1
|
Bratland Å, Munoz-Couselo E, Mortier L, Roshdy O, González R, Schachter J, Arance AM, Grange F, Meyer N, Joshi AJ, Billan S, Hughes BGM, Grob JJ, Ramakrishnan K, Ge J, Gumuscu B, Swaby RF, Gutzmer R. Health-Related Quality of Life with Pembrolizumab in Patients with Locally Advanced or Recurrent or Metastatic Cutaneous Squamous Cell Carcinoma: KEYNOTE-629. Dermatol Ther (Heidelb) 2023; 13:3165-3180. [PMID: 37943491 PMCID: PMC10689716 DOI: 10.1007/s13555-023-01059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION At first interim analysis of KEYNOTE-629, health-related quality of life (HRQoL) with pembrolizumab was stable or improved over 48 weeks in recurrent or metastatic (R/M) cutaneous squamous cell carcinoma (cSCC). HRQoL results from the second interim analysis in R/M or locally advanced (LA) cSCC are presented. METHODS Patients received pembrolizumab 200 mg every 3 weeks for ≤ 2 years. Change in EORTC Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and EQ-5D-5L scores were exploratory end points. Primary analysis was performed at week 12 to ensure adequate completion/compliance. Descriptive analyses were also conducted through weeks 48 and 75 for the LA and R/M cohorts, respectively. RESULTS At data cutoff (29 July 2020), mean scores in the LA cohort (n = 47) were stable from baseline to week 12 for EORTC QLQ-C30 global health status (GHS)/quality of life (QoL) (-0.27 points [95% confidence interval (CI) -10.93 to 10.39]), physical functioning (-1.29 points [95% CI -8.77 to 6.19]), and EQ-5D-5L visual analog scale (2.06 [95% CI -7.70 to 11.82]). HRQoL remained stable through week 48 in the LA cohort; 76.6% and 74.5% of patients had improved or stable GHS/QoL and physical functioning scores, respectively. HRQoL continued to show stability or improvement through week 75 in the R/M cohort (n = 99); 71.7% and 64.6% of patients had improved or stable GHS/QoL and physical functioning scores, respectively. CONCLUSIONS Pembrolizumab has demonstrated antitumor activity and manageable safety. The current analysis shows pembrolizumab treatment preserved HRQoL. Collectively, these results support pembrolizumab as standard of care for LA or R/M cSCC. TRIAL REGISTRATION ClinicalTrials.gov, NCT03284424-September 15, 2017.
Collapse
Affiliation(s)
- Åse Bratland
- Head and Neck Oncology, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway.
| | - Eva Munoz-Couselo
- Department of Medical Oncology, Melanoma and Other Skin Tumors Unit, Vall d'Hebron Hospital, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
- Vall d'Hebron Institute of Oncology (VHIO), Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - Laurent Mortier
- Department of Dermatology, INSERM U 1189, Université Lille, Centre Hospitalier Regional Universitaire de Lille, 2, Avenue Oscar Lambret, 59037, Lille, France
| | - Osama Roshdy
- Division of Dermatology, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G4, Canada
| | - Rene González
- Surgical Oncology, Centro Estatal de Cancerologiade Chihuahua, C. Ejercito Mexicano 3700, 31000, Chihuahua, Mexico
| | - Jacob Schachter
- Division of Oncology, Level 2, Cancer Center (Oncology Institute), Sheba Medical Center-Tel Hashomer, Emek HaEla Street 1, 52621, Ramat Gan, Israel
| | - Ana M Arance
- Medical Oncology, Hospital Clinic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Florent Grange
- Dermatology/Oncology, CHU Reims-Hôpital Robert Debre, Avenue du General Koenig Service de Dermatologie, 51100, Reims, France
- Dermatology Department, Valence Hospital, 179 Bd Maréchal Juin, 26000, Valence, France
| | - Nicolas Meyer
- Onco-Dermatology, Institut Claudius Regaud, Institut Universitaire du Cancer and CHU, 1 Avenue Irene Joliot Curie, 31059, Toulouse, France
| | - Abhishek Jagdish Joshi
- Department of Medical Oncology, Townsville University Hospital, 55 Keane Street, Douglas, QLD, 4814, Australia
| | - Salem Billan
- Head and Neck Malignancies Unit, Rambam Health Care Campus, Technion-Israel Institute of Technology, HaAliya HaShniya St 8, 52621, Haifa, Israel
| | - Brett G M Hughes
- Oncology, Clinical Research Unit, Medical Oncology, Royal Brisbane and Women's Hospital, Butterfield Street, Ground Floor, Building 34, Herston, QLD, 4029, Australia
- Department of Oncology, University of Queensland, 308 Queen St, Brisbane, QLD, 4000, Australia
| | - Jean-Jacques Grob
- Dermatology, AIX-Marseille University and APHM Hospital Marseille, 264 Rue Saint Pierre, 13385, Marseille, France
| | | | - Joy Ge
