Study Compares Impact of Two Therapies on Survival in Squamous Cell Carcinoma

Survival rates in patients with cutaneous squamous cell carcinoma were similar in those receiving high-dose chemoradiotherapy vs conventional radical surgery, according to the results of a recent study published in the British Journal of Dermatology.

“Although the authors suggest CRT [chemoradiotherapy] offers similar long-term survival, surgery is still the treatment of choice with adjuvant measures, which includes radiation and/or chemotherapy,” noted Jerry D. Brewer, MD, MS, a professor of dermatology at the Mayo Clinic in Rochester, Minnesota, in an interview with Cancer Network.

In the current study, Hiura et al retrospectively assessed the cases of 34 patients with stage IV cutaneous squamous cell carcinoma. A total of 21 received chemotherapy while 13 received conventional radical surgery.

Among those who received high-dose chemoradiotherapy, the best overall response rate was 75%, and the disease control rate was 88%. The 1-year overall survival rate and the 1-year progression-free survival rate were 79% and 44%, respectively, in patients who received chemoradiotherapy vs 82% and 38%, respectively, in patients who received radical surgery.

However, researchers found that overall survival rates were lower among those who received low-dose chemoradiotherapy: median overall survival was 12.5 months in patients who received chemoradiotherapy vs 18.5 months in those who received radical surgery.

On subgroup analysis, patients who were administered low-dose 5-fluorouracil plus cisplatin (FP) exhibited better overall survival than other treatment groups.

The following regimens were employed during chemoradiotherapy: FP (cisplatin 15 mg/m² [Day 1-5]; 5-fluorouracil 800 mg/m² [Day 1-5]; every 4 weeks); FP’ (carboplatin area under the curve 5 [Day 1]; 5-fluorouracil 600 mg/m² [Day 1-5]; every 4 weeks); and S-1 ± CDDP (tegafur/gimeracil/oteracil 120 mg/day for 21 days ± cisplatin 60 mg/m² [Day 8]).

With respect to treatment-related adverse events, blood toxicities were most common, especially among patients receiving low-dose FP. These blood toxicities were readily managed with granulocyte colony–stimulating factor injection and/or a blood transfusion.

The current case series builds on previous research that comprised case reports. Despite the low power of the current study, Hiura et al stressed that it is likely the largest study to date.

“The main take home message is that cSCC [cutaneous squamous cell carcinoma] should be treated correctly, promptly, and aggressively the first time,” said Brewer. “Recurrent cSCC is very challenging. Sometimes a multidisciplinary approach for aggressive cSCC is best, which may include the combination of surgery, radiation, and/or chemotherapy.”

Looking forward, Brewer sees immunotherapy studies as being more telling. “It will be interesting and exciting when studies start to look more at immunotherapy, for patients that can tolerate it, as adjunctive measures for aggressive cSCC in terms of survival compared to traditional chemotherapeutic approaches,” he said.