radiotherapy, or combination treatment. While metastatic cSCC is easily diagnosed, locally advanced disease lacks consensus definition and diagnosis is made after multidisciplinary board consultation. Identifying patients with aggressive cSCC at highest risk for relapse may prevent the occurrence of advanced disease. Prognostic factors suggested by most guidelines include tumor diameter (>2 cm), localization on temple/ear/lip/area, thickness (>6 mm), or invasion beyond subcutaneous fat, poor grade of differentiation, desmoplasia, perineural invasion, bone erosion, immunosuppression, undefined borders, recurrence, growth rate, site of prior radiotherapy, and lymphatic or vascular involvement. Although risk factors associated with worse outcomes are well known, there is still a gap of knowledge on the precise risk of each factor taken individually. The aim of this review is to summarize cSCC prognostic factors and encompass the various staging systems to guide management and follow-up in cSCC patients at higher risk for local recurrence and metastasis. Finally, we describe the hallmarks of the advanced disease. Advanced cSCC diagnosis should be made by a multidisciplinary board considering patients’ performance status and disease characteristics

scholarly journals Study of epidemiology, clinicopathological correlation, prognostic factors and management in squamous cell carcinoma of vulva

2018 ◽  
Vol 8 (1) ◽  
pp. 223
Author(s):  
Chetana D. Parekh ◽  
Ruchi S. Arora ◽  
Shilpa M. Patel ◽  
Pabashi Poddar ◽  
Ava D. Desai ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Prognostic Factors ◽  
Hiv Infection ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Hpv 16 ◽  
Locally Advanced Disease

Background: Carcinoma of the vulva is rare cancer, pruritus is the most common and long-lasting reported symptom. It is found to be associated with HPV and HIV infection. Currently, a more individualized and less radical treatment is suggested. In this study we evaluated epidemiology, clinicopathological prognostic factors, HPV distribution and risk factors for metastases to lymph nodes. We also reviewed multidisciplinary clinical management carried out at our institute.Methods: It is a prospective study of 25 biopsy proven cases of Squamous Cell Carcinoma of Vulva, treated at our center from September 2014 to September 2016. We collected the data regarding the clinical presentation, histological details, treatment given, survival and complications. HPV 16 and 18 testing were done using PCR method. Median follow up of the patients are for 24 months.Results: The mean age of patients was 54.6 years. Commonest presentation was perineal itching (36%). HPV 16/18 were positive in 25% of the patients. Radical vulvectomy with bilateral groin dissection was done in 14/25 (56%) patients. Among these 14 patients, 35.7 % (5/14) has lymph node metastases, disease free survival was 63.6% and overall survival was 81.1% for median follow up of 24 months. About one third of the patient presented with locally advanced disease.  Six (24%) patients received only chemo radiation as a treatment.Conclusions: HPV and HIV infection increase the risk of vulvar cancer. Individualization of treatment is necessary. The use of preoperative chemoradiation in locally advanced disease might have promising results in future.

222 Increased PD-L1 tumor expression correlates with high rate of response to PD-1 inhibitors in patients with unresectable, recurrent, and metastatic cutaneous squamous cell carcinoma

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A241-A241
Author(s):  
Nate Bowers ◽  
Kimberly Burcher ◽  
Jess Savas ◽  
Phillip Williford ◽  
Laura Doerfler ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Tumor Tissue ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Cutaneous Squamous Cell Carcinoma ◽  
Maximum Response ◽  
Locally Advanced Disease ◽  
Rate Of Response

