Treatment of unresectable and metastatic cutaneous squamous cell carcinoma

Lee D. Cranmer, Candace Engelhardt, Sherif S. Morgan

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Cutaneous squamous cell carcinoma (SCC) is an already common disorder with a rapidly increasing incidence. Treatment of early disease depends primarily on surgery or destructive techniques. In contrast to the frequency of early SCC, unresectable or metastatic SCC is relatively rare, but potentially life-threatening without clearly proven treatment options. Few rigorous studies of the treatment of advanced SCC have been undertaken. In the past, various agents have been explored in a limited fashion, including chemotherapy (cisplatin, fluoropyrimidines, bleomycin, doxorubicin), 13-cis-retinoic acid, and interferon-α2a. Clinical activity has been suggested by these trials, but their small sizes, heterogeneous patient populations, and lack of randomization have hindered the use of their results in defining treatment paradigms. Only one rigorous randomized trial has focused on cutaneous SCC. Enrolling 66 patients, that trial randomized patients at high recurrence risk to either observation or postoperative interferon-α2a and 13-cis-retinoic acid. This treatment did not improve time to recurrence or prevent secondary cutaneous SCC from developing. Though not in the metastatic setting, this study casts doubt on the ability of this regimen to control metastatic disease. Recently, agents targeting the human epidermal growth factor receptor (erlotinib, gefitinib, cetuximab) have displayed preliminary evidence of activity in phase II clinical trials and case series reports. Expression of this receptor is frequent in cutaneous SCC and appears to be prognostically adverse. Only the conduct of rigorous trials, with well-defined endpoints, adequate patient numbers, and preferably randomization, can prove the clinical efficacy of this promising treatment approach and define better therapy for this vexing clinical problem.

Original languageEnglish (US)
Pages (from-to)1320-1328
Number of pages9
JournalOncologist
Volume15
Issue number12
DOIs
StatePublished - Dec 2010

Fingerprint

Squamous Cell Carcinoma
Skin
Isotretinoin
Random Allocation
Interferons
Therapeutics
Recurrence
Phase II Clinical Trials
Bleomycin
Epidermal Growth Factor Receptor
Doxorubicin
Cisplatin
Observation
Drug Therapy
Incidence
Population

Keywords

  • Cutaneous squamous cell carcinoma
  • Epidermal growth factor receptor
  • Skin cancer treatment

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Treatment of unresectable and metastatic cutaneous squamous cell carcinoma. / Cranmer, Lee D.; Engelhardt, Candace; Morgan, Sherif S.

In: Oncologist, Vol. 15, No. 12, 12.2010, p. 1320-1328.

Research output: Contribution to journalArticle

Cranmer, Lee D. ; Engelhardt, Candace ; Morgan, Sherif S. / Treatment of unresectable and metastatic cutaneous squamous cell carcinoma. In: Oncologist. 2010 ; Vol. 15, No. 12. pp. 1320-1328.
@article{a0d616b6cb60409f907b76b06092274c,
title = "Treatment of unresectable and metastatic cutaneous squamous cell carcinoma",
abstract = "Cutaneous squamous cell carcinoma (SCC) is an already common disorder with a rapidly increasing incidence. Treatment of early disease depends primarily on surgery or destructive techniques. In contrast to the frequency of early SCC, unresectable or metastatic SCC is relatively rare, but potentially life-threatening without clearly proven treatment options. Few rigorous studies of the treatment of advanced SCC have been undertaken. In the past, various agents have been explored in a limited fashion, including chemotherapy (cisplatin, fluoropyrimidines, bleomycin, doxorubicin), 13-cis-retinoic acid, and interferon-α2a. Clinical activity has been suggested by these trials, but their small sizes, heterogeneous patient populations, and lack of randomization have hindered the use of their results in defining treatment paradigms. Only one rigorous randomized trial has focused on cutaneous SCC. Enrolling 66 patients, that trial randomized patients at high recurrence risk to either observation or postoperative interferon-α2a and 13-cis-retinoic acid. This treatment did not improve time to recurrence or prevent secondary cutaneous SCC from developing. Though not in the metastatic setting, this study casts doubt on the ability of this regimen to control metastatic disease. Recently, agents targeting the human epidermal growth factor receptor (erlotinib, gefitinib, cetuximab) have displayed preliminary evidence of activity in phase II clinical trials and case series reports. Expression of this receptor is frequent in cutaneous SCC and appears to be prognostically adverse. Only the conduct of rigorous trials, with well-defined endpoints, adequate patient numbers, and preferably randomization, can prove the clinical efficacy of this promising treatment approach and define better therapy for this vexing clinical problem.",
keywords = "Cutaneous squamous cell carcinoma, Epidermal growth factor receptor, Skin cancer treatment",
author = "Cranmer, {Lee D.} and Candace Engelhardt and Morgan, {Sherif S.}",
year = "2010",
month = "12",
doi = "10.1634/theoncologist.2009-0210",
language = "English (US)",
volume = "15",
pages = "1320--1328",
journal = "Oncologist",
issn = "1083-7159",
publisher = "AlphaMed Press",
number = "12",

