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Dhillon J, Li DQ, Burnier M, Shenouda G, Arthurs BP, El-Hadad C. Cemiplimab for metastatic squamous cell carcinoma of the orbit, periocular adnexa, and thigh. Orbit 2024; 43:258-264. [PMID: 36052515 DOI: 10.1080/01676830.2022.2118789] [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: 04/30/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
The current case presentation highlights the potential of cemiplimab, a programmed cell death protein-1 (PD-1) inhibitor, as first-line treatment for periocular metastatic cutaneous squamous cell carcinoma (SCC) without requiring curative surgery or radiotherapy. A 64-year-old male presented with a progressing 4.5 × 3.0 cm left upper eyelid lesion initially diagnosed as psoriasis. Work-up revealed cutaneous SCC with tumor invasion into extraconal fat and lacrimal gland, and metastasis to the left parotid lymph node. The patient also presented with a suspicious lesion on his left medial thigh found to be a second primary on pathology. To avoid orbital exenteration and treat the multifocal disease, the patient was started on intravenous cemiplimab immunotherapy. Following six doses, repeated FGD-PET-CT revealed a complete response of the left eyelid lesion and residual low-grade hypermetabolic activity of the left medial thigh lesion. Biopsy confirmed chronic inflammation and fibrosis with no signs of malignancy. This unique case with dual primary cutaneous SCC provides support for cemiplimab in treating locally invasive periocular SCC, and potentially abrogating the need for highly morbid exenteration procedures to preserve binocular vision.
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Affiliation(s)
- Jobanpreet Dhillon
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, USA
| | - Daniel Q Li
- Department of Ophthalmology & Visual Sciences, McGill University, Montreal, QC, USA
| | - Miguel Burnier
- Department of Ophthalmology & Visual Sciences, McGill University, Montreal, QC, USA
| | - George Shenouda
- Department of Radiation Oncology, McGill University, Montreal, QC, USA
| | - Bryan P Arthurs
- Department of Ophthalmology & Visual Sciences, McGill University, Montreal, QC, USA
| | - Christian El-Hadad
- Department of Ophthalmology & Visual Sciences, McGill University, Montreal, QC, USA
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2
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Sordi E, Piscitelli P, Albanese C, Melcarne A, Tardio A, Quarta F, Greco E, Miani A, Falco A, De Matteis E, Congedo M, Civino A. Incidence of Non-Melanoma Skin Cancers in Salento (Southern Italy): A 15-Year Retrospective Analysis from the Cancer Registry of Lecce. EPIDEMIOLOGIA 2023; 5:1-10. [PMID: 38534803 DOI: 10.3390/epidemiologia5010001] [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: 08/31/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Non-melanoma skin cancers (NMSCs) include basal cell carcinoma (BCC) and squamous-cell carcinoma (SCC), as well as a wide range of rare skin tumors. NMSCs is the most frequently diagnosed type of tumor among Caucasians. We aimed at estimating the incidence and mortality of NMSCs in the Salento area (Lecce province, Southern Italy), whose population is assumed to experience heavy and frequent sun exposure due to climatic/environmental factors, both for working and leisure activities. MATERIALS AND METHODS We computed the incidence of NMSCs in the Province of Lecce by examining the comprehensive real-world data collected by the local cancer registry, which covers all the 830,000 inhabitants, over a period of fifteen years (from 2003 to 2017), with a focus on the latest 5 years (2013-2017) for the analysis of the different histologic morphologies of these tumors. The incidence of NMSCs has been described in terms of absolute frequencies, crude rates and age-adjusted direct standardized rates (DSR). Joinpoint analysis was used to examine temporal trends in the incidence of NMSCs and estimate annual percent changes (APCs). RESULTS During the period of 2003-2017, the incidence of NMSCs reached a direct standardized rate (DSR) of 162.62 per 100,000 in men (mortality 1.57 per 100,000) and 89.36 per 100,000 in women (mortality 0.52 per 100,000), respectively. The incidence significantly increased among both men and women across the entire period. Basal cell carcinoma (BCC), with its different morphologies, represented about 67.6% of the NMSCs in men (n = 2139 out of a total of 3161 tumors observed between 2013 and 2017) and about 75.8% of the NMSCs in women (n = 1718 out of a total of 2264 tumors from 2013 to 2017), thus accounting for the vast majority of NMSCs. The results are consistent with the literature data carried out both at national and international level. CONCLUSIONS Proper monitoring of this phenomenon through timely reporting and recording of all new NMSC cases is necessary to develop new preventive strategies.