BackgroundPD-1 inhibitors were approved for locally advanced and metastatic cutaneous squamous cell carcinoma (CSCC) in 2019.1 The identification of tumor characteristics that predict potential responders to immune checkpoint inhibitors (ICI) is an area of ongoing research. Here we present a series of consecutive patients with locally advanced, recurrent, or metastatic CSCC treated with PD-1 inhibitors and analyze tumor and blood genomics as well as PD-L1 expression with the aim of correlating with treatment response.MethodsWe analyzed cases of CSCC treated with single agent PD-1 inhibitors in the last 2 years at Wake Forest. Demographic and outcome data were collected. Tumor tissue, whenever available, was tested for PD-L1, TMB, MSI, and genetic mutations. Blood was tested for circulating tumor at the beginning of treatment and at the time of maximum response.ResultsFourteen patients with CSCC treated with PD-1 ICI were included in this study. Six had locally advanced disease, seven had recurrent locally advanced disease, and one had metastatic disease. Four patients received treatment for >12 months and all had complete response (CR). Five patients had 6–12 months of treatment and all had near CR (pending imaging studies and ctDNA to confirm). Three patients had <6 months of treatment and had partial response (PR). Two of the patients had progressive disease, although one with possible pseudoprogression based on review of post-treatment surgical pathology specimen. Treatment was well tolerated with no immune related side-effects except one case of grade I hypothyroidism. Eleven patients had sufficient tumor tissue for genomic and PD-L1 testing. Initial blood genomic testing was performed in 12 of 13 patients and in follow up in patients who achieved maximum response. Patients with CR had PD-L1 of at least 30%. The additional tested patients had PD-L1 above 10%. The most frequently mutated gene was TP53 present in tumor in all tested patients and in blood in 6 patients, followed by NOTCH1/2 detected in the tumor of 10 of 11 patients tested. TMB was intermediate/high in tested patients except in the only patient who presented clear tumor progression.ConclusionsTreatment of locally advanced, recurrent, and metastatic CSCC with ICI led to a dramatic change in the management and prognosis of CSCC. Our series of patients with CSCC had a higher than reported rate of response. This corresponded with high TP53 alterations, NOTCH 1/2 alterations, high/intermediate TMB, and high level of expression of PD-L1. PD-L1 rates were higher than previously published.1 2Ethics ApprovalThe study was approved by Wake Forest University Institution’s Ethics Board, approval number IRB00056249.ReferencesMigden MR, Rischin D, Schmults CD, Guminski A, Hauschild A, Lewis KD, et al. PD-1 blockade with cemiplimab in advanced cutaneous squamous-cell carcinoma. N Engl J Med. 2018;379:341–51.Garcia-Pedrero JM, Martinez-Camblor P, Diaz-Coto S, et al. Tumor programmed cell death ligand 1 expression correlates with nodal metastasis in patients with cutaneous squamous cell carcinoma of the head and neck. J Am Acad Dermatol 2017;77(3):527–533.

Squamous Cell Carcinoma of the Esophagus: Multimodal Therapy in Locally Advanced Disease

2001 ◽  
Vol 26 (1) ◽  
pp. 72-78 ◽  
Author(s):  
Issam El Nakadi, M.D. ◽  
Jean-Luc Van Laethem, M.D. ◽  
Jean-Jacques Houben, M.D. ◽  
France Gay, M.D. ◽  
Jean Closset, M.D. ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Multimodal Therapy ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Carcinoma Of The Esophagus ◽  
Locally Advanced Disease

scholarly journals Age-related Differences in Tumour Characteristics and Prognostic Factors for Disease Progression in Cutaneous Squamous Cell Carcinoma of the Head and Neck

2021 ◽  
Author(s):  
Alet J.G. Leus ◽  
Marjolijn S. Haisma ◽  
Jorrit B. Terra ◽  
Gilles F.H. Diercks ◽  
Marloes S. Van Kester ◽  
...  
Keyword(s):  
Risk Factors ◽  
Squamous Cell Carcinoma ◽  
Prognostic Factors ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Cutaneous Squamous Cell Carcinoma ◽  
Tumour Diameter ◽  
Progression Of Disease ◽  
Tumour Characteristics

