In a patient with unresectable, multifocal recurrent cutaneous squamous cell carcinoma and underlying T-cell large granular lymphocytic leukemia with baseline moderate pancytopenia, is anti-PD-1 therapy (e.g., cemiplimab) an appropriate and safe treatment option?

This is a complicated question!

First, be sure of the diagnosis. The differential diagnosis is quite long. If it is something else that may or may not influence your decision.

Second, if we agree that the lesions are not resectable, might they be treated with radiation therapy? This will not give the long-term good effect one hopes for with cemiplimab, but overall, the response rates are higher, and if not tried, radiation could give helpful palliation.

Third: What are the other characteristics of the patient? Do they have an autoimmune disease? Are they on immunosuppressants? If so, then likely the usual rules about treating patients with those conditions apply.

Fourth: Are there data that suggest response rates will be lower than expected...