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Affiliation(s)
| | - Prisco Piscitelli
- Local Health Authority ASL Le, 73100 Lecce, Italy
- Department of Experimental Medicine, University of Salento, 73100 Lecce, Italy
| | - Carla Albanese
- Experimental Zooprophylactic Institute of Apulia and Basilicata (IZSPB), 71121 Foggia, Italy
| | | | - Anna Tardio
- Local Health Authority ASL Le, 73100 Lecce, Italy
| | | | - Enrico Greco
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, 34100 Trieste, Italy
- Italian Society of Environmental Medicine (SIMA), 20123 Milan, Italy
| | - Alessandro Miani
- Italian Society of Environmental Medicine (SIMA), 20123 Milan, Italy
| | - Andrea Falco
- Department of Health Sciences, European University of Madrid, 28670 Madrid, Spain
| | | | | | - Adele Civino
- Local Health Authority ASL Le, 73100 Lecce, Italy
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Bazzacco G, Zelin E, Toffoli L, Conforti C, di Meo N, Fedele D, Zalaudek I. Dichotomic response patterns to PD-1 blockade with cemiplimab in a patient with multiple squamous cell carcinomas. J Eur Acad Dermatol Venereol 2023; 37:e547-e549. [PMID: 36305888 DOI: 10.1111/jdv.18705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Giulia Bazzacco
- Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, Italy
| | - Enrico Zelin
- Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, Italy
| | - Ludovica Toffoli
- Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, Italy
| | - Claudio Conforti
- Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, Italy
| | - Nicola di Meo
- Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, Italy
| | - Dahlia Fedele
- Skin Cancer Unit, Department of Medical Oncology, Maggiore Hospital of Trieste, Trieste, Italy
| | - Iris Zalaudek
- Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, Italy
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Zelin E, Maronese CA, Dri A, Toffoli L, Di Meo N, Nazzaro G, Zalaudek I. Identifying Candidates for Immunotherapy among Patients with Non-Melanoma Skin Cancer: A Review of the Potential Predictors of Response. J Clin Med 2022; 11:3364. [PMID: 35743435 PMCID: PMC9225110 DOI: 10.3390/jcm11123364] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Non-melanoma skin cancer (NMSC) stands as an umbrella term for common cutaneous malignancies, including basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), together with rarer cutaneous cancers, such as Merkel cell carcinoma (MCC) and other forms of adnexal cancers. The majority of NMSCs can be successfully treated with surgery or radiotherapy, but advanced and metastatic stages may require systemic approaches such as immunotherapy with immune checkpoint inhibitors (ICIs). SUMMARY Since immunotherapy is not effective in all patients and can potentially lead to severe adverse effects, an important clinical question is how to properly identify those who could be suitable candidates for this therapeutic choice. In this paper, we review the potential features and biomarkers used to predict the outcome of ICIs therapy for NMSCs. Moreover, we analyze the role of immunotherapy in special populations, such as the elderly, immunocompromised patients, organ transplant recipients, and subjects suffering from autoimmune conditions. KEY MESSAGES Many clinical, serum, histopathological, and genetic features have been investigated as potential predictors of response in NMSCs treated with ICIs. Although this field of research is very promising, definitive, cost-effective, and reproducible biomarkers are still lacking and further efforts are needed to validate the suggested predictors in larger cohorts.
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Affiliation(s)
- Enrico Zelin
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (E.Z.); (L.T.); (N.D.M.); (I.Z.)
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Arianna Dri
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy;
- Department of Medical Oncology, Azienda Sanitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Ludovica Toffoli
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (E.Z.); (L.T.); (N.D.M.); (I.Z.)
| | - Nicola Di Meo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (E.Z.); (L.T.); (N.D.M.); (I.Z.)
| | - Gianluca Nazzaro
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (E.Z.); (L.T.); (N.D.M.); (I.Z.)
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Lebas E, Marchal N, Rorive A, Nikkels AF. Cemiplimab for locally advanced cutaneous squamous cell carcinoma: safety, efficacy, and position in therapy panel. Expert Rev Anticancer Ther 2021; 21:355-363. [PMID: 33554680 DOI: 10.1080/14737140.2021.1876567] [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: 12/13/2022]
Abstract
INTRODUCTION Locally advanced cutaneous squamous cell carcinoma (lacSCC) is rare. Approximately one-fourth of the cases are observed among immunocompromised patients, in particular in solid organ transplant recipients (OTRs). LacSCC has a very poor prognosis. Surgery with or without radiotherapy remains the golden standard of treatment for cSCC. However, in advanced cases, there is a medical need for alternative treatment options. Classic systemic treatments include chemotherapy and/or EGFR inhibitors. Recently the effectiveness of programmed cell death protein-1 (PD-1) inhibitors has been demonstrated for lacSCC. Cemiplimab is a recombinant IgG4 human monoclonal antibody against the PD-1 protein for the intravenous treatment of lacSCC. AREAS COVERED The principal studies evaluating the efficacy and safety of cemiplimab for lacSCC are presented. EXPERT OPINION Cemiplimab is the first anti-PD-1 antibody that was FDA (2018) and EMA (2019) approved as a systemic treatment for lacSCC and/or metastatic cSCC when curative surgery or radiotherapy is no longer amenable. For this situation, experts currently recommend cemiplimab as a first-line systemic alternative. As cemiplimab therapy is potentially associated with a risk of organ graft rejection, pros and cons should be evaluated for every individual OTR patient with lacSCC.
