Dr Neil Gross: QOL Improvement Likely Following Treatment With Cemiplimab for cSCC

Patients may be able to forgo radiation following use of cemiplimab to treat their resectable cutaneous squamous cell carcinoma (cSCC), as it is likely to demonstrate significant improvement in quality of life (QOL) for patients and enable less invasive surgeries, noted Neil D. Gross, MD, FACS, head and neck surgeon and director of clinical research in the Department of Head and Neck Surgery at The University of Texas MD Anderson Cancer Center.

Transcript

How does cemiplimab fulfill an unmet need in the immunotherapy space?

Immunotherapy is currently approved for use in unresectable cutaneous squamous cell carcinoma, and it’s really taken a page from the melanoma history. Immunotherapy has changed the practice of melanoma over the last decade or two, but it has yet to change the practice of [resectable] cutaneous squamous cell carcinoma. But both are uniquely responsive to immunotherapy and that has to do with the UV damage created from sun exposure and that is particularly well suited to immunotherapy.

Historically, patients with advanced cutaneous squamous cell carcinoma would be treated with surgery and radiation as the primary treatment—but that has a lot of potential toxicities. Surgeries can be functionally devastating, and radiation can have long-term side effects. Immunotherapy is approved for unresectable disease, but this is the first study to bring it earlier into the phase of care and to see if that can impact function and outcomes for patients.

So, we don’t have the long-term survival data for these patients, we don’t have the long-term quality-of-life data—those data are maturing—but I think we’ll see that the oncologic outcomes will be at least as good and durable. We know this from the long-term follow-up from the pilot trial, which is now over 3 years old. I think, importantly, it will demonstrate significant improvement in quality of life for patients, enabling less invasive surgeries, and for many patients, enabling the avoidance of radiation therapy, which can be very toxic in the head and neck region.

It's such a grind going in for treatment over and over again. These patients, at least in the head and neck, they go for 6 weeks. The impact on quality of life is particularly dramatic in the head and neck; it’s just such a sensitive area. It’s where people eat, where they breathe, where they’re seen, or where they see from; it can affect their hearing, all their senses. So, it can be functionally devastating, the treatments, including radiation, and that can last a lifetime, too, not just during treatment.

The huge benefit of this approach is that I believe many patients will be able to avoid radiation treatment after surgery, and that’s where I think it can have a profound impact on quality of life long term. So a smaller surgery, more focused surgery, and perhaps avoiding radiation altogether. Just a smarter approach to this disease than what we’ve been using in the past.