Guidelines for cutaneous squamous cell carcinoma of the head and neck do not take the age of the patient into account, but instead assume equal tumour characteristics and prognostic factors for poor outcome in younger and elderly patients. The aim of this study was to compare tumour characteristics of younger (< 75 years) and elderly (≥ 75 years) patients and identify age-specific risk factors for progression of disease, comprising local recurrence, nodal metastasis and distant metastasis. Patient and tumour characteristics were compared using χ2 or Fisher’s exact tests. Multivariable competing risk analyses were performed to compare risk factors for progression of disease, incorporating the risk of dying before developing progression of disease. A total of 672 patients with primary cutaneous squamous cell carcinoma of the head and neck were retrospectively included. Larger tumour diameter, worse differentiation grade and deeper invasion were observed in older patients. In elderly patients, but not in younger patients, tumour diameter ≥ 40 mm, moderate differentiation grade and an invasion depth ≥ 2 mm were independent risk factors for progression of disease.

scholarly journals Increased PD-L1 Tumor Expression Correlates with High Rate of Response to PD-1 Inhibitors in Patients with Unresectable, Recurrent, and Metastatic Cutaneous Squamous Cell Carcinoma

2021 ◽  
Vol 5 (1) ◽  
pp. 22-24
Author(s):  
Nathan Bowers ◽  
Mercedes Porosnicu
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Cutaneous Squamous Cell Carcinoma ◽  
Imaging Studies ◽  
Tumor Expression ◽  
Rate Of Response

Background: PD-1 inhibitors were approved for locally advanced and metastatic cutaneous squamous cell carcinoma (CSCC) in 2019 with ORR of 47% and CR of 4%. The identification of tumor characteristics that predict potential responders to immune checkpoint inhibitors (ICI) is an area of ongoing research. Here we present a series of consecutive patients with locally advanced unresectable, recurrent, or metastatic CSCC treated with PD-1 inhibitors and analyze tumor and blood genomics as well as PD-L1 expression with the aim to correlate with treatment response. Methods:  We analyzed all cases of CSCC treated with single agent PD-1 inhibitors in the last 2 years at Wake Forest Comprehensive Cancer Center. Demographic and outcome data was collected. Tumors tested for genomics and PD-L1 expression in all cases with available tissue. PD-L1 tumor expression was tested by IHC utilizing DAKO 22C3 pharmDx antibodies.  Tumor genomic studies including TMB and MSI were performed by Foundation Medicine platform. Blood was tested for circulating tumor DNA by Guardant 360 platform, at the beginning of treatment and in follow up at the time of maximum response.  Response was assessed by RECIST 1.1 Criteria. Results (Table 1): Eleven patients with CSCC treated with PD-1 ICI were included in this study. Five patients had locally advanced disease, five patients had recurrent locally advanced disease, and three patients had metastatic disease. Three patients received treatment for at least 12 months and all have CR to date. Two patients have been on treatment for 6 months, and they have excellent PR with possible CR per imaging studies. Of the six patients who have been on treatment for less than 6 months, one patient has excellent PR with negative PET, three patients have very good clinical response with imaging studies pending, one patient has questionable response, and one patient only recently started treatment. Treatment is well tolerated with no treatment discontinuation. Immune-related complications are rare consisting of only one patient developing hypothyroidism during treatment. Eight patients had sufficient tumor tissue for genomic and PD-L1 testing. Initial blood genomic testing was performed in 10 of 11 patients and in follow up in all three patients who achieved maximum response. Patients with CR had PD-L1 of at least 30%. The additional tested patients have PD-L1 above 10%.  The most frequently mutated tDNA gene was TP53 and the second most frequently mutated gene was the NOTCH1/2. TMB was intermediate or high in all tested patients. Discussion:  Treatment of locally advanced unresectable, recurrent, and metastatic CSCC with ICI has led to a dramatic change in the management and prognosis of CSCC. Our series of patients with CSCC has a higher than reported rate of response and especially complete response. This corresponds with high TP53 alterations (100% of patients), NOTCH 1/2 alterations (90 % of patients) and high level of expression of PD-L1 (90% patients). Interestingly, PD-L1 rates were higher than previously published.

