Liu Yuxin, Fitzgerald Bailey, Perry Edward, Pathak Ashutosh, Chao Herta H
1 Yale University, New Haven, CT, USA.
2 Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
J Investig Med High Impact Case Rep. 2019 Jan-Dec;7:2324709619850216. doi: 10.1177/2324709619850216.
Cutaneous squamous cell carcinoma is a common type of skin cancer, with aggressive metastatic or locally advanced disease representing an uncommon minority of presentations. Emerging data have supported the Food and Drug Administration approval of the anti-PD1 human monoclonal antibody cemiplimab in select patients with advanced disease. However, there is limited data regarding durability of effect and generalizability of anti-PD1 effectiveness across therapies. Additionally, information regarding applicability of these regimens to the rare spindle cell variant and to central nervous system metastases for cutaneous squamous cell carcinoma is unfortunately limited.
A 72-year-old gentleman presented with facial neurological deficits and a dermal nodule and was diagnosed with spindle cell squamous cell carcinoma with perineural invasion. His course was notable for early intracranial metastasis with progressive neurological deficits despite recurrent radiation therapy with intermittent response. When progressive left-sided weakness prompted imaging evaluation that was concerning for disease recurrence after exhaustion of radiation therapy options, the patient was started on systemic therapy with the anti-PD-1 monoclonal antibody treatment prior to the approval of cemiplimab. Pembrolizumab was chosen due to the fact that the patient was ineligible for clinical trials and for its every 21-day dosing. With this treatment, he has achieved a durable clinical response, resulting in near resolution of neurological deficits and more than a year of progression-free survival to date, despite aggressive intracranial disease.
This case suggests that anti-PD-1 therapy with pembrolizumab may represent an effective and well-tolerated treatment for patients with metastatic spindle cell squamous cell carcinoma including patients with metastatic disease to the central nervous system.
皮肤鳞状细胞癌是一种常见的皮肤癌类型，侵袭性转移性或局部晚期疾病仅占少数不常见的病例表现。新出现的数据支持美国食品药品监督管理局批准抗PD1人源单克隆抗体西米普利单抗用于部分晚期疾病患者。然而，关于疗效持久性以及抗PD1疗法有效性在不同治疗中的可推广性的数据有限。此外，不幸的是，关于这些治疗方案对罕见的梭形细胞变体以及皮肤鳞状细胞癌中枢神经系统转移的适用性信息也很有限。
一名72岁男性患者出现面部神经功能缺损和一个皮肤结节，被诊断为伴有神经周围侵犯的梭形细胞鳞状细胞癌。他的病程特点是早期颅内转移，尽管反复进行放射治疗且有间歇性缓解，但仍出现进行性神经功能缺损。当进行性左侧肢体无力促使进行影像学评估，提示在放射治疗方案用尽后疾病复发时，在西米普利单抗获批之前，该患者开始接受抗PD-1单克隆抗体的全身治疗。选择派姆单抗是因为该患者不符合临床试验条件，且其给药周期为每21天一次。通过这种治疗，他获得了持久的临床缓解，神经功能缺损几乎完全缓解，至今已无进展生存超过一年，尽管颅内疾病进展迅速。
该病例表明，对于转移性梭形细胞鳞状细胞癌患者，包括有中枢神经系统转移的患者，使用派姆单抗进行抗PD-1治疗可能是一种有效且耐受性良好的治疗方法。
