1
|
Wu Z, Tao C, Yang L, Yan Y, Pan L, Zhang L. Treatment benefit of electrochemotherapy for superficial squamous cell carcinoma: a systematic review and single-arm meta-analysis. Clin Transl Oncol 2024; 26:2608-2617. [PMID: 38758386 DOI: 10.1007/s12094-024-03522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE Treating aggressive superficial squamous cell carcinoma (SCC) poses challenges due to invasiveness. Palliative care is recommended for inoperable cases with extensive tumors near vital organs, risking disfigurement or functional impairment. Electrochemotherapy (ECT) is an emerging cutaneous tumor treatment, but its efficacy against superficial SCC remains uncertain. This study conducts a systematic review and single-arm meta-analysis to evaluate ECT's effectiveness against superficial SCC and provide current evidence for clinical practice. METHODS Embase, PubMed and Cochrane Library were searched for studies up to May 2023. The random effects model analyzed complete response (CR) and partial response (PR), with subgroup assessment based on drug dosage, treatment response evaluation, tumor size, primary/recurrent status, and tumor location. RESULTS Ten studies involving 162 patients and 208 tumors were included. Pooled CR and PR rates for ECT-treated superficial SCC were 66.5% (95% CI 48.4%-82.5%; I2 = 84%) and 20.3% (95% CI 10.5%-32.3%; I2 = 70%), respectively. Subgroup analysis indicated ECT's superiority in treating primary tumors (PR: 70%, CR: 30%) and tumors ≤ 3 cm (PR: 81.3%, CR: 10.1%) compared to recurrent tumors (PR: 56.7%, CR: 36.5%) and tumors > 3 cm (PR: 45.2%, CR: 34.4%). CONCLUSION This single-arm meta-analysis confirms ECT's efficacy against superficial SCC, especially in primary tumors and those ≤ 3 cm in diameter. The study highlights the impact of tumor location and response evaluation on ECT's benefits, warranting further investigation through additional research.
Collapse
Affiliation(s)
- Zhuoxia Wu
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Chen Tao
- School of Mathematics and Statistics, Northeast Normal University, Changchun, 130024, Jilin, China.
| | - Liehao Yang
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Yan Yan
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Lingfeng Pan
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Lianbo Zhang
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| |
Collapse
|
2
|
Alberti A, Gurizzan C, Baggi A, Bossi P. Where do we stand with immunotherapy for nonmelanoma skin cancers in the curative setting? Curr Opin Otolaryngol Head Neck Surg 2024; 32:89-95. [PMID: 37997885 DOI: 10.1097/moo.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW Nonmelanoma skin cancers (NMSC) represent a heterogeneous group of diseases that encompasses among the principal histologies basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC), and Merkel cell carcinoma (MCC). Given the fact that high tumor mutational burden due to ultraviolet mutagenesis represents a common hallmark of NMSCs, immunotherapy has proved to be a promising therapeutic approach in recent years. The aim of this review is to shed light on immunotherapy applications in NMSCs in the curative setting. RECENT FINDINGS Immune checkpoint inhibitors represent the first-line treatment of choice for advanced cSCC and MCC, while in second line for BCC. Given this success, more and more trials are evaluating the use of immune checkpoint blockade in neoadjuvant setting for NMSCs. Clinical trials are still ongoing, with the most mature data being found in cSCC. Also, translational studies have identified promising biomarkers of response. SUMMARY Locoregional treatments of NMSCs can have non negligible functional and cosmetic impacts on patients, affecting their quality of life. As immunogenic diseases, neoadjuvant immunotherapy represents a promising treatment that could change the therapeutic path of these patients. Upcoming results from clinical trials will address these crucial issues.
