Historical Treatment Approaches for CSCC

Transcript: Axel Hauschild, MD: Cutaneous squamous cell carcinoma is a common disease. It’s the second most observed skin cancer in humans, and cutaneous squamous carcinomas can typically be easily treated by surgery. So 90% of all cutaneous squamous cell carcinomas will be removed and never recur. But there’s 10% percent of locally advanced and metastatic cutaneous squamous cell carcinomas, which are not so easy to treat. And traditionally we use chemotherapies, platinum-based chemotherapies, to treat those patients who were not eligible for either surgery or radiotherapy.

Comorbidities are an important issue because on average, patients with locally advanced and metastatic cutaneous squamous cell carcinomas are 15 years older than the metastatic melanoma patients. So we have the problem of an increasing age, and these are typically patients at age 75 and older. Therefore, they have comorbidities, co-medications, and we need to respect these co-medications.

One of the reasons patients come with neglected tumors, huge tumors that are bleeding, is because they believe they are too old to be treated or they are likely to die soon, which is not always the case. They might have a good life expectancy, but they’re not willing to be treated by surgery. Therefore, these complex cases need to be discussed in the interdisciplinary tumor board, and there the comorbidities are playing an important role, particularly if patients are considered for surgery with full anesthesia.

Typically, in Germany and elsewhere, we are discussing those complex cases in interdisciplinary tumor boards, and the interdisciplinary team is coming to a decision. And typically it’s a question of if the is patient operable—yes or no—if the patient is a candidate for radiotherapy, or if the patient needs systemic treatment.

Traditionally in Germany, the dermato-oncologists are giving systemic treatments; for instance, chemotherapies or EGFR receptor inhibitors, and in our day, the PD-1 [programmed cell death protein 1] antibodies. In other countries this is done by medical oncologists who are sitting on the table at the interdisciplinary tumor board. So it’s not a problem at all to refer those patients to the right persons to get the intralesional therapy or the infusions.

Transcript Edited for Clarity