Premium
Treatment approaches in immunosuppressed patients with advanced cutaneous squamous cell carcinoma
Author(s) -
Willenbrink T.J.,
JambusariaPahlajani A.,
Arron S.,
Seckin D.,
Harwood C.A.,
Proby C.M.
Publication year - 2019
Publication title -
journal of the european academy of dermatology and venereology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.655
H-Index - 107
eISSN - 1468-3083
pISSN - 0926-9959
DOI - 10.1111/jdv.15843
Subject(s) - medicine , immunosuppression , clinical trial , merkel cell carcinoma , oncology , capecitabine , adjuvant , skin cancer , ipilimumab , disease , immunotherapy , cancer , carcinoma , colorectal cancer
Abstract Immunosuppression, both iatrogenic and disease‐related, is associated with a greatly increased incidence of cutaneous SCC ( cSCC ) and with aggressive cSCC and worse disease outcomes. Consequently, rapid access to skin cancer services and prudent surgical choices, such as circumferential margin assessment, is essential when treating advanced cSCC in an immunosuppressed patient. For high‐risk cancers and control of cSCC multiplicity, additional strategies should be actively considered within the multidisciplinary clinical care team. These include minimization or revision of immunosuppressive medications, systemic chemoprevention (including retinoids, nicotinamide, capecitabine) and adjuvant therapies such as radiotherapy. Unfortunately, there is a relative paucity of good evidence for many of these treatments in the immunosuppressed. Systemic treatments for metastatic cSCC are often contraindicated in organ transplant recipients, notably checkpoint inhibitor immunotherapy. There are also toxicity concerns with some conventional chemotherapies and EGFR inhibitors. Until recently, clinical trials have largely excluded immunosuppressed individuals. Development of more effective treatment for advanced cSCC in this high‐risk group and prospective clinical trials are now research priorities.