Rescue therapy with anti-programmed cell death protein 1 inhibitors (PD-1) of advanced cutaneous squamous cell carcinoma and basosquamous carcinoma: preliminary experience in 5 cases

Abstract

Locally unresectable and metastatic cutaneous squamous cell carcinomas pose a therapeutic challenge. Their overall response to chemotherapy, radiation and/or EGFR inhibitors is poor. Five consecutive heavily pretreated advanced patients with progressive cutaneous squamous cell carcinoma (four cases) or basosquamous carcinoma (one case) received an immune checkpoint inhibitor, either nivolumab or pembrolizumab, directed at PD-1 receptor. Two patients with large necrotic lesions obtained partial responses and three cases experienced stabilization of their disease. Responses were observed within three months and persisted beyond 6 months. Tolerance to treatment was good with no significant toxicity. Two patients died after 5.5 and 6 months due to complications unrelated to anti-PD1 therapy. Limited genomic profiling showed all tumors had a high overall mutation burden. Our observations suggest that anti-PD-1 inhibitors may have a clinically meaningful activity in aggressive advanced cutaneous squamous cell cancers refractory to standard therapy. The value of PD-1 blocking agents in aggressive non-melanoma skin cancers needs to be confirmed in prospective trials.

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