“I suggest that dermatologists who are interested in learning more about cemiplimab and participating in this aspect of patient care should talk to people in their community who have experience with immunotherapy,” she says.
Alongside its 50% efficacy rate, cemiplimab does produce some side effects. The most common are rash, fatigue and diarrhea. Less common, but still possible, are pneumonitis, colitis, and hepatitis, occurring in approximately 2.4%, 0.9%, and 2.1% of patients, respectively. For most of these cases, Dr. Schmults says, oral prednisone is the main treatment. When these problems occur, cemiplimab is sometimes discontinued temporarily. In more severe cases, though, it may be discontinued permanently and hospitalization may be needed. The American Society of Clinical Oncology has published guidelines for how to handle immune-related toxicities of immunotherapy drugs like cemiplimab.
Most of cemiplimab’s side-effects are due to overstimulation of the immune system, which can impact any organ in the body. And, in some cases, the effect can be permanent. For example, Dr. Schmults says, the medication frequently affects the thyroid, producing either hypothyroidism, treated with levothyroxine or hyperthyroidism. A patient could also develop permanent diabetes if autoimmune pancreatitis is present.
Dr. Schmults cautions that cemiplimab is not safe for all patients with squamous cell carcinoma. If a patient has received an organ transplant or has an immune-mediated disease, such as severe lupus, this medication may not be an option. In those cases, a dermatologist should consult with other members of the patient’s healthcare team to determine the best path forward for treatment.
Ultimately, Dr. Schmults says, it’s important for dermatologists to be aware of this treatment option when surgery fails. Knowing how to combine existing and future treatments with intravenous systemic therapies, particularly cemiplimab, will be vital to patient management.
“As providers, dermatologists should know this drug approach is available for patients who have exhausted the other curative methods of surgery and radiotherapy,” she says. “There really isn’t another option right now.”