Hopeful Outcomes In Immunotherapy for Non-Melanoma Skin Cancers
Hopeful Outcomes In Immunotherapy for Non-Melanoma Skin Cancers from Patient Empowerment Network on Vimeo.
What should non-melanoma skin cancer patients know about immunotherapy? Expert Dr. Silvina Pugliese explains common situations when immunotherapy is used and updates about immunotherapy treatment and research.
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.
“…ask your oncologist or your treating dermatologist whether your skin cancer, your non-melanoma skin cancer, if it is advanced or unable to be cut out completely, or whether there is any metastatic disease if you would be a candidate for immunotherapy.”
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Dr. Pugliese, what is the role of immunotherapy in patients with non-melanoma skin cancers, specifically those whose cancer is in an advanced stage or in their first line of treatment?
Dr. Silvina Pugliese:
So one of the things that we learn about non-melanoma skin cancers is that the majority of those skin cancers are treated with easier and more localized treatments. So, for example, topical chemotherapy creams, a topical cream like imiquimod (Aldara, Zyclara) for some very early basal cell, or very, I should say superficial basal cell and also squamous cell cancer. And for patients that have more invasive disease, those are often treated surgically with surgical excision or most micrographic surgery for certain areas of the skin. That being said, we do have patients who go on to have more advanced skin cancer, and this is much more common in squamous cell cancer than it is in basal cell cancer.
And squamous cell cancer is the place where immunotherapy is being used the most currently. So currently immunotherapy is utilized in patients who have priMary Leer or recurrent locally advanced squamous cell cancer and are also non-surgical candidates or who have already had surgery but have high-risk disease or who have skin cancers that cannot be entirely resected or removed or cannot be operated on for a variety of different reasons or just cannot be removed completely.
We also utilize it in patients who have distant metastatic disease, meaning their skin cancer has moved beyond the area where it originated in and beyond local lymph nodes, for example. So it could be in another organ system entirely. And in those cases, we often can’t completely cut every area out. And so we use a systemic treatment such as immunotherapy.
In recent years, the medications called anti-PD-1 inhibitors have been shown to have some robust clinical data in terms of being a novel treatment option for patients with advanced squamous cell cancer that cannot be completely removed surgically or who have some of those other categorizations that we talked about. The two immunotherapies or immunotherapeutic agents that are most commonly used for squamous cell cancer currently are cemiplimab (Libtayo) and pembrolizumab (Keytruda). And those are systemic treatments that can be used alone without radiation.
And there are interestingly some ongoing trials looking at cemiplimab for treatment of basal cell cancer. So again, there are many less patients with advanced basal cell cancer. So the trials are not large. So it is mostly case reports, but there is some evidence that cemiplimab can be helpful for the treatment of basal cell carcinoma that is advanced or metastatic.
My activation tip for this question is to ask your oncologist or your treating dermatologist whether your skin cancer, your non-melanoma skin cancer, if it is advanced or unable to be cut out completely, or whether there is any metastatic disease if you would be a candidate for immunotherapy.