Adjuvant Immunotherapy for High-Risk cSCC

This video series has been produced independently by Dermatology Times and supported through an educational grant by Sun Pharmaceuticals.

Dr. Chandra details the CPOST trial, a randomized phase 3 study in which 415 patients received either adjuvant cemiplimab for one year or placebo. The primary endpoint of disease-free survival was profoundly improved, with a hazard ratio near 0.3. She cautions against extrapolating the results to every patient, emphasizing that CPOST enrolled a strictly high-risk population. The case patient meets some but not all of these criteria, so she would review the clinical and histologic picture, and the patient's ability to tolerate immunotherapy, before recommending it.

Dr. Patel frames the recurring tension between treating in the adjuvant setting and letting disease declare itself, noting that an adjuvant option now exists for the high risk patients while immunotherapy remains available if a tumor later recurs. Dr. Carr explains why clinicians repeatedly recite CPOST's inclusion criteria: a parallel pembrolizumab trial, KEYNOTE-630, did not meet its endpoints, and the leading explanation is that CPOST enrolled a higher-risk cohort where the benefit is real. Treating lower-risk patients in the adjuvant setting risks exposing them to toxicity without meaningful gain.

Dr. Patel closes by cautioning against over-referral of every tumor labeled high-risk, a term that carries different meanings across the oncology, surgical, and dermatology literature. He reframes KEYNOTE-630 not as simply negative but as a signal that underscores the importance of accurate risk stratification, identifying precisely which patients stand to benefit.

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