Use of Neoadjuvant Atezolizumab in Advanced Squamous Cell Skin Cancer

By: Amanda E. Ruffino, BA
Posted: Friday, January 3, 2025

Neoadjuvant use of atezolizumab before curative surgical resection was found to be well tolerated and active in patients with advanced cutaneous squamous cell carcinoma, in a single-arm phase II trial. Vasu Divi, MD, of Stanford University, California, and colleagues found that the majority of patients tolerated three preoperative doses without significant toxicity or disease progression. In fact, more than half of the patients exhibited a pathologic response, with 35% achieving complete pathologic remission. The team’s findings were published in JCO Oncology Advances.

“Neoadjuvant immunotherapy is emerging as a potential paradigm change for advanced cutaneous squamous cell carcinoma,” stated the study authors. “Further follow-up is necessary to determine the impact of this approach on long-term disease control.”

This trial enrolled 20 patients with advanced cutaneous squamous cell carcinoma of the head and neck, including stage III or IV disease or stage II lesions associated with high morbidity from standard therapies. Participants received up to three doses of atezolizumab, an anti–PD-L1 checkpoint inhibitor, at 1,200 mg every 21 days before surgery. The study primarily aimed to evaluate the percentage of patients completing all three doses and remaining eligible for surgery without interruptions attributable to toxicity or disease progression.

A total of 16 patients (80%) successfully completed all three doses, and all participants proceeded to surgery. A pathologic complete response was observed in seven patients (35%), and four additional patients (20%) had a major pathologic response (< 10% viable tumor). Radiologic Response Evaluation Criteria in Solid Tumors responses were noted in eight patients (40%), and just one patient (5%) experienced disease progression. Treatment-related adverse events were reported to be minimal, with one patient (5%) experiencing grade 3 pneumonitis, which resolved after the first dose.

Disclosure: For full disclosures of the study authors, visit ascopubs.org.

JCO Oncology Advances