How would you treat a patient with aggressive metastatic cutaneous squamous cell carcinoma, which is not amenable to surgery or radiation?

This is an interesting question. Recently, in the NEJM (July 2018), there was a phase 1/2 study using an anti-PD-1 agent (cemiplimab) for advanced, unresectable, or metastatic cutaneous squamous cell carcinoma. Previously, this was a tumor type with no approved therapies, and treatment recommendatio...

Checkpoint inhibitor therapy is the recommended treatment for such patients. Three agents are approved: cemiplimab, pembrolizumab, and cosibelimab. All have comparable efficacy. None have been compared to each other.

I do not recommend combining cetuximab with cemiplimab in the first-line setting.

I...

Often the first question is how the patient got to this point.

Is this someone who has neglected a squamous cell carcinoma, or perhaps many, or is this someone who has had multiple surgeries and radiation treatments and is finally beyond that, or is this perhaps an immunocompromised patient, usually...

I usually use cetuximab/carboplatin/5fu as 1st line therapy if pt is fit. if not, then single agent cetuximab or weekly platinum. There is not much data but mostly extrapolation from head/neck cancer.

For 2nd line therapy, I try to use pd-1 or pd-l1 inhibitor which would be off-label use, if one ca...