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Journal of Neuro-Oncology

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01-09-2023 | Cutaneous Squamous Cell Carcinoma | Case Study

Durable tumor regression and restoration of neurologic function after treatment with anti-PD-1 in patients with functionally unresectable cutaneous squamous cell carcinoma with perineural spread into the cavernous sinus

Authors: Andrew R. Carey, Govind Warrier, Jenny K. Hoang, Megan D. Schollenberger, Evan J. Lipson, Nicholas R. Mahoney

Published in: Journal of Neuro-Oncology | Issue 2/2023

Abstract

Purpose

To describe tumor response and cranial nerve function outcomes after administration of anti-PD-1 to patients with cutaneous squamous cell carcinoma (CSCC) with perineural spread to cranial nerves (CN) extending into the cavernous sinus.

Methods

Electronic patient records from a single institution were queried for patients with CSCC of the head and neck causing diplopia (ICD-10 H53.2) who were treated with anti-PD-1. Data extracted included demographics, duration of anti-PD-1 therapy, immune-mediated adverse reactions, tumor response per adapted RECIST v1.1, and changes in CN function and symptoms (e.g., pain). All patients were prescribed cemiplimab 350 mg IV q3 weeks.

Results

Four patients met inclusion criteria. They had varying degrees of pain and sensory deficits in branches of the trigeminal nerve (CN V). One, 2, 3 and 1 patients had baseline involvement of CN III, IV, VI and VII, respectively. MRI confirmed perineural cavernous sinus involvement in all patients. Duration of anti-PD-1 therapy ranged 15–60 weeks. All patients experienced an objective anti-tumor response to anti-PD-1; partial response n = 2, complete response n = 2. At a median follow-up of 22 months, responses were ongoing in all patients. All patients demonstrated improvement in ocular motility deficits and pain with resolution of symptoms in 3 and 1 patients, respectively.

Conclusion

Administration of anti-PD-1 to patients with CSCC with perineural spread into the cavernous sinus can generate durable anti-tumor regressions and restore CN function, while sparing the morbidity associated with surgical resection and/or radiotherapy. Our findings add to emerging literature supporting this treatment approach for this patient population.

Iancu DC-E, Fulga A, Vesa D et al (2023) Insight on common forms of cutaneous head and neck carcinoma (Review). Mol Clin Oncol 18:28. https://doi.org/10.3892/mco.2023.2624CrossRefPubMedPubMedCentral

ten Hove MW, Glaser JS, Schatz NJ (1997) Occult perineural tumor infiltration of the trigeminal nerve. Diagnostic considerations. J Neuroophthalmol 17:170–177PubMed

Migden MR, Rischin D, Schmults CD et al (2018) PD-1 blockade with cemiplimab in advanced cutaneous squamous-cell carcinoma. N Engl J Med 379:341–351. https://doi.org/10.1056/NEJMoa1805131CrossRefPubMed

Grob J-J, Gonzalez R, Basset-Seguin N et al (2020) Pembrolizumab monotherapy for recurrent or metastatic cutaneous squamous cell carcinoma: a single-arm phase II trial (KEYNOTE-629). J Clin Oncol 38:2916–2925. https://doi.org/10.1200/JCO.19.03054CrossRefPubMedPubMedCentral

Center for Drug Evaluation, Research FDA approves cemiplimab-rwlc for metastatic or locally advanced cutaneous squamous cell carcinoma. In: U.S. Food and Drug Administration. https://www.fda.gov/drugs/drug-approvals-and-databases/fda-approves-cemiplimab-rwlc-metastatic-or-locally-advanced-cutaneous-squamous-cell-carcinoma. Accessed 30 Apr 2023

Gross ND, Miller DM, Khushalani NI et al (2022) Neoadjuvant cemiplimab for stage II to IV cutaneous squamous-cell carcinoma. N Engl J Med 387:1557–1568. https://doi.org/10.1056/NEJMoa2209813CrossRefPubMedPubMedCentral

Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247. https://doi.org/10.1016/j.ejca.2008.10.026CrossRefPubMed

Chan AC, Tan BY, Goh Y et al (2022) Aseptic meningitis after BNT-162b2 COVID-19 vaccination. Brain Behav Immun Health 19:100406. https://doi.org/10.1016/j.bbih.2021.100406CrossRefPubMed

Lin A, Schmalbach CE (2023) Surgery in the era of immunotherapy for advanced head and neck non-melanoma skin cancer. Curr Oncol Rep. https://doi.org/10.1007/s11912-023-01391-8CrossRefPubMedPubMedCentral

10.

Tiosano A, Ben-Ishai M, Cnaany Y et al (2023) Primary cemiplimab treatment for orbital squamous cell carcinoma is effective and may alleviate the need for orbital exenteration. Eye. https://doi.org/10.1038/s41433-022-02358-yCrossRefPubMed

11.

McLean LS, Lim AM, Webb A et al (2021) Immunotherapy to avoid orbital exenteration in patients with cutaneous squamous cell carcinoma. Front Oncol 11:796197. https://doi.org/10.3389/fonc.2021.796197CrossRefPubMed

12.

Nightingale J, Gandhi M, Helena J et al (2022) Immunotherapy for the treatment of perineural spread in cutaneous head and neck squamous cell carcinoma: time to rethink treatment paradigms. Head Neck 44:1099–1105. https://doi.org/10.1002/hed.27005CrossRefPubMed

13.

Wu MP, Reinshagen KL, Cunnane MB et al (2022) Clinical perineural invasion and immunotherapy for head and neck cutaneous squamous cell carcinoma. Laryngoscope 132:1213–1218. https://doi.org/10.1002/lary.29953CrossRefPubMed

14.

Erkan S, Savundra JM, Wood B et al (2017) Clinical perineural invasion of the trigeminal and facial nerves in cutaneous head and neck squamous cell carcinoma: outcomes and prognostic implications of multimodality and salvage treatment. Head Neck 39:1280–1286. https://doi.org/10.1002/hed.24607CrossRefPubMed

15.

Martins F, Sofiya L, Sykiotis GP et al (2019) Adverse effects of immune-checkpoint inhibitors: epidemiology, management and surveillance. Nat Rev Clin Oncol 16:563–580. https://doi.org/10.1038/s41571-019-0218-0CrossRefPubMed

16.

Gambichler T, Scheel CH, Reuther J, Susok L (2022) Management of immune-related adverse events in anti-PD-1-treated patients with advanced cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol 36(Suppl 1):23–28. https://doi.org/10.1111/jdv.17402CrossRefPubMed

Title: Durable tumor regression and restoration of neurologic function after treatment with anti-PD-1 in patients with functionally unresectable cutaneous squamous cell carcinoma with perineural spread into the cavernous sinus
Authors: Andrew R. Carey
Govind Warrier
Jenny K. Hoang
Megan D. Schollenberger
Evan J. Lipson
Nicholas R. Mahoney
Publication date: 01-09-2023
Publisher: Springer US
Keywords: Cutaneous Squamous Cell Carcinoma
Cutaneous Squamous Cell Carcinoma
Diplopia
Orbitotomy
Published in: Journal of Neuro-Oncology / Issue 2/2023
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-023-04427-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Durable tumor regression and restoration of neurologic function after treatment with anti-PD-1 in patients with functionally unresectable cutaneous squamous cell carcinoma with perineural spread into the cavernous sinus

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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