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Abstract
BACKGROUND The cutaneous squamous cell carcinoma (CSCC) is the second most common nonmelanoma skin cancer with an increasing incidence rate. Patients presenting with high-risk lesions associated with locally advanced or metastatic CSCC face high rates of recurrence and mortality. METHODS Selective literature review based on PubMed and consideration of current guidelines "Aktinische Keratosen und Plattenepithelkarzinom der Haut" and "Prävention von Hautkrebs". FINDINGS Complete surgical excision with histopathological control of excision margins is the gold standard in the treatment of primary CSCC. Radiotherapy can be used as an alternative treatment of inoperable CSCCs. In 2019, the PD1-antibody cemiplimab, has been approved for the treatment of locally advanced and metastatic CSCC by the European Medicines Agency. After 3 years of follow up, Cemiplimab shows overall response rates of 46 %, the median overall survival and median response rate had not been reached yet. Additional immunotherapeutics, combinations with other agents and oncolytic viruses are all potentially worth study to try, so clinical trial data will be forthcoming over the next few years to guide optimal use of these agents. CONCLUSION Multidisciplinary board decisions are mandatory for all patients with advanced disease who require more than surgery. Further development of existing therapeutic concepts, identification of new combination therapies and the development of new immunotherapeutics will be the key challenge over the next few years.
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Affiliation(s)
- Birgit Burda
- Klinik für Dermatologie, Klinikum Nürnberg Nord, Nürnberg, Deutschland
| | - Erwin S Schultz
- Klinik für Dermatologie, Klinikum Nürnberg Nord, Nürnberg, Deutschland
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Di Brizzi EV, Argenziano G, Brancaccio G, Scharf C, Ronchi A, Moscarella E. The current clinical approach to difficult-to-treat basal cell carcinomas. Expert Rev Anticancer Ther 2023; 23:43-56. [PMID: 36579630 DOI: 10.1080/14737140.2023.2161517] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Basal cell carcinoma (BCC) is the most common malignant tumor in adult white populations. If BCCs are not treated for years, if they cause massive destruction of the surrounding tissues, if they are considered unresectable or not eligible for radiotherapy they become progressively 'locally advanced' (laBCC) or metastatic (mBCC). These tumors are defined as 'difficult-to-treat BCC.' AREAS COVERED A comprehensive search on PubMed was conducted to identify relevant literature about the several approved and recommended treatment options for the management of difficult-to-treat BCC published from January 2012 to July 2022. Surgical options, radiotherapy, hedgehog inhibitors, immunotherapy, and combined treatments are discussed. The keywords used were basal cell carcinoma; difficult-to-treat BCC; management of difficult-to-treat BCC; surgical therapy; radiotherapy; hedgehog inhibitors; immunotherapy. EXPERT OPINION Identifying the best approach to DTT BCCs is one of the main challenges for the dermato-oncologist. The introduction of HHI for the treatment of advanced BCCs has revolutionized the clinical management of DTT BCCs. The immune checkpoint inhibitor cemiplimab has been approved for the treatment of locally advanced or metastatic BCC refractory to HHI therapy or in patients intolerant to HHI therapy. Multidisciplinary teams (MDTs) play a key role in managing these complex patients.
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Affiliation(s)
| | | | | | - Camila Scharf
- Dermatology Unit, University of Campania, Naples, Italy
| | - Andrea Ronchi
- Pathology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
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Burda B, Schultz ES. Das kutane Plattenepithelkarzinom – ein Update. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1666-3585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Hintergrund Das kutane Plattenepithelkarzinom (PEK) ist nach dem Basalzellkarzinom der zweithäufigste bösartige Hauttumor. In Deutschland wurden 2014 über 50.000 PEK-Neuerkrankungen dokumentiert. Mit Zunahme der durchschnittlichen Lebenserwartung und Komorbiditäten treten mittlerweile auch gehäuft lokal fortgeschrittene Tumore mit Metastasierung auf.
Methode Selektive Literaturrecherche in PubMed und unter Berücksichtigung der deutschen S3-Leitlinien „Aktinische Keratosen und Plattenepithelkarzinom der Haut“ und „Prävention von Hautkrebs“.