Collapse
Affiliation(s)
- Andrea Alberti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia
| | - Cristina Gurizzan
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia
| | - Alice Baggi
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia
| | - Paolo Bossi
- Department of Biomedical Sciences - Humanitas University, Medical Oncology and Hematology Unit
- Humanitas Cancer Center - IRCCS Humanitas Research Hospital, Rozzano MI, Italy
| |
Collapse
|
3
|
Kim EY, Granger EE, Schoenfeld JD, Silk AW, Margalit D, Tishler R, Ruiz ES. Outcomes of palliative radiation therapy for cutaneous squamous cell carcinoma: A retrospective cohort study. JAAD Int 2024; 14:26-28. [PMID: 38054197 PMCID: PMC10694558 DOI: 10.1016/j.jdin.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Affiliation(s)
- Emily Y. Kim
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Emily E. Granger
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jonathan D. Schoenfeld
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Ann W. Silk
- Harvard Medical School, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Danielle Margalit
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Roy Tishler
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Emily S. Ruiz
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
4
|
Somani AK, Ibrahim SF, Tassavor M, Yoo J, Farberg AS. Use of the 40-gene Expression Profile (40-GEP) Test in Medicare-eligible Patients Diagnosed with Cutaneous Squamous Cell Carcinoma (cSCC) to Guide Adjuvant Radiation Therapy (ART) Decisions Leads to a Significant Reduction in Healthcare Costs. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2024; 17:41-44. [PMID: 38298751 PMCID: PMC10826833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Objective Adjuvant radiation therapy (ART) is often recommended for high-risk cSCC patients but carries significant costs and risks. This study aims to determine if utilizing the 40-GEP test to guide ART can reduce healthcare costs in cSCC management. Methods Medical claims data with new diagnoses of cSCC for the 12 months ending June 2022 in the Medicare (≥65 years) population (source: IQVIA claims database) were obtained and normalized to the general population for missingness. CPT codes associated with radiation therapy within one-year post diagnosis were used to establish adjuvant RT use (defined as 'ART'). Average weighted direct costs for four major ART modalities were calculated from published studies and (IQVIA). Sensitivity analysis was used to assess the financial impact of ART treatment using varying distributions of 40-GEP Class results. Results Normalized medical claims data identified 22,917 Medicare-eligible cSCC patients who received ART within the United States. The weighted average direct cost for ART, which includes the four most used CPT code-defined modalities (IGRT, IMRT, IMPT, and XRT), was $60,693 per patient, amounting to an annual projected ART cost of $1.4 billion. Using the distribution of 40-GEP results from published studies, utilization of a 40-GEP test result to avoid ART in these patients could save up to $972 million in Medicare-eligible population. Sensitivity analysis shows, depending upon the distribution of the 40-GEP results, that for every 10% of Class 2A test results omitting ART, an extra $38-66 million in annual savings is expected. Limitations Potential limitations include a need for more comprehensive patient information and the cost of ART-related complications. Conclusion Utilizing the 40-GEP test results to guide ART decision-making would result in material savings to Medicare.
Collapse
Affiliation(s)
- Ally-Khan Somani
- Dr. Somani is with the Department of Dermatology at Indiana's University School of Medicine in Indianapolis, Indiana
| | - Sherrif F Ibrahim
- Dr. Ibrahim is with Rochester Dermatologic Surgery in Victor, New York
| | - Michael Tassavor
- Dr. Tassavor is with Medical Dermatology and Cosmetic Surgery Centers in New York, New York
| | - Jane Yoo
- Dr. Yoo is with the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Aaron S Farberg
- Dr. Farberg is with Baylor Scott and White Health System in Dallas, Texas
| |
Collapse
|
5
|
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
|
6
|
Rembielak A, Yau T, Akagunduz B, Aspeslagh S, Colloca G, Conway A, Danwata F, Del Marmol V, O'Shea C, Verhaert M, Zic R, Livesey D. Recommendations of the International Society of Geriatric Oncology on skin cancer management in older patients. J Geriatr Oncol 2023; 14:101502. [PMID: 37080793 DOI: 10.1016/j.jgo.2023.101502] [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] [Received: 01/12/2023] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Non-melanoma skin cancer (NMSC) is becoming ever more prevalent among older adults. However, older adults with NMSC are often underrepresented in clinical trials and guidelines on effective management is still unclear. The International Society of Geriatric Oncology (SIOG) created a multi-disciplinary task force to explore the potential in developing practical guidelines for the treatment of older patients with basal cell carcinoma (BCC) and skin (cutaneous) squamous cell carcinoma (cSCC). MATERIALS AND METHODS A systematic literature search to identify relevant and up-to-date literature on treatment of NMSC in older adults was conducted on various databases including MEDLINE, Embase, CINAHL, Cochrane, and PubMed. The resulting papers were discussed by an expert panel, leading to a consensus recommendation. RESULTS A total of 154 articles were identified for the expert panel to utilise in generating consensus recommendations. A major focus on geriatric assessment and management options including surgery, radiotherapy, systemic therapy, clinical monitoring, and medical/medicophysical therapy were reviewed for recommendations. DISCUSSION Patient age should not be the sole deciding factor in the management of patients with NMSC. Assessment from a multidisciplinary team (MDT) is crucial, and the decision-making process should consider the patient's lifestyle, needs, and expectations. A comprehensive geriatric assessment should also be considered. Patients should feel empowered to advocate for themselves and have their views considered a part of the MDT discussion.
Collapse
Affiliation(s)
- Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Thomas Yau
- Barts and the London School of Medicine and Dentistry, Young SIOG Member, Queen Mary University of London, London, UK.
| | - Baran Akagunduz
- Young SIOG Member, Department of Medical Oncology, Erzincan Binali Yıldrıım University Medical School, Erzincan, Turkey
| | - Sandrine Aspeslagh
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Belgium.
| | - Giuseppe Colloca
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Aoife Conway
- Department of Radiation Oncology, The Mater Hospital, Crows Nest, NSW, Australia.
| | - Falalu Danwata
- Rosemere Cancer Centre, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK.
| | - Veronique Del Marmol
- Department of Dermatology and Venereology, Hopital Erasme-Université Libre de Bruxelles, Brussels, Belgium.
| | | | - Marthe Verhaert
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Belgium.
| | - Rado Zic
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, Zagreb, Croatia.
| | - Dan Livesey
- The Christie Library, School of Oncology, The Christie NHS Foundation Trust, Manchester, UK.
| |
Collapse
|