Update on Nonsurgical Treatments of Non-Melanoma Skin Cancer
Posted: Monday, September 24, 2018
A review of clinical trials published in the Dermatologic Surgery explored nonsurgical options for patients with locally advanced and metastatic non-melanoma skin cancer who are not candidates for surgical resection. Of the various immunotherapies and targeted treatments, PD-1 inhibitors and cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4) inhibitors have shown tolerable toxicity and preliminary activity.
“Future studies are necessary to optimize the treatment response of patients receiving immunotherapy by identifying key biomarkers, finding a solution to overcome treatment resistance, and exploring possibilities of combination therapy,” stated review author Michael R. Migden, MD, of The University of Texas MD Anderson Cancer Center, Houston, and colleagues.
Eight clinical trials involving PD-1 inhibitors indicated both complete and partial patient responses. Although limited, two clinical trials investigating CTLA-4 inhibitors supported their possible role in mitigating cancer progression. Additionally, various trials of EGFR inhibitors and hedgehog pathway inhibitors have shown clinical benefits.
However, acquired resistance is a concern with these therapies. One study found 25% of patients treated with PD-1 inhibitors and at least 29% of patients treated with the hedgehog pathway inhibitor vismodegib developed resistance. As for toxicity, EGFR inhibitors have been related to serious adverse events such as a grade 4 infusion reaction and grade 3 interstitial pneumopathy. Use of hedgehog inhibitors has been related to muscle spasms, alopecia, dysgeusia, nausea, elevated blood creatine kinase levels, and fatigue.