Ergebnisse Beim PEK ist der Goldstandard die vollständige Exzision des Primärtumors mittels histopathologischer Kontrolle der Schnittränder. Eine Radiotherapie kann eingesetzt werden, wenn eine vollständige Exzision nicht erreicht werden kann bzw. Inoperabilität besteht. Im Falle eines metastasierten (mPEK) oder lokal fortgeschrittenen (laPEK) PEK, welches nicht kurativ operiert oder bestrahlt werden kann, werden systemische medikamentöse Therapien eingesetzt. Mit der Zulassung des PD1-Antikörpers Cemiplimab steht seit 2019 in der EU eine neue systemische Therapie zur Behandlung des fortgeschrittenen PEK zur Verfügung. Nach bis zu 3 Jahren Follow-up sprechen noch 46% der Patienten mit mPEK und laPEK auf Cemiplimab an, der Medianwert für das Gesamtüberleben und die Ansprechdauer ist in beiden Gruppe noch nicht erreicht. Weitere Antikörper gegen PD1 oder PDL1, Kombinationstherapien sowie die Immuntherapie mit onkolytischen Viren ermöglichen zahlreiche Therapieoptionen und sind aktuell Gegenstand der Forschung.
Schlussfolgerung Mit der Zunahme von fortgeschrittenen Stadien des PEK nimmt die Wichtigkeit des interdisziplinären Tumorboards für den Therapieentscheid immer mehr zu. Die Weiterentwicklung bestehender therapeutischer Konzepte, die Identifikation von gut wirksamen Kombinationstherapien sowie die Entwicklung weiterer verträglicher zielgerichteter Systemtherapien ist eine entscheidende dermatoonkologische Herausforderung der nächsten Jahre.
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Affiliation(s)
- Birgit Burda
- Klinik für Dermatologie, Klinikum Nürnberg Nord, Nürnberg, Deutschland
| | - Erwin S. Schultz
- Klinik für Dermatologie, Klinikum Nürnberg Nord, Nürnberg, Deutschland
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Xie Y, Li Q, Gao Z, Sun J, Li D, Harvey C, Qu J, Snow S, Li Q. Juvéderm Volift (VYC-17.5L), a Hyaluronic Acid Filler with Lidocaine, is Safe and Effective for Correcting Nasolabial Folds in Chinese Subjects. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:237-245. [PMID: 35210801 PMCID: PMC8859541 DOI: 10.2147/ccid.s344350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/27/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE Hyaluronic acid injectable gels are commonly used to treat nasolabial folds (NLFs). We evaluated the safety and effectiveness of VYC-17.5L for correcting NLFs in Chinese subjects. PATIENTS AND METHODS This prospective, multicenter, double-blind, within-subject‒controlled study randomized adults with moderate-to-severe NLFs to VYC-17.5L treatment (initial and touch-up) in 1 NLF and control (without lidocaine) in the contralateral NLF. Effectiveness endpoints at 6 months included noninferiority of VYC-17.5L to control in NLF Severity Scale response rate (primary endpoint), subject-reported procedural pain (11-point scale), and investigator and subject assessments using the Global Aesthetic Improvement Scale (GAIS). RESULTS A total of 175 subjects were included. The primary endpoint was met, with response rates of 84.2% for VYC-17.5L and 82.5% for control. Mean pain scores after initial and touch-up treatments were 2.4 for VYC-17.5L versus 5.2 for control (P < 0.001) and 2.0 versus 3.3 (P < 0.001), respectively. Investigator-rated GAIS scores were 86.5% for VYC-17.5L versus 86.0% for control. There were no between-group differences in subject-rated GAIS scores. Safety profiles were comparable for VYC-17.5L and control. CONCLUSION VYC-17.5L was noninferior to control without lidocaine for correcting moderate-to-severe NLFs in Chinese subjects and was superior to control in reducing procedural pain.
