A new systemic medication option offers promising results for patients with high-risk squamous cell carcinoma for whom surgery has not worked, according to Chrysalyne Schmults, M.D., associate professor of dermatology at Harvard Medical School and vice chair of surgical oncology at Brigham and Women’s Hospital dermatology department, Boston. An intravenous, programmed death receptor-1 inhibitor drug called cemiplimab (Libtayo, Sanofi and Regeneron Pharmaceuticals) could offer a long-term halt of disease for a significant number of patients with this disease.
“We’ve gone for so many years, in fact, the entire history of squamous cell carcinoma without an FDA-approved treatment for people who fail surgery and radiation,” she says. “We’ve been in dire need of a good treatment option for when patients become unresectable. Now, we have a drug with a 50% response rate, and that’s a big improvement for these patients.”
This therapeutic advancement is significant, she says, because squamous cell carcinoma kills approximately the same number of patients annually as melanoma. But, until now, patients have only received an EGFR antagonist or platinum-based chemotherapy after an unsuccessful surgery or radiation. Efficacy for these options is short term and only occurs in roughly 20% of patients.
For appropriate patients, the cemiplimab dose is 350mg every three weeks. Each infusion session lasts 30 minutes. Although the dermatologist is likely the first provider to identify and diagnose squamous cell carcinoma, a medical oncologist will typically administer the medication in the United States, Dr. Schmults says. Still, it is important for dermatologists to be aware of the drug and to become familiar with its impact and side effects, especially since these drugs will likely be combined in the future with drugs that will be injected directly into tumors by dermatologists.
Few dermatology centers nationwide are equipped to deliver cemiplimab, but providers who wish to assume a more active role with the medication could pursue treatment privileges at an infusion center with appropriate safeguards and nursing support for intravenous systemic therapy, she says. Additional education is currently available via the European Academy of Dermatologic Oncology.