Dramatic response of refractory metastatic squamous cell carcinoma of the skin with cetuximab/pembrolizumab

Abstract

Cutaneous squamous cell carcinoma (cSCC) accounts for 20% of skin cancers. At an advanced stage the prognosis is poor, making cSCC the second leading cause of death from skin cancer. In cases of metastatic or unresectable disease, anti-programmed cell death 1 (anti-PD1) treatment has shown promising results in a recent phase II study. Although anti-PD1 treatment now offers higher response rates, the responses remain inconsistent and may lead to therapeutic impasses. Preclinical data have suggested synergy between anti-epidermal growth factor receptor (anti-EGFR) and immunotherapy. We report the case of a patient with metastatic cSCC that proved refractory first to anti-EGFR/carboplatin and then to immunotherapy, but who showed a complete and durable response with cetuximab/pembrolizumab combination. This response could reflect synergy of the two treatments.

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“…Interestingly, according to a prespecified subgroup analysis of the NCT02721732 open-label, phase II clinical trial, those patients with advanced cSCC that achieved CR (3/19) remained free of recurrence after a long-term follow-up, potentially experiencing cure [ 66 ]. Currently, ongoing studies are evaluating not only pembrolizumab monotherapy (NCT02964559), but also novel therapeutic approaches for la-cSCC, such as pembrolizumab associated with cetuximab [ 67 ], a human-murine chimeric monoclonal IgG1 antibody directed against EGFR (NCT03082534), with promising results reported for recurrent or metastatic head and neck SCC [ 68 ].…”

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“…The prognosis can be very good, with a 90% survival rate for 10 years, when the disease is in its early stages; if the cancer is extensive or metastasized, survival is reduced to 15.3 months on average, making it the second leading cause of death from cSCC after melanoma in skin cancers [135,136].…”