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Affiliation(s)
- Yun Xie
- Plastic Surgery Department of Shanghai 9th People's Hospital, Shanghai, People's Republic of China
| | - Qin Li
- Plastic Surgery Department of General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong, People's Republic of China
| | - Zhanwei Gao
- Plastic Surgery Department of Japan Friendship Hospital, Chaoyang, Beijing, People's Republic of China
| | - Jiaming Sun
- Plastic Surgery Department of Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Dong Li
- Plastic Surgery Department of Peking University Third Hospital, Haidian, Beijing, People's Republic of China
| | | | - Jiazhi Qu
- Allergan Aesthetics, an AbbVie Company, Beijing, People's Republic of China
| | - Sean Snow
- Allergan Aesthetics, an AbbVie Company, Irvine, CA, USA
| | - Qingfeng Li
- Plastic Surgery Department of Shanghai 9th People's Hospital, Shanghai, People's Republic of China
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5
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Christensen RL, Hendel KK, Persson DP, Husted S, Olesen UH, Haedersdal M. Topical delivery of PD-1 inhibitors with laser-assisted passive diffusion and active intradermal injection: Investigation of cutaneous pharmacokinetics and biodistribution patterns. Lasers Surg Med 2021; 54:170-181. [PMID: 34859463 DOI: 10.1002/lsm.23504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Current cancer immunotherapeutic treatment with PD-1 inhibitors is administered systemically. However, a local treatment strategy may be advantageous as it could provide targeted drug delivery as well as attenuate side effects seen with systemic treatments. For keratinocyte cancers, where surgical excision is not always applicable, an alternate local treatment approach would be beneficial. This study aims to examine cutaneous pharmacokinetics and biodistribution of the PD-1 inhibitor nivolumab, locally delivered either by ablative fractional laser (AFL)-assisted passive diffusion or active intradermal injection, in vivo. MATERIALS AND METHODS In vivo pig skin was either exposed to CO2 AFL (80 mJ/mb by two stacked pulses of 40 mJ/mb) at 5% or 15% density followed by topical application of nivolumab (1 mg/ml, 100 µl/10 × 10 mm) or intradermally injected with nivolumab (1 mg/ml, 100 µl). Cutaneous nivolumab delivery was evaluated at different timepoints (0, 1, 2, 4 hours and 2 days) at two tissue depths (100-800 and 900-1600 µm) by ELISA. Visualization of cutaneous biodistribution was shown in vertical tissue sections using HiLyte FluorTM 488 SE labeled nivolumab for fluorescence microscopy whereas nivolumab was DOTA-tagged with Dysprosium before the laser ablation-inductively coupled plasma-mass spectrometry analysis (LA-ICP-MS). RESULTS Our in vivo study revealed different pharmacokinetic and biodistribution patterns for the AFL- and injection techniques. A superficial horizontal band-like uptake of nivolumab was provided with AFL-assisted passive diffusion whereas a deep focal deposition was seen with active intradermal injection, compared with controls showing remnant deposition on the skin surface. AFL-assisted nivolumab uptake in upper dermis peaked after 4 hours (p < 0.01). The cutaneous concentration of nivolumab achieved by intradermal injection was markedly higher than with AFL, the highest deposition with intradermal injection was detected at time 0 hours in both upper and deep dermis (p < 0.01) and decreased throughout the study period, although the concentration remained higher compared with saline control injections at all time points (0 hours -2 d) (p < 0.01). CONCLUSION Local cutaneous delivery of nivolumab with either AFL or intradermal injection revealed two different pharmacokinetic and biodistribution patterns. Passive AFL-assisted diffusion of nivolumab resulted in enhanced uptake after 4 hours, while intradermal actively injected nivolumab showed immediate enhanced cutaneous deposition with retention up to 2 days after injection. The two local delivery techniques show potential for development of individualized treatment strategies depending on the clinical tumor appearance.
