Tag Archive for: non-melanoma skin cancer treatment

Treatment Options for Advanced Non-Melanoma Skin Cancer

Treatment Options for Advanced Non-Melanoma Skin Cancer from Patient Empowerment Network on Vimeo.

Treatment options for advanced non-melanoma skin cancers are ever-changing. Dr. Diwakar Davar reviews current treatment options and discusses which medical professionals are involved in treating advanced non-melanoma skin cancers.

Dr. Diwakar Davar is the Clinical Director of the Melanoma and Skin Cancer Program at UPMC Hillman Cancer Center. Learn more about Dr. Davar.

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An Expert’s Perspective on Advanced Non-Melanoma Skin Cancer Research

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Emerging Treatments for Advanced Non-Melanoma Skin Cancer: What’s Showing Promise

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Transcript:

Katherine:

What approaches are currently available to treat these more common forms of advanced non-melanoma skin cancer? 

Dr. Davar:

Right now, the most common mode of treatment is typically treating cancer that is localized.  

Again, even with the extremely increasing incidence of these cancers, the vast majority of cancers that we detect are still localized and are amenable to easy surgical eradication by a trained dermatologist or a trained mole surgeon. A trained dermatologist, a trained mole surgeon, a plastic surgeon, these are commonly the physicians that encounter these patients. Surgical removal is still the primary mode of eradications of these lesions. However, increasingly, there is a role for early systemic therapy and local regional therapy to improve patient outcomes for reasons that we can talk about. Still, the vast majority of patients are still treated surgically and then increasingly, there is the role for referral to medical oncologists and radiation oncologists to talk about alternative forms of treatment that may be needed after that. 

Katherine:

What sort of alternative therapies? Are you looking at targeted therapies? Immunotherapies? 

Dr. Davar:

The primary reason for which advances have happened in this disease is really the advent of effective systemic immunotherapy and the spillover of immunotherapy into the patient landscape in these diseases. The reason for that is as follows. Immunotherapy essentially is most effective in tumors that carry a high tumor mutation burden. For example, melanoma has a tumor mutation burden on average of about 15, and the tumor mutation burden in melanoma is driven by the fact that melanoma, cutaneous melanoma is an ultraviolet light-driven skin cancer.  

However, non-melanoma skin cancers have tumor mutation burdens that are many, many magnitudes higher than that of melanoma. For example, the median tumor mutation burden in cutaneous squamous cell carcinoma is 50. Melanoma is 15. The median tumor mutation burden in cutaneous squamous cell carcinoma is three times that of melanoma. Similarly, for Merkel cell carcinoma. A large majority of Merkel cell carcinoma is caused by an unusual virus known as a Merkel cell polyomavirus. Both the viral driven tumors and the non-viral driven tumors have high tumor mutation burdens, and the same is true of basal cell carcinoma because of ultraviolet light exposure.  

The primary reason why immunotherapy has gotten a foothold in these diseases is because the underlying etiologic agent that drives carcinogenesis, ultraviolet light for the majority of these, and the Merkel cell polyomavirus for the subcategory of non-melanoma skin cancer that is Merkel are both associated with a response to immunotherapy.   

As a result of that, immunotherapy, anti-PD-1 immunotherapy is now standard of care for patients with tumors that are either locally advanced undissectible or locally advanced and/or metastatic, that is, that they have spread. They are now available for use and FDA-approved for this indication in both Merkel, basal, as well as non-melanoma cutaneous squamous cell carcinoma. 

Non-Melanoma Skin Cancers and Clinical Trials | Advancing Science for Everyone

Non-Melanoma Skin Cancers and Clinical Trials: Advancing Science for Everyone from Patient Empowerment Network on Vimeo.

What is the value of non-melanoma skin cancer clinical trials? Expert Dr. Silvina Pugliese from explains why clinical trial participation is important and shares advice for patients.

Silvina Pugliese, M.D., is a Clinical Assistant Professor of Dermatology and Attending Physician at the Stanford Medicine Outpatient Center and Stanford Cancer Institute. Learn more about Dr. Pugliese.

[ACT]IVATION TIP

“…if you are interested in participating in a clinical trial, in advancing medical knowledge, and you feel comfortable doing so, please ask your dermatologist or your oncologist, whether they’re aware of any clinical trials that are available for your particular type of skin cancer.”

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What Should Non-Melanoma Skin Cancer Patients Consider About Treatment?

Hopeful Outcomes In Immunotherapy for Non-Melanoma Skin Cancers

What Is the Role of Immunotherapy for Non-Melanoma Skin Cancers?


