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Soo Park, MD
Soo Park, MD
Posted: Tuesday, October 8, 2024
Immunotherapy may be a practical option even for very elderly patients with advanced cutaneous squamous cell carcinoma (SCC), according to the experience of Elisabetta Gambale, MD, of the University of Florence, Italy, and colleagues, who detailed a case study in the journal Cancer Diagnosis & Prognosis. They treated a 90-year-old woman for a limited time with the monoclonal antibody against PD-1 cemiplimab-rwlc, in combination with locoregional radiotherapy, intended to enhance the immunotherapy’s efficacy.
Integrating cemiplimab with the radiotherapy achieved a “synergistic and excellent outcome,” according to the authors, offering the patient significant clinical improvement with no severe safety issues. They believe this finding has wider importance; when elderly patients cannot be cured with surgery or radiation therapy alone, immunotherapy—the standard of care for managing cutaneous SCC—is often not considered because of concerns about tolerability and possible adverse effects. Yet patients aged 75 and older are 5 to 10 times more likely than younger ones to develop cutaneous SCC, likely from cumulative exposure to ultraviolet radiation, they added.
The patient began first-line therapy with cemiplimab in August 2022. When she experienced disease progression, the team decided in April 2023, she would receive five external-beam radiotherapy sessions while continuing cemiplimab. She achieved rapid objective improvement—in fact, an objective complete response—but the patient’s Eastern Cooperative Oncology Group (ECOG) performance status score declined to 3.
In August 2023, the physicians permanently discontinued cemiplimab, and the patient experienced quick clinical improvement. “The latest whole-body CT scan and clinical evaluation performed in April 2024 confirmed complete response, with ECOG performance status of 1,” they declared. In their view, regarding clinical trials of immunotherapy in cutaneous cancers, “the inclusion of elderly patients… seems to be imperative, and systematic reporting of subgroup analyses by age may shed light on their optimal management.”
Disclosure: The study authors reported no conflicts of interest.
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