Front-Line Immunotherapy for Locally Advanced Basal Cell Carcinoma: Case Studies
Posted: Thursday, August 6, 2020
For patients with locally advanced basal cell carcinoma, anti–PD-1 inhibition therapy (nivolumab and pembrolizumab) may offer some treatment benefit, based on two case studies published in the Journal of the American Association of Dermatology Case Reports. However, due to the limited data available, “patient cases should be discussed at multidisciplinary tumor boards,” to decide the best course of treatment for such patients, reported Sarah A. Weiss, MD, of the Yale Cancer Center and Yale University School of Medicine, and colleagues.
Two patients with locally advanced basal cell carcinoma were featured. They both underwent diagnostic biopsies prior to treatment to confirm the diagnosis of basal cell carcinoma. Specimens were histologically examined with immunohistochemical stains for CD3, CD4, CD8, and PD-L1.
One patient was a 70-year-old woman who presented with basal cell carcinoma with focal keratinization on her thigh (confirmed through biopsy). Testing of the patient’s CD3, CD4, and CD8 levels revealed moderate lymphocytic inflammation. In addition, there was 0% PD-L1 expression in her tumor cells. Her tumor was not metastatic but extended into the lateralis muscle. She was administered 480 mg of nivolumab every 4 weeks. This intervention revealed shrinkage of the tumor after the first cycle. However, the patient developed hypothyroidism as a result of immunotherapy.
The second patient was a 77-year-old woman with infiltrative basal cell carcinoma on her back and chest. She also had moderate inflammation following assessment of CD4-positive and CD8-positive T-cell levels. Similarly, there was 0% PD-L1 expression in her tumor cells. This patient was administered 200 mg of intravenous pembrolizumab every 3 weeks. Following the first treatment, a decrease in tumor size was seen; after five treatments, and a 90% reduction in tumor size was observed. Furthermore, her hemoglobin levels improved to 11.7 g/dL.
Disclosure: For full disclosures of the study authors, visit jaadcasereports.org.