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Affiliation(s)
- Rikke L Christensen
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kristoffer K Hendel
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Daniel P Persson
- Department of Plant and Environmental Sciences, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Søren Husted
- Department of Plant and Environmental Sciences, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Uffe H Olesen
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
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6
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Non-Surgical Treatments for Keratinocyte Carcinomas. Adv Ther 2021; 38:5635-5648. [PMID: 34652721 DOI: 10.1007/s12325-021-01916-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
Skin cancer is the most common malignancy worldwide, comprising approximately 30% of all human tumors. In recent decades, the incidence of keratinocyte carcinomas, which include basal cell carcinoma and cutaneous squamous cell carcinoma, has been steadily increasing globally (Rogers et al. in JAMA Dermatol 151(10):1081-1086. https://doi.org/10.1001/jamadermatol.2015.1187 , 2015; Nehal and Bichakjian in N Engl J Med 379(4):363-374. https://doi.org/10.1056/nejmra1708701 , 2018). Most tumors are cured with surgical excision; however, some tumors are best treated with non-surgical approaches. Superficial tumors can often be cured with non-surgical methods whereas more advanced stage tumors may not be amenable to surgery. Additionally, surgical treatment may not be available for all populations depending on geographic location and accessibility to care. This article reviews commonly utilized nonsurgical options such as cryotherapy, photodynamic therapy, topical treatments, and radiation as well as systemic treatments including immunotherapies and chemotherapies.
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Moujaess E, Merhy R, Kattan J, Sarkis AS, Tomb R. Immune checkpoint inhibitors for advanced or metastatic basal cell carcinoma: how much evidence do we need? Immunotherapy 2021; 13:1293-1304. [PMID: 34463126 DOI: 10.2217/imt-2021-0089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Basal cell carcinoma (BCC) is one of the most frequent and most curable tumors at its early stages. BCC rarely metastasizes and its treatment in this setting is still challenging. Hedgehog inhibitors showed an activity in advanced or metastatic disease. However, there is an unmet need for new agents. Immune checkpoint inhibitors have been assessed in melanoma and other cutaneous tumors, and very recently an anti-PD1 was approved for advanced BCC. In this paper, available data are reviewed on experimental and preclinical studies evaluating immunotherapy in BCC, as well as on the clinical evidence supporting the efficacy and safety of immune checkpoint inhibitors for advanced or metastatic BCC based on case reports, case series and clinical trials.
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Affiliation(s)
- Elissar Moujaess
- Department of Hematology & Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, 1100, Lebanon
| | - Reine Merhy
- Department of Dermatology & Venerology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, 1100, Lebanon
| | - Joseph Kattan
- Department of Hematology & Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, 1100, Lebanon
| | - Anne-Sophie Sarkis
- Department of Dermatology & Venerology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, 1100, Lebanon
| | - Roland Tomb
- Department of Dermatology & Venerology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, 1100, Lebanon
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Cytotoxic T-Lymphocyte-Associated Protein-4 and Lymphocyte Activation Gene-3 Expression in Orbitally-Invasive Versus Nodular Basal Cell Carcinoma. Ophthalmic Plast Reconstr Surg 2021; 37:S109-S111. [PMID: 32991494 DOI: 10.1097/iop.0000000000001853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the expression of cytotoxic T-lymphocyte-associated protein-4 (CTLA-4) and lymphocyte activation gene-3 (LAG-3) in nodular and orbitally-invasive forms of basal cell carcinoma (BCC). METHODS Immunohistochemical staining for CTLA-4 and LAG-3 was performed on the pathology specimens of BCC from orbital exenteration and nodular forms. The numbers of positively-staining cells/×40 field were counted across 5 consecutive fields of each specimen and statistical analysis was performed to calculate the difference in expression between the 2 groups. RESULTS Nine cases of orbitally-invasive BCC and 6 cases of nodular BCC were studied. The mean numbers of CTLA-4-positively staining cells were 11.51 cells/×40 field (median = 6.60 cells/×40 field, range = 0.4-31.8 cells/×40 field) in invasive BCC and 0.90 cells/×40 field (median = 0.60 cells/×40 field, range = 0.0-2.8 cells/×40 field) in nodular specimens. The difference between the 2 groups was statistically significant (p = 0.0030). The mean number of LAG-3-positively staining cells was 0.58 cells/×40 field (median = 0.0, range = 0.0-2.8 cells/×40 field) in invasive BCC and 3.13 cells/×40 field (median = 0.0, range = 0.0-18.18 cells/×40 field). There was no significant difference in LAG-3 positivity between tumor groups (p = 0.5564). CONCLUSIONS CTLA-4 expression was enriched in orbitally invasive BCC compared with nodular forms of BCC, whereas LAG-3 expression did not differ between these entities. CTLA-4 mediated immune suppression may facilitate the development of orbitally invasive BCC. Treatment strategies that use existing medications to target CTLA-4 may decrease the requirement for orbital exenteration and provide enhanced survival outcomes.