- Medical Oncology, Merck & Co., Inc., 2025 E Scott Ave, Rahway, NJ, 07065, USA
| | - Burak Gumuscu
- Medical Oncology, Merck & Co., Inc., 2025 E Scott Ave, Rahway, NJ, 07065, USA
| | - Ramona F Swaby
- Medical Oncology, Merck & Co., Inc., 2025 E Scott Ave, Rahway, NJ, 07065, USA
| | - Ralf Gutzmer
- Department of Dermatology, Skin Cancer Center Hannover, Hannover Medical School, Carl-Neuberg-Str. 1, 60325, Hannover, Germany
- Department of Dermatology, Johannes Wesling Medical Center Hans-Nolte-Straße 1, 32429, Minden, Germany
- Ruhr University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| |
Collapse
|
2
|
Nguyen NP, Thariat J, Gorobets O, Vinh-Hung V, Kim L, Blanco SC, Vasileiou M, Arenas M, Mazibuko T, Giap H, Vincent F, Chi A, Loganadane G, Mohammadianpanah M, Rembielak A, Karlsson U, Ali A, Bose S, Page BR. Immunotherapy and Hypofractionated Radiotherapy in Older Patients with Locally Advanced Cutaneous Squamous-Cell Carcinoma of the Head and Neck: A Proposed Paradigm by the International Geriatric Radiotherapy Group. Cancers (Basel) 2023; 15:4981. [PMID: 37894347 PMCID: PMC10605563 DOI: 10.3390/cancers15204981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Cutaneous skin carcinoma is a disease of older patients. The prevalence of cutaneous squamous-cell carcinoma (cSCC) increases with age. The head and neck region is a frequent place of occurrence due to exposure to ultraviolet light. Surgical resection with adjuvant radiotherapy is frequently advocated for locally advanced disease to decrease the risk of loco-regional recurrence. However, older cancer patients may not be candidates for surgery due to frailty and/or increased risk of complications. Radiotherapy is usually advocated for unresectable patients. Compared to basal-cell carcinoma, locally advanced cSCC tends to recur locally and/or can metastasize, especially in patients with high-risk features such as poorly differentiated histology and perineural invasion. Thus, a new algorithm needs to be developed for older patients with locally advanced head and neck cutaneous squamous-cell carcinoma to improve their survival and conserve their quality of life. Recently, immunotherapy with checkpoint inhibitors (CPIs) has attracted much attention due to the high prevalence of program death ligand 1 (PD-L1) in cSCC. A high response rate was observed following CPI administration with acceptable toxicity. Those with residual disease may be treated with hypofractionated radiotherapy to minimize the risk of recurrence, as radiotherapy may enhance the effect of immunotherapy. We propose a protocol combining CPIs and hypofractionated radiotherapy for older patients with locally advanced cutaneous head and neck cancer who are not candidates for surgery. Prospective studies should be performed to verify this hypothesis.
Collapse
Affiliation(s)
- Nam P. Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC 20059, USA;
| | - Juliette Thariat
- Department of Radiation Oncology, Francois Baclesse Cancer Center, 14000 Cain, France;
| | - Olena Gorobets
- Department of Oral Surgery, University of Martinique, 97213 Martinique, France;
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Institut Bergonie, 33076 Bordeaux, France;
| | - Lyndon Kim
- Division of Neuro-Oncology, Mount Sinai Hospital, New York, NY 10029, USA;
| | - Sergio Calleja Blanco
- Department of Oral and Maxillofacial Surgery, Howard University, Washington, DC 20059, USA;
| | - Maria Vasileiou
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - Meritxell Arenas
- Department of Radiation Oncology, Sant Joan de Reus University Hospital, University of Rovira, I Virgili, 43204 Tarragona, Spain;
| | - Thandeka Mazibuko
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC 20001, USA; (T.M.); (U.K.)
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Felix Vincent
- Department of Surgery, Southern Regional Health System, Lawrenceburg, TN 29425, USA;
| | - Alexander Chi
- Department of Radiation Oncology, Xuanwu Hospital, Capital Medical University, Beijing 101125, China;
| | | | - Mohammad Mohammadianpanah
- Colorectal Research Center, Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran;
| | - Agata Rembielak
- Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK;
- Division of Cancer Sciences, Faculty of Biomedicine and Health, School of Medical Sciences, The University of Manchester, Manchester M13 9PL, UK
| | - Ulf Karlsson
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC 20001, USA; (T.M.); (U.K.)
