Would you consider neoadjuvant immunotherapy prior to radiation for a locally advanced skin squamous cell carcinoma?

While the definitive trials are yet outstanding and enrollment in NRG HN0014 (NCT06568172) should be encouraged where it is open, the present indications for using cemiplimab should follow its principal indication, unresectable cutaneous squamous cell cancer, a minority of cases at 5%. Practically speaking, the drug is expensive and should be used as intended, and can be followed by radiotherapy when response is felt to have peaked; use your clinical judgment. A picture is worth a thousand words...

This is an ever-increasing paradigm that is being adopted with little real data behind it. It is a question that arises in almost every tumor board. As has been stated, the data we have is mostly extrapolation from the phase II trial of 79 patients who had immunotherapy followed by surgery (Gross et al., PMID 36094839) and case reports/case series. There are currently no reported randomized trials specifically addressing the question of neoadjuvant/induction immunotherapy followed by definitive ...

Yes. I have done it for cases that are unresectable or the patient refuses surgery. For example, the PNI of a named nerve. At least 2 cycles, but we often give more to get maximum response. Depends on the response and if there were clinically positive nodes, but I have omitted elective nodal radiation and have reduced the radiation dose.

The recently accrued MSKCC Phase 2 RAMPART trial (Chris Barker PI) did exactly that. We were a participating site.

We tried to get industry support to do a tria...