Review Touts Benefits of Immunotherapy for Non-Melanoma Skin Cancers

May 3, 2019
Naveed Saleh, MD, MS

The authors discuss the potential use and limitations of immunotherapy among patients with squamous cell cancer, basal cell carcinoma, and other skin cancers.

A recent review published in Drugs in Context focused on the use of immunotherapy to treat non-melanoma skin cancers. 

Meenal Kheterpal, MD, a dermatologist at Duke Health, noted that although the paper is a brief review, it offers several valuable insights for oncologists. 

“The article is well-timed. It mentions that we now have a new class of therapy [immunotherapy] which has robust evidence in terms of overall response, disease control, and outcomes in a fair number of patients,” she said. “The article could bring attention to immunotherapy as a potential treatment option for medical, radiation, and surgical oncologists, who are at the forefront of deciding the fate of these patients.”

The authors predict that advanced cutaneous squamous cell cancer (CSCC) will soon be treated with checkpoint control. Recent studies have supported the use of cemiplimab and pembrolizumab as treatments for patients with locally advanced and metastatic CSCC.

“We now have data to support the use of these therapies,” said Kheterpal. “What it would take for these drugs to become first-line treatment for locally advanced and metastatic squamous and basal cell carcinoma? I don’t know if immunotherapy could ever be first-line for CSCC. There are medical reasons for that.”

Kheterpal explained that a large proportion of people with advanced non-melanoma cancers are solid organ-transplant recipients, and it may not be a good idea to engage the immune systems of these patients. “If you give somebody immunotherapy, it can rev up the immune system, and the organ may be rejected.”

Nevertheless, she sees immunotherapy as clinically effective in patients with non-melanoma cancer who are not transplant recipients, as well as those who harbor advanced metastatic disease and have no other options.

Kheterpal stressed that the benefit of immunotherapy in skin cancers is variable, with certain cancers being much more vulnerable to its effects. “Immunotherapy is now first-line treatment for Merkel cell carcinoma, one of the most aggressive skin cancers, which is extremely rare. The article talks about Merkel cell carcinoma, but it doesn’t mention that pembrolizumab was recently approved as first-line treatment for recurrent locally advanced and metastatic MCC,” she said.

“In some cases-like Merkel cell carcinoma and melanoma-immunotherapy is far more promising and the path far more clear. However, in cutaneous squamous cell cancer-due to other comorbidities-the use is somewhat challenging. Potentially, alternative scheduling, such as lower dosing or intralesional routes of drug administration, can help sort that out.”

In addition to discussing immunotherapy, the authors of the review reported that although the incidence and prevalence of cutaneous squamous cell cancer and basal cell cancer have increased from 3% in 1960 to 8% now, the frequencies of these cancers are not formally documented.

Kheterpal foresees consequences due to underreporting, including lack of drug development for these cancers. Without adequate numbers, it is hard for drug companies to gauge consumer need.

“Almost all cancers are reportable,” she said. “You can quantify and look at every cancer. We don’t know the true incidence of basal and squamous cell cancers. It’s very hard to quantify. There is no SEER database reporting requirement for non melanoma skin cancers in the United States.”