Do you consider downstaging neoadjuvant cemiplimab for borderline resectable CSCC in order to facilitate surgical resection?

Very good question. Data from use of neoadjuvant therapy in many solid tumors has shown that when they clinically regress, actual pathologic response is more heterogeneous. Although an area can appear to have a complete clinical response- random biopsies can show areas of viable microscopic tumor st...

The answer is yes, since the publications of the neoadjuvant cemiplimab study in the NEJM (Gross et al., PMID 36094839/). However, this is a change of standard of care, not yet vetted in the NCCN guidelines (Guideline SCC4), nor FDA approved for this indication. Thus, off label cemiplimab or pembrol...

I will consider neoadjuvant downstaging for borderline resectable CSCC after a multidisciplinary discussion. In some instances, neoadjuvant cemiplimab will result in a complete clinical response whereby the patient will understandably refuse surgery. For these situations, I will consider consolidati...