Transcript:

Mary Leer:

Why is clinical trial participation so important in non-melanoma skin cancers, and what advice do you have for patients considering a clinical trial?

Dr. Silvina Pugliese:

This is a great question. So it is much more common to have early stage localized disease for basal cell cancer and squamous cell cancer. So the overall case number that we see for advanced or unresectable or metastatic disease for squamous cell cancer and especially for basal cell cancer is much lower than the usual numbers we hear of 4 million cases annually of basal cell cancer in the U.S., and 2 million of squamous cell cancer. And the reason this is important is because when we have a lower pool to evaluate or study, when we think about these more advanced skin cancers, we have less patients to recruit for some of these studies. This is especially important when we think about advanced or metastatic basal cell cancer, which is very rare.

Also very important we think about less common skin cancers like Merkel cell carcinoma or DFSP. And when we think about how uncommon these skin cancers can be in skin of color, we realize we’re really drawing from a very small pool of patients. So my point here is that you can make a true impact by enrolling in a clinical trial, especially as we’re looking at what are some of the best treatment options for these more advanced skin cancers or metastatic skin cancers? Because we do need the right patients to be enrolled in order to study these research questions.

So my activation tip is, if you are interested in participating in a clinical trial, in advancing medical knowledge, and you feel comfortable doing so, please ask your dermatologist or your oncologist, whether they’re aware of any clinical trials that are available for your particular type of skin cancer. Of course, never feel any pressure to do this, it’s completely optional, but often it can provide more, a novel treatment option for your cancer or allow you to have certain treatment that’s not available through insurance, for example, at the moment. And also in doing so, advance the knowledge that we have in our field and help patients in the future who have your same skin cancer and are in your same position. 


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What Should Non-Melanoma Skin Cancer Patients Consider About Treatment?

What Should Non-Melanoma Skin Cancer Patients Consider About Treatment? from Patient Empowerment Network on Vimeo.

What is vital for non-melanoma skin cancer patients to know about treatment decisions? Expert Dr. Silvina Pugliese from Stanford Cancer Center explains how she works with patients and shares advice for communicating with your doctor.

Silvina Pugliese, M.D., is a Clinical Assistant Professor of Dermatology and Attending Physician at the Stanford Medicine Outpatient Center and Stanford Cancer Institute. Learn more about Dr. Pugliese.

[ACT]IVATION TIP

“…making sure that you have received all the information that you want, that you’ve received the opinions that you think are important for making that decision, and that you feel comfortable like you were able to make an informed decision.”

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See More from [ACT]IVATED Non-Melanoma Skin Cancer

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Melanoma vs. Non-Melanoma Skin Cancer | What’s the Difference?

Melanoma vs. Non-Melanoma Skin Cancer | What’s the Difference?


Transcript:

Mary Leer:

Dr. Pugliese, I’m curious, how do you work with your patients to make treatment decisions? And my curiosity in part is coming from, I have several family members that have had non-melanoma skin cancer, so I’m curious how you work with your patients and with the increase in treatment options, what should non-melanoma skin cancer patients consider when they’re deciding on a treatment?

Dr. Silvina Pugliese:

Those are great questions. So one of the first things that I do when working with patients to make any kind of treatment decision is, of course, first establish just a very open and trusting relationship where patients feel comfortable talking to me about what their concerns are with their skin cancer diagnosis and what their treatment preferences are because we could have all the information in the world, but it’s really not ideal to make a decision if we don’t know what a patient wants to do and what their fears are and what their questions are. So just having a really open and trusting relationship I think is an important foundation that we need before we can really counsel anyone on treatment decisions. And then the next component is really that knowledge piece. So presenting all the options that are available to me that I know of.

And, of course, always connecting patients when needed to other resources. I work very closely with other oncologists, with oncologists, I’m sorry, with other dermatologists, with oncologists, with radiation oncologists, with medical oncologists, with surgical oncologists because often the treatment for patients that have more advanced squamous cell cancer is going to be a multidisciplinary treatment, involving many different specialties.

So for that reason, it’s very important to make sure that I’m not only discussing the things that I can do in dermatology, but that I’m connecting patients to all of the available resources. I do provide my opinion when patients ask, but again it’s really about what patients want to do. And I do think that it’s a very personal decision. We think about treatment options for treating non-melanoma skin cancers.

So listening, establishing a good relationship, providing all of the available treatment options, and then just having a conversation and being available when questions arise. I find that some patients want the lowest risk of recurrence always, and other patients are more focused on side effects. So that is going to impact how we frame, we discuss the treatment options available.