}

TY - JOUR

T1 - Treatment of unresectable and metastatic cutaneous squamous cell carcinoma

AU - Cranmer, Lee D.

AU - Engelhardt, Candace

AU - Morgan, Sherif S.

PY - 2010/12

Y1 - 2010/12

N2 - Cutaneous squamous cell carcinoma (SCC) is an already common disorder with a rapidly increasing incidence. Treatment of early disease depends primarily on surgery or destructive techniques. In contrast to the frequency of early SCC, unresectable or metastatic SCC is relatively rare, but potentially life-threatening without clearly proven treatment options. Few rigorous studies of the treatment of advanced SCC have been undertaken. In the past, various agents have been explored in a limited fashion, including chemotherapy (cisplatin, fluoropyrimidines, bleomycin, doxorubicin), 13-cis-retinoic acid, and interferon-α2a. Clinical activity has been suggested by these trials, but their small sizes, heterogeneous patient populations, and lack of randomization have hindered the use of their results in defining treatment paradigms. Only one rigorous randomized trial has focused on cutaneous SCC. Enrolling 66 patients, that trial randomized patients at high recurrence risk to either observation or postoperative interferon-α2a and 13-cis-retinoic acid. This treatment did not improve time to recurrence or prevent secondary cutaneous SCC from developing. Though not in the metastatic setting, this study casts doubt on the ability of this regimen to control metastatic disease. Recently, agents targeting the human epidermal growth factor receptor (erlotinib, gefitinib, cetuximab) have displayed preliminary evidence of activity in phase II clinical trials and case series reports. Expression of this receptor is frequent in cutaneous SCC and appears to be prognostically adverse. Only the conduct of rigorous trials, with well-defined endpoints, adequate patient numbers, and preferably randomization, can prove the clinical efficacy of this promising treatment approach and define better therapy for this vexing clinical problem.

AB - Cutaneous squamous cell carcinoma (SCC) is an already common disorder with a rapidly increasing incidence. Treatment of early disease depends primarily on surgery or destructive techniques. In contrast to the frequency of early SCC, unresectable or metastatic SCC is relatively rare, but potentially life-threatening without clearly proven treatment options. Few rigorous studies of the treatment of advanced SCC have been undertaken. In the past, various agents have been explored in a limited fashion, including chemotherapy (cisplatin, fluoropyrimidines, bleomycin, doxorubicin), 13-cis-retinoic acid, and interferon-α2a. Clinical activity has been suggested by these trials, but their small sizes, heterogeneous patient populations, and lack of randomization have hindered the use of their results in defining treatment paradigms. Only one rigorous randomized trial has focused on cutaneous SCC. Enrolling 66 patients, that trial randomized patients at high recurrence risk to either observation or postoperative interferon-α2a and 13-cis-retinoic acid. This treatment did not improve time to recurrence or prevent secondary cutaneous SCC from developing. Though not in the metastatic setting, this study casts doubt on the ability of this regimen to control metastatic disease. Recently, agents targeting the human epidermal growth factor receptor (erlotinib, gefitinib, cetuximab) have displayed preliminary evidence of activity in phase II clinical trials and case series reports. Expression of this receptor is frequent in cutaneous SCC and appears to be prognostically adverse. Only the conduct of rigorous trials, with well-defined endpoints, adequate patient numbers, and preferably randomization, can prove the clinical efficacy of this promising treatment approach and define better therapy for this vexing clinical problem.

KW - Cutaneous squamous cell carcinoma

KW - Epidermal growth factor receptor

KW - Skin cancer treatment

UR - http://www.scopus.com/inward/record.url?scp=78650972423&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78650972423&partnerID=8YFLogxK

U2 - 10.1634/theoncologist.2009-0210

DO - 10.1634/theoncologist.2009-0210

M3 - Article

C2 - 21147868

AN - SCOPUS:78650972423

VL - 15

SP - 1320

EP - 1328

JO - Oncologist

JF - Oncologist

SN - 1083-7159

IS - 12

ER -