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Villegas-Romero I, Jiménez-Gallo D, Gutiérrez-Bayard L, Linares-Barrios M. Advanced Cutaneous Squamous Cell Carcinoma Treated with Pembrolizumab. ACTAS DERMO-SIFILIOGRAFICAS 2021:S1578-2190(21)00176-1. [PMID: 34162504 DOI: 10.1016/j.adengl.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- I Villegas-Romero
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, Spain.
| | - D Jiménez-Gallo
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - L Gutiérrez-Bayard
- Unidad de Gestión Clínica de Oncología Radioterápica, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - M Linares-Barrios
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, Spain
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10
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Zelin E, Zalaudek I, Agozzino M, Dianzani C, Dri A, Di Meo N, Giuffrida R, Marangi GF, Neagu N, Persichetti P, Toffoli L, Conforti C. Neoadjuvant Therapy for Non-melanoma Skin Cancer: Updated Therapeutic Approaches for Basal, Squamous, and Merkel Cell Carcinoma. Curr Treat Options Oncol 2021; 22:35. [PMID: 33725197 PMCID: PMC7966643 DOI: 10.1007/s11864-021-00826-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/17/2022]
Abstract
OPINION STATEMENT Recently introduced systemic therapies for locally advanced and metastatic non-melanoma skin cancers (NMSCs) are paving the way for neoadjuvant approach. Although none of the therapeutic options has currently gained indication in this setting, neoadjuvant approach for NMSCs is an open field and we are likely to see huge developments in the near future. Targeted therapy with sonic hedgehog pathway inhibitors is very effective in locally advanced or multiple basal cell carcinomas while immunotherapy with immune checkpoint inhibitors appears to be promising for advanced cutaneous squamous cell carcinoma and Merkel cell carcinoma. To date, targeted therapy and immunotherapy represent the frontiers in NMSC therapeutic management and, according to recent studies, good results can be achieved.
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Affiliation(s)
- Enrico Zelin
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy.
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Marina Agozzino
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Caterina Dianzani
- Plastic and Reconstructive Surgery Department, Campus Biomedico University, Rome, Italy
| | - Arianna Dri
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Nicola Di Meo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology Section, University of Messina, Messina, Italy
| | | | - Nicoleta Neagu
- Dermatology Clinic, Mures Country Hospital, Tirgu Mures, Romania
| | - Paolo Persichetti
- Plastic and Reconstructive Surgery Department, Campus Biomedico University, Rome, Italy
| | - Ludovica Toffoli
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Claudio Conforti
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
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Villegas-Romero I, Jiménez-Gallo D, Gutiérrez-Bayard L, Linares-Barrios M. Advanced Cutaneous Squamous Cell Carcinoma Treated with Pembrolizumab. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:S0001-7310(20)30531-7. [PMID: 33307003 DOI: 10.1016/j.ad.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/10/2019] [Accepted: 01/13/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- I Villegas-Romero
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, España.