The good news, I will say for most squamous cell cancer and basal cell cancer is that, again, the treatment options are going to be lower risk, so for most basal cell and squamous cell, we will discuss depending on the subtype, either using topical creams or doing surgical excision or doing Mohs surgery depending on the location, and then based on that, I would ask patients what their greatest concerns are, what their goals are, and what their clinical follow-up can be so that we make the best decision for patients.

So my activation tip for patients in terms of this question is to make sure that before making any kind of treatment decision, you feel comfortable asking questions, that you feel like all your answers have been addressed. You should never make a decision where you think you’re making it based on incomplete information, and, of course, we can never know the outcome, and we can’t know everything about everything.

But I think it is really important that you feel the most comfortable possible when you make a treatment decision, it is very impactful. So again, just making sure that you have received all the information that you want, that you’ve received the opinions that you think are important for making that decision, and that you feel comfortable like you were able to make an informed decision.


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Which Non-Melanoma Skin Cancer Treatments Are Available for Patients?

Which Non-Melanoma Skin Cancer Treatments Are Available for Patients? from Patient Empowerment Network on Vimeo.

Which non-melanoma skin cancer treatments are available for patients? Expert Dr. Silvina Pugliese from Stanford Cancer Center shares updates on treatments for basal cell carcinoma and squamous cell cancer.

Silvina Pugliese, M.D., is a Clinical Assistant Professor of Dermatology and Attending Physician at the Stanford Medicine Outpatient Center and Stanford Cancer Institute. Learn more about Dr. Pugliese.

[ACT]IVATION TIP

“…if you have a diagnosis, a new diagnosis of basal cell cancer and squamous cell cancer, to know that the treatment options that are available to you are often going to be things that are fairly minimally invasive. So you might be recommended to try a topical cream for the earlier variants of basal cell cancer and squamous cell cancer, or you will have an outpatient procedure to have the skin cancers cut out, either with a surgical excision or with the procedure called Mohs micrographic surgery.”

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Hopeful Outcomes In Immunotherapy for Non-Melanoma Skin Cancers

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Transcript:

Mary Leer:

Dr. Pugliese, what promising treatments are available for newly diagnosed patients with non-melanoma skin cancers?

Dr. Silvina Pugliese:

For the purposes of answering this question, I’m going to focus on the two most common types of non-melanoma skin cancer, which are basal cell cancer and squamous cell cancer. And one of the things I tell my patients who are newly diagnosed is letting them know that most basal cancer and most squamous cell cancer can be treated with fairly, and I’ll call them simple procedures or treatment in the sense that most of these skin cancers will not need any radiation or any type of chemotherapy or immunotherapy. So that’s the majority, it’s not all.

But, for example, for basal cell cancer, it’s really just a very low number of patients that have advanced basal cell cancer or metastatic basal cell cancer. For a very early stages of the disease or certain subtypes such as superficial basal cell cancer, which just lives on the top surface of the skin, we can even treat that with a topical medication, such as a topical chemotherapy medication called Fluorouracil or another topical cream called imiquimod (Aldara, Zyclara). For other subtypes of basal cell cancer, which invade a little deeper into the skin, surgical excision is preferred. If it’s in a functionally sensitive area such as the face, for example, this will generally be treated with the type of procedure called Mohs micrographic surgery. 

A very similar treatment algorithm exists for squamous cell cancer. Early squamous cell cancers that are insight to in the very top layer of the skin can also be treated, it’s off-label treatment, but can be treated with topical fluorouracil cream or topical imiquimod cream. And for squamous cell cancers that are more invasive or for squamous cell cancers that have some more aggressive features, those would be treated with surgical excision and in certain areas, Mohs micrographic surgery would be utilized. 

Activation tip for this question is that if you have a diagnosis, a new diagnosis of basal cell cancer and squamous cell cancer, to know that the treatment options that are available to you are often going to be things that are fairly minimally invasive. So you might be recommended to try a topical cream for the earlier variants of basal cell cancer and squamous cell cancer, or you will have an outpatient procedure to have the skin cancers cut out, either with a surgical excision or with the procedure called Mohs micrographic surgery.


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How a Skin Cancer Expert Empowers Patients

How a Skin Cancer Expert Empowers Patients from Patient Empowerment Network on Vimeo.

 

Dr. Anna Pavlick is a medical oncologist with over 20 years of experience treating patients with skin cancer and is the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. To learn more about Dr. Pavlick, visit here.

What are steps does skin cancer expert Dr. Anna Pavlick take to empower her patients? Dr. Pavlick explains how self-education and being comfortable with your healthcare team are key components of patient empowerment.

