Systemic treatments for non-melanoma skin cancers
Abstract
One in every 3 cancers diagnosed, including both melanoma and non-melanoma, is a skin cancer. Non-melanoma skin cancer (NMSC) which includes basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and, among others, other rarer NMSC such as Merkel cell carcinoma (MCC), represents the majority of skin cancers diagnosed in Canada and globally. NMSC is not included in most provincial and territorial cancer registries making it difficult to characterize the incidence and outcomes. Dermatologists across Canada manage NMSC daily with topical and surgical treatments. However, in rare cases these tumours can progress to become unresectable, locally destructive, metastasize and even cause death. For NMSC that progresses, there are systemic treatment options to help manage these malignancies. The aim of this article is to review the common systemic treatments for management of locally advanced, unresectable and/or metastatic NMSCs.
References
Skin cancers. World Health Organization. https://www.who.int/uv/faq/skincancer/en/index1.html. Date accessed: 11 Nov 2022
Public Health Agency of Canada (phac). Non melanoma skin cancer [Web page]. Ottawa, ON: phac; 2014. [Available at https://www.canada.ca/en/public-health/services/chronic-diseases/cancer/non-melanoma-skin-cancer.html; cited 06 Mar 2022]
Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence Estimate of Nonmelanoma Skin Cancer (Keratinocyte Carcinomas) in the U.S. Population, 2012. JAMA Dermatol. 2015 Oct;151(10):1081-6. doi: 10.1001/jamadermatol.2015.1187. PMID: 25928283.
Piva de Freitas P, Senna CG, Tabai M, Chone CT, Altemani A. Metastatic Basal Cell Carcinoma: A Rare Manifestation of a Common Disease. Case Rep Med. 2017;2017:8929745. doi: 10.1155/2017/8929745. Epub 2017 Nov 27. PMID: 29279714; PMCID: PMC5723960.
Tang S, Thompson S, Smee R. Metastatic basal cell carcinoma: case series and review of the literature. Australas J Dermatol. 2017 May;58(2):e40-e43. doi: 10.1111/ajd.12459. Epub 2016 Feb 24. PMID: 26916335.
Bisceglia M, Panniello G, Galliani CA, Centola M, D’Errico MM, Minenna E, Tucci FA, Ben-Dor DJ. Metastatic Basal Cell Carcinoma of the Skin: A Comprehensive Literature Review, Including Advances in Molecular Therapeutics. Adv Anat Pathol. 2020 Sep;27(5):331-353. doi: 10.1097/PAP.0000000000000267. PMID: 32618586.
Product monograph: https://www.rochecanada.com/PMs/Erivedge/Erivedge_PM_E.pdf
Sekulic, A., Midgen M.R., et. Al. Efficacy and safety of vismodegib in advanced basal-cell carcinoma. The New England Journal of Medicine. 2012. 366:23.
Yarchoan M., Hopkins A. and Jaffee E. M. 2017. Tumor mutational burden and response rate to PD-1 inhibition. N. Engl. J. Med. 377:2500.
Chalmers Z. R., Connelly C. F., Fabrizio D. et al.. 2017. Analysis of 100,000 human cancer genomes reveals the landscape of tumor mutational burden. Genome Med. 9:34.
Product monograph: https://pdf.hres.ca/dpd_pm/00050602.PDF
Migden MR, Rischin D, Schmults CD, Guminski A, Hauschild A, Lewis KD, Chung CH, Hernandez-Aya L, Lim AM, Chang ALS, Rabinowits G, Thai AA, Dunn LA, Hughes BGM, Khushalani NI, Modi B, Schadendorf D, Gao B, Seebach F, Li S, Li J, Mathias M, Booth J, Mohan K, Stankevich E, Babiker HM, Brana I, Gil-Martin M, Homsi J, Johnson ML, Moreno V, Niu J, Owonikoko TK, Papadopoulos KP, Yancopoulos GD, Lowy I, Fury MG. PD-1 Blockade with Cemiplimab in Advanced Cutaneous Squamous-Cell Carcinoma. N Engl J Med. 2018 Jul 26;379(4):341-351. doi: 10.1056/NEJMoa1805131. Epub 2018 Jun 4. PMID: 29863979.
Rischin D, Khushalani NI, Schmults CD, Guminski A, Chang ALS, Lewis KD, Lim AM, Hernandez-Aya L, Hughes BGM, Schadendorf D, Hauschild A, Thai AA, Stankevich E, Booth J, Yoo SY, Li S, Chen Z, Okoye E, Chen CI, Mastey V, Sasane M, Lowy I, Fury MG, Migden MR. Integrated analysis of a phase 2 study of cemiplimab in advanced cutaneous squamous cell carcinoma: extended follow-up of outcomes and quality of life analysis. J Immunother Cancer. 2021 Aug;9(8):e002757. doi: 10.1136/jitc-2021-002757. PMID: 34413166; PMCID: PMC8382148.
D’Angelo SP, Bhatia S, Brohl AS, Hamid O, Mehnert JM, Terheyden P, Shih KC, Brownell I, Lebbé C, Lewis KD, Linette GP, Milella M, Xiong H, Guezel G, Nghiem PT. Avelumab in patients with previously treated metastatic Merkel cell carcinoma (JAVELIN Merkel 200): updated overall survival data after >5 years of follow-up. ESMO Open. 2021 Dec;6(6):100290. doi: 10.1016/j.esmoop.2021.100290. Epub 2021 Oct 26. PMID: 34715570; PMCID: PMC8564559.