Cemiplimab in a very frail population of patients with advanced or metastatic cutaneous squamous cell carcinoma: A monocenter real-life experience from Italy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21524-e21524
Author(s):  
Michele Guida ◽  
Annarita Fanizzi ◽  
Davide Quaresmini ◽  
Annalisa Nardone ◽  
Andrea Armenio ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Antitumor Activity ◽  
Cell Carcinoma ◽  
Clinical Outcomes ◽  
Squamous Cell ◽  
Life Experience ◽  
Locally Advanced ◽  
Real Life ◽  
Cutaneous Squamous Cell Carcinoma ◽  
High Antitumor Activity

e21524 Background: Cutaneous squamous cell carcinoma (CSCC) is the second most common skin cancer. Although representing less than 5% of all CSCCs, advanced stages are difficult to treat. Cemiplimab, an antiPD-1 monoclonal antibody, is the first approved immunotherapy in the US and EU for patients with locally advanced (laCSCC) or metastatic (mCSCC) CSCC. Phase I-II studies showed high antitumor activity and good tolerability, but few data are still available regarding cemiplimab in real life experience in non-selected patients. Methods: We recruited 30 consecutive patients with laCSCC (25 pts) and mCSCC (5 pts) treated with cemiplimab from August 2019 to November 2020 at our Institution. Median age was 81 years (range 36-95); 24 males; median ECOG PS 1 (range 0-2). Five patients had an immunosuppressive condition including 3 patients with stable hematologic malignancies and two patients on immunosuppressive therapy for kidney transplantation and Crohn’s disease, respectively. The majority of patients had comorbidities (median 3). Cemiplimab was administered at the flat dose of 350 mg i.v. every 21 days until disease progression or unacceptable toxicity. In all patients we evaluated clinical outcomes, toxicity, and associations between clinical outcomes and peripheral blood parameters. Results: We reported 23 responses (ORR 76.7%) with CR in 5 patients (16.7%). One patient had SD for 5 months. The global DCR was 80%. The median duration of response and PFS was not reached at a median follow-up of 6 months. We observed a higher ORR in head and neck primary tumours (87% vs. 42.9% of others, p = 0.016) and in patients with haemoglobin level > 12 g/dL (87.5% vs. 64.3%). No significative difference in ORR was observed with respect to the median age (81.3% in >81 years vs. 71.4% in < 81 years). Among the 5 patients with immunosuppressive status, a response was obtained in 4 patients (80%), including 1 CR. Nine patients died, 7 for PD and 2 for causes unrelated to the disease. Twenty patients (67.7%) still have an ongoing response. The treatment was well tolerated by the majority of patients. The most common adverse events were fatigue in 7 patients (23.3%) and skin toxicity in 10 patients (33.3%) including pruritus in 6 patients, rash in 3 patients, bullous erythema in 1 patient. Only 3 (10%) patients experienced severe (grade 3/4) toxicity. Three responder patients interrupted treatment (2 for toxicity after 7 and 9 cycles, and one for pre-existing dementia) but maintaining their response. Conclusions: In our real-life experience cemiplimab showed high antitumor activity with acceptable safety profile similar to those in selected patients of trials. Moreover, its antitumor activity resulted not impaired in very elderly patients or in those with immunocompromized status.

scholarly journals Metastatic cutaneous squamous cell carcinoma of the head and neck: Characteristics of the primary and poor prognostic factors

2012 ◽  
Vol 10 (8) ◽  
pp. S5
Author(s):  
David Walker ◽  
Rajeev Mathew ◽  
Tatiana Gutierrez ◽  
Reza Nouraei ◽  
Patrick McCabe ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Prognostic Factors ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Cutaneous Squamous Cell Carcinoma
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