| | - D Jiménez-Gallo
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, España
| | - L Gutiérrez-Bayard
- Unidad de Gestión Clínica de Oncología Radioterápica, Hospital Universitario Puerta del Mar, Cádiz, España
| | - M Linares-Barrios
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, España
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Christensen RL, Omland SH, Persson DP, Husted S, Haedersdal M, Olesen UH. Topical Delivery of Nivolumab, a Therapeutic Antibody, by Fractional Laser and Pneumatic Injection. Lasers Surg Med 2020; 53:154-161. [PMID: 32997833 DOI: 10.1002/lsm.23322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/27/2020] [Accepted: 09/09/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES PD-L1 is a tumor ligand that binds to the PD-1 receptor on immune cells, thereby inhibiting the antitumor immune response. The antibody nivolumab is a PD-1 inhibitor, Food and Drug Administration approved for systemic treatment of several aggressive cancer types. Topically applied nivolumab may hold potential as a future strategy to treat keratinocyte cancer, but its molecular properties preclude unassisted topical uptake. The aim of this study was to investigate uptake and biodistribution of topically delivered nivolumab, assisted by two physical enhancement techniques with different delivery kinetics; ablative fractional laser (AFL) and electronically controlled pneumatic injection (EPI). STUDY DESIGN/MATERIALS AND METHODS In vitro porcine skin was exposed to CO2 AFL (20 mJ/mb, 5% density), followed by passive diffusion of nivolumab in a Franz cell (1 mg/ml, 18 hours, n = 6) or treated with EPI (4 bar) for immediate delivery of nivolumab (1 mg/ml, 10 minutes, n = 6). The resulting nivolumab skin concentrations were quantified by enzyme-linked immunosorbent assay (ELISA) at three skin depths (100, 500, and 1500 µm), comparing the uptake from assisted delivery with intact skin. Biodistribution of nivolumab in the skin for all interventions was visualized by laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) and fluorescence microscopy. RESULTS Delivery of nivolumab by AFL-assisted passive diffusion and immediate EPI both resulted in significantly enhanced uptake of nivolumab in all skin depths compared with intact skin (P < 0.05). With AFL, nivolumab concentrations reached 86.3 µg/cm3 (100 µm), 105.8 µg/cm3 (500 µm), and 19.3 µg/cm3 (1500 µm), corresponding to 2-10% of the applied concentration, with the highest deposition in the mid dermis. Immediate EPI delivered 429.4 µg/cm3 (100 µm), 584.9 µg/cm3 (500 µm), and 295.9 µg/cm3 (1500 µm) into the skin, corresponding to 29-58% of the applied nivolumab concentration. From qualitative visualization of the biodistribution, it appeared that nivolumab distributed in a horizontal and continuous homogenous band in the upper and mid dermis through AFL-exposed skin, whereas EPI-delivery showed a deep focal deposition extending into the deep dermis. CONCLUSIONS AFL-assisted passive diffusion and immediate EPI-assisted delivery show the potential to deliver therapeutic antibodies locally. Future in vivo and pharmacokinetic studies would reveal the full potential for topical antibody delivery by energy-based devices. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Rikke L Christensen
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, 2400, Denmark
| | - Silje H Omland
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, 2400, Denmark
| | - Daniel P Persson
- Department of Plant and Environmental Sciences, Faculty of Science, University of Copenhagen, Frederiksberg, 1870, Denmark
| | - Søren Husted
- Department of Plant and Environmental Sciences, Faculty of Science, University of Copenhagen, Frederiksberg, 1870, Denmark
| | - Merete Haedersdal
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, 2400, Denmark
| | - Uffe H Olesen
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, 2400, Denmark
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Frazzette N, Khodadadi-Jamayran A, Doudican N, Santana A, Felsen D, Pavlick AC, Tsirigos A, Carucci JA. Decreased cytotoxic T cells and TCR clonality in organ transplant recipients with squamous cell carcinoma. NPJ Precis Oncol 2020; 4:13. [PMID: 32550269 PMCID: PMC7270180 DOI: 10.1038/s41698-020-0119-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/19/2020] [Indexed: 01/14/2023] Open
Abstract
T-cell landscape differences between cutaneous squamous cell carcinoma (cSCC) tumors in immune competent (SCC in IC) and immunocompromised organ transplant recipients (TSCC in OTR) are unclear. We developed an analytical method to define tumor infiltrating lymphocyte (TIL) phenotype in cSCC from immune competent and immune suppressed patients using single-cell TCR sequencing and gene expression data. TSCC exhibits reduced proportions of cytotoxic and naïve TILs and similar numbers of regulatory TILs. Fewer, more heterogeneous TCR clonotypes are observed in TIL from OTR. Most TCR sequences for top ten clonotypes correspond to known antigens, while 24% correspond to putative neoantigens. OTR show increased cSCC events over 12 months possibly due to reduced cytotoxic T-cells. Our novel method of barcoding CD8+ T-cells is the first providing gene expression and TCR sequences in cSCC. Knowledge regarding putative antigens recognized by TCRs with phenotypic function of T-cells bearing those TCRs could facilitate personalized cSCC treatments.
