Treating Cutaneous Squamous Cell Carcinoma and Basal Cell Carcinoma

Daniel Olson, MD, University of Chicago Medicine, Illinois, highlights a patient case of non-melanoma skin cancer where pembrolizumab was utilized to treat cutaneous squamous cell carcinoma and basal cell carcinoma.

Transcript:

Hi, my name is Dan Olson and I'm an oncologist at the University of Chicago where I'm Assistant Professor of Medicine. I specialize in the treatment of patients with advanced skin cancers.

In this case, I highlight a patient who has two non-melanoma skin cancers. Here, it's cutaneous squamous cell cancers, as well as basal cell cancer, where we use pembrolizumab. And in this case, we treated with a systemic therapy, the pembrolizumab in this case, where we felt that both surgery and radiation, which can be effective for non-melanoma skin cancers, had unfavorable tradeoffs. And we thought that the potential risk of pembrolizumab certainly outweighed the tradeoffs with the other approaches.

In this case, the patient had a good favorable response, and saw multiple different lesions of different cancer types regress at the same time. This reflects a challenge, that we often see in patients with these type of skin cancers, is that they can have them in multiple places. And sometimes, in locations where surgery and radiation become difficult. But fortunately, with using the systemic treatment like pembrolizumab, we can effectively treat these lesions in all the different sites where they are. And fortunately, for this patient, that is the case, where we've seen an improvement in all of her treated lesions.

Regarding the quiz question, at the end, I discussed the use of an immune checkpoint inhibitor for patients with different scenarios or backgrounds, and all of these are appropriate. Certainly, we know that pembrolizumab can be effective for patients with melanoma, with metastatic disease, and it's well tolerated, even in old older patients, where we might not consider other systemic anti-cancer therapies, like chemotherapy. Certainly, immune checkpoint inhibitors in PD-1 inhibitors, specifically like pembrolizumab, can be well tolerated in these patients.

The one group, where we might certainly would not consider giving this treatment, would be patients who depend on their immune system, and the suppression of their immune system specifically, are patients with solid organ transplants. In those cases, we know that immune check points, which we block with immune checkpoint inhibitors, are really important for maintaining tolerance of these transplanted organs. Giving a medication like pembrolizumab would be highly risky, and could potentially lead to a patient's own immune system activating against the graft, and then, the ultimate dysfunction of that organ. So in those cases, we look for alternatives before ever considered an immune checkpoint inhibitor, on the hopes that we can control their cancer.

So thank you for taking the time to review this vignette. I hope you found it informative. Thanks for your attention. Take care.