 

Katherine:

Yeah. Dr. Pavlik, how do you empower patients? 

Dr. Pavlick:

You know, when I talk to patients I really do try to number one: educate them. I am big believer in bad artwork, because I’m a bad artist. And so I really try to draw out schematics to help patients understand how they therapy that I’m proposing is going to work, so they understand the mechanism. Patients will also go home with printed handouts so that they can go back and read about what we talked about, because many times patients absorb maybe one-quarter of what’s been said in a consult. 

I encourage people to bring their family members or friends so that they can hear; two sets of ears is always better than one. And I fully support them; if they want to go get a second opinion, my answer is, “Absolutely.” I do not get offended. I feel that if – because a lot of times the patient’s going to say, “I don’t want a second opinion, but my family does.” You’ve got to live with your family. Go get the second opinion. 99 percent of the time, experts who do this for a living all have the same answers. And so it just is going to solidify for your family that the right thing is being done, and then you can also decide where do you feel most comfortable?  

If Dr. A and Dr. B tell you the same thing, what environment do you feel most comfortable in, so in the event that you had questions, or you didn’t feel well, where do you want to go? So, I strongly encourage that. And if somebody comes back and says, “You know, I really think that this place fits me better,” my answer is, “That’s absolutely fine; thank you for letting me know. If there’s anything I can do, please reach out.” Because, again, bottom line is I just want the best outcome for the patient.  

What Do Advanced Non-Melanoma Skin Cancer Patients Need to Know About Treatment and Research?

What Do Advanced Non-Melanoma Skin Cancer Patients Need to Know About Treatment and Research? from Patient Empowerment Network on Vimeo.

What therapies are emerging for advanced non-melanoma skin cancer (ANMSC)? Dr. Anna Pavlick shares the latest in ANMSC research news, including developments in targeted therapy and immunotherapy. 

Dr. Anna Pavlick is a medical oncologist with over 20 years of experience treating patients with skin cancer and is the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. To learn more about Dr. Pavlick, visit here

Katherine:

Are there developments in advanced non-melanoma skin cancer treatment and research that patients should know about?  

Dr. Pavlick:

Well, I think when it comes to non-melanoma skin cancers, the developments over the last five years have been groundbreaking. 

I think the first major advancement we made was to identify that the hedgehog pathway is a pathway that basal cell cancers follow in order to spread to other parts of the body. And we found out that if we can block that pathway, we can control basal cell cancer very easily because more than 90 percent of basal cell cancers use that pathway to spread. So it’s like a roadblock. If you’re doing construction and you come to point where you’ve got the detour, well, you can’t keep going straight ahead – you get stopped. And that’s what targeted therapies do, and we found that there are hedgehog inhibitors that are these roadblocks for basal cell cancer.  

Dr. Pavlick:

So what has been evolved since then is looking at immunotherapy as a way to control non-melanoma skin cancers because, as you know, melanoma was the first place that immunotherapy really became paramount as the key treatment that makes the hugest impact on patients. And because of what we learned in melanoma, finding out that the number of mutations that melanomas have make it very susceptible to immunotherapy. We then went and looked at, “Well, what does squamous cell cancer have, what does basal cell cancer have?” 

Well, we found out that basal cell, squamous cell and Merkel cell cancer have a very high mutational burden, and translating that, we said, “Well, we now know this: these are cancers that should now response to immunotherapy as well.” And they do. And they do very, very beautifully. Unfortunately, like every story, it’s not 100 percent of the tumors that will respond. It’s basically in the 50 percent range. So although it’s still a very high number, you need to know that going into it when you treat a patient with locally advanced squamous cell cancer, only 50 percent are going to have a response. So, if you don’t see that tumor getting better pretty darn quickly, you better start thinking, “This might be somebody who’s not going to respond to immunotherapy, and what’s going to be my Plan B?”  

Katherine:

Right.  

Dr. Pavlick:

Because squamous cell cancers in general respond very, very quickly to immunotherapy. 

Usually within a matter of four to six weeks, you’re already starting to see improvement. When it comes to basal cell cancer on the other hand, basal cell cancers – because they develop very, very slowly over years – it takes months of immunotherapy to get them to respond. So I tell patients with locally advanced basal cell, “You really have to be patient, because we expect this to take somewhere between three and 6 months for us to start seeing something get better.” It doesn’t mean that it’s not working, it’s just basal cells just respond much slower. I think when patients are prepared and knowing that this is not a quick eight weeks – we’re going to know for sure whether this helps or not – it helps patients to be able to understand that, “I’m in this for at least six months –maybe longer.”