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Affiliation(s)
- Nicholas Frazzette
- Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, NY USA
| | | | - Nicole Doudican
- Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, NY USA
| | - Alexis Santana
- Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, NY USA
| | - Diane Felsen
- Department of Pediatric Urology, Weill Medical College of Cornell, New York, USA
| | - Anna C Pavlick
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY USA
| | - Aristotelis Tsirigos
- Applied Bioinformatics, New York University Langone Medical Center, New York, NY USA
| | - John A Carucci
- Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, NY USA
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de Lima PO, Joseph S, Panizza B, Simpson F. Epidermal Growth Factor Receptor's Function in Cutaneous Squamous Cell Carcinoma and Its Role as a Therapeutic Target in the Age of Immunotherapies. Curr Treat Options Oncol 2020; 21:9. [PMID: 32016630 DOI: 10.1007/s11864-019-0697-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OPINION STATEMENT Recent studies have evidenced the potential of combining anti-EGFR therapies with anti-PD-1/PD-L1 checkpoint therapies. Both anti-EGFR and anti-PD-1/PD-L1 have been separately tested in the treatment of cutaneous SCC (cSCC). Here, we review recent data on EGFR in the context of cancer progression, as a prognostic and as a therapeutic target in cSCC. Anti-EGFR/checkpoint immunotherapy and other combination therapy approaches are discussed. With the advent of immunotherapy, EGFR is still a valid cSCC target.
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Affiliation(s)
- Priscila Oliveira de Lima
- The University of Queensland Diamantina Institute, University of Queensland, Woolloongabba, Queensland, Australia
| | - Shannon Joseph
- The University of Queensland Diamantina Institute, University of Queensland, Woolloongabba, Queensland, Australia
| | - Benedict Panizza
- Faculty of Medicine, University of Queensland, Woolloongabba, Queensland, Australia.,Otolaryngology-Head and Neck Surgery Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Fiona Simpson
- The University of Queensland Diamantina Institute, University of Queensland, Woolloongabba, Queensland, Australia.
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Petersen ET, Ahmed SR, Chen L, Silapunt S, Migden MR. Review of systemic agents in the treatment of advanced cutaneous squamous cell carcinoma. Future Oncol 2019; 15:3171-3184. [PMID: 31382778 DOI: 10.2217/fon-2019-0158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Advanced cutaneous squamous cell carcinoma (cSCC) accounts for only 5% of all cases of cSCC but up to 60% of disease related deaths. Historically, this disease has lacked effective treatment options due to a combination of poor response rate, poor response durability and significant treatment-associated morbidity. Autumn of 2018 marked the first time ever that an agent received US FDA approval for advanced cSCC and the future is looking much brighter for this previously neglected patient population. The purpose of this article is to review the various systemic treatment options for advanced cSCC moving from the past to the present, highlighting their relative merits and shortcomings, and to briefly speculate on future developments in the field of advanced cSCC.
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Affiliation(s)
- Erik T Petersen
- University of Texas MD Anderson Cancer Center, Department of Dermatology, Mohs and Dermasurgery Unit, Houston, TX 77030, USA
| | - Saqib R Ahmed
- University of Texas MD Anderson Cancer Center, Department of Dermatology, Mohs and Dermasurgery Unit, Houston, TX 77030, USA
| | - Leon Chen
- University of Texas McGovern Medical School Department of Dermatology, Houston, TX 77030, USA
| | - Sirunya Silapunt
- University of Texas McGovern Medical School Department of Dermatology, Houston, TX 77030, USA
| | - Michael R Migden
- University of Texas MD Anderson Cancer Center, Department of Dermatology, Mohs and Dermasurgery Unit, Houston, TX 77030, USA.,University of Texas MD Anderson Cancer Center Department of Head & Neck Surgery, Houston, TX 77030, USA
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