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Affiliation(s)
- Eve Lebas
- Departments of Dermatology and Medical Oncology Skin Cancer Center, University Hospital Centre, CHU Du Sart Tilman, Liège, BELGIUM
| | - Nathalie Marchal
- Departments of Dermatology and Medical Oncology Skin Cancer Center, University Hospital Centre, CHU Du Sart Tilman, Liège, BELGIUM
| | - Andrée Rorive
- Departments of Dermatology and Medical Oncology Skin Cancer Center, University Hospital Centre, CHU Du Sart Tilman, Liège, BELGIUM
| | - Arjen F Nikkels
- Departments of Dermatology and Medical Oncology Skin Cancer Center, University Hospital Centre, CHU Du Sart Tilman, Liège, BELGIUM
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Prodinger C, Bauer JW, Laimer M. Translational perspectives to treat Epidermolysis bullosa-Where do we stand? Exp Dermatol 2020; 29:1112-1122. [PMID: 33043517 PMCID: PMC7756480 DOI: 10.1111/exd.14194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023]
Abstract
Epidermolysis bullosa (EB) is the prototypical example of genetic skin fragility disorders. Genotypic heterogeneity, modifier genes, epigenetic, biochemical and environmental factors alter and determine pathogenic traits and, ultimately, the wide and striking phenotypic variability in EB. Besides the primary structural-functional defect, chronic tissue damage with induction and dysregulation of inflammatory pathways is a common pathogenic mechanism in EB. In localized variants, the inflammatory aberrations may mainly affect the micromilieu of lesional skin, while a systemic inflammatory response was shown to contribute to the systemic morbidity in severe EB subtypes with extensive cutaneous involvement. Our continued understanding of the pathophysiology of EB, as well as advances in molecular technologies, has paved the way for translational therapeutic approaches. The spectrum comprises of corrective and symptom-relieving therapies that include innovative therapeutic options garnered from the bench, repurposed drugs approved for other diseases, as well as strategies for gene-, protein- and cell-based therapies. Immunological traits further define new targets of therapy, aimed at improving skin barrier restoration, microbial surveillance and infection control, wound healing and anti-neoplastic effects. Clinical availability and feasibility of these approaches for all EB patients and subtypes are currently limited, reflecting issues of efficacy, specificity, tolerability and safety. A multistep targeting approach and highly individualized, risk-stratified combinatory treatment plans will thus be essential for sustained efficacy and improved overall quality of life in EB.
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Affiliation(s)
- Christine Prodinger
- Department of Dermatology and AllergologyUniversity Hospital of the Paracelsus Medical University SalzburgSalzburgAustria
| | - Johann W Bauer
- Department of Dermatology and AllergologyUniversity Hospital of the Paracelsus Medical University SalzburgSalzburgAustria
| | - Martin Laimer
- Department of Dermatology and AllergologyUniversity Hospital of the Paracelsus Medical University SalzburgSalzburgAustria
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Caldaria A, Giuffrida R, di Meo N, Massari L, Dianzani C, Cannavò SP, Degrassi F, Casablanca E, Zalaudek I, Conforti C. Diagnosis and treatment of melanoma bone metastasis: A multidisciplinary approach. Dermatol Ther 2020; 33:e14193. [DOI: 10.1111/dth.14193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/03/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Antonio Caldaria
- Orthopedic and Traumatology Unit Sant'Anna University Hospital Ferrara Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology University of Messina Messina Italy
| | - Nicola di Meo
- Dermatology Clinic, Hospital Maggiore of Trieste University of Trieste Trieste Italy
| | - Leo Massari
- Orthopedic and Traumatology Unit Sant'Anna University Hospital Ferrara Italy
| | - Caterina Dianzani
- Plastic Surgery Unit, Section of Dermatology Campus Biomedico University Rome Italy
| | | | - Ferruccio Degrassi
- Department of Radiology, Maggiore Hospital of Trieste University of Trieste Trieste Italy
| | - Edoardo Casablanca
- Department of Orthopedics and Trauma Surgery University of Verona Verona Italy
| | - Iris Zalaudek
- Dermatology Clinic, Hospital Maggiore of Trieste University of Trieste Trieste Italy
| | - Claudio Conforti
- Dermatology Clinic, Hospital Maggiore of Trieste University of Trieste Trieste Italy
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