Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
J Eur Acad Dermatol Venereol. 2022 Jan;36 Suppl 1:41-44. doi: 10.1111/jdv.17405.
Cutaneous squamous cell carcinoma (