| | - Ahmed Ali
- Division of Hematology Oncology, Howard University, Washington, DC 20059, USA;
| | - Satya Bose
- Department of Radiation Oncology, Howard University, Washington, DC 20059, USA;
| | - Brandi R. Page
- Department of Radiation Oncology, Johns Hopkins University, Baltimore 21218, MD, USA;
| |
Collapse
|
3
|
Lorini L, Alberti A, Bossi P. Advanced Cutaneous Squamous Cell Carcinoma Management in Immunotherapy Era: Achievements and New Challenges. Dermatol Pract Concept 2023; 13:dpc.1304a251. [PMID: 37992352 PMCID: PMC10656166 DOI: 10.5826/dpc.1304a251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 11/24/2023] Open
Abstract
Introduction of immunotherapy (IT) has radically changed the therapeutic scenario in patients affected by locally advanced and/or metastatic cutaneous squamous cell carcinoma (cSCC) patients. If it is well consolidated the role of immunotherapy in the setting of a disease not amenable to curative surgery and/or radiation, how to integrate immune checkpoint inhibitors in the curative setting is still under evaluation. Surgery combined or not with adjuvant radiotherapy remains the mainstay of curative treatment in localized cSCC; however, promising data with neoadjuvant or perioperative immunotherapy could pave the way towards treatment de-escalation according to the response achieved. On the other side, data on adjuvant treatment with pembrolizumab and cemiplimab after surgery and radiation are still awaited. Several questions related to the activity and the safety of immunotherapy in the real-world setting still remain without answer, and several points need to be better explored. In the current review we will explore the updated literature on the use of immunotherapy in cSCC, and we will show the current challenges in its use.
Collapse
Affiliation(s)
- Luigi Lorini
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Andrea Alberti
- Medical Oncology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Paolo Bossi
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| |
Collapse
|
4
|
Barnes EA, Tsao MN, Taggar AS, Ravi A, Paudel MR. Optimizing surface mould brachytherapy for treatment of nasal basal cell carcinoma using customized applicators. Brachytherapy 2023; 22:665-672. [PMID: 37277286 DOI: 10.1016/j.brachy.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/23/2023] [Accepted: 05/04/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE Surface mould brachytherapy (SMBT) is ideal in treating superficial skin cancer over the curved surface of the nasal ala. We describe the process of initiating and optimizing SMBT treatment at our institution including clinical workflow, generation of three dimensional (3D) printed custom applicators, and clinical outcomes. METHODS AND MATERIALS Planning CT scans were used to acquire images for delineating target volumes. The applicator was designed with customized catheter positioning (3-5mm from target) to cover target volume while sparing dose to organs at risk (OAR) such as adjacent skin and nasal mucosa. Applicators were 3D printed, with transparent resin to aid visualization of underlying skin. Dosimetric parameters evaluated included CTV D90, CTV D0.1cc, and D2cc to OARs. Clinical outcomes assessed were local control, acute and late toxicity (Common Terminology Criteria for Adverse Events v5.0 [CTCAEv5.0]), and cosmesis (Radiation Therapy Oncology Group [RTOG]). RESULTS Ten patients were treated with SMBT with a median followup of 17.8 months. Dose prescription was 40 Gy in 10 daily fractions. Mean CTV D90 was 38.5 Gy (range 34.7-40.6), mean CTV D0.1cc 49.2 Gy (range 45.6-53.5), which was <140% of the prescription dose in all patients. Treatment was well tolerated, with acceptable Grade 2 acute, Grade 0-1 late skin toxicity, and good-excellent cosmesis for all patients. Two patients experienced local failure, and both underwent surgical salvage. CONCLUSIONS SMBT was successfully planned and delivered for superficial nasal BCC using 3D printed custom applicators. Excellent target coverage was achieved while minimizing dose to OAR. Toxicity and cosmesis rates were good-excellent.
Collapse
Affiliation(s)
- Elizabeth A Barnes
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
| | - May N Tsao
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Amandeep S Taggar
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Ananth Ravi
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Moti R Paudel
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Conforti C, Toffoli L, Agozzino M, Fedele D, Moroso S, di Meo N, Zalaudek I. Maintenance of clinical response after short treatment with cemiplimab for advanced squamous cell carcinoma. J Eur Acad Dermatol Venereol 2022; 36:e443-e445. [PMID: 35037322 DOI: 10.1111/jdv.17939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/04/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Claudio Conforti
- Skin Cancer Unit, Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Ludovica Toffoli
- Skin Cancer Unit, Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Marina Agozzino
- Skin Cancer Unit, Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Dahlia Fedele
- Skin Cancer Unit, Department of Medical Oncology, Maggiore Hospital, Trieste, Italy
| | - Stefano Moroso
- Skin Cancer Unit, Department of Medical Oncology, Maggiore Hospital, Trieste, Italy
| | - Nicola di Meo
- Skin Cancer Unit, Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Iris Zalaudek
- Skin Cancer Unit, Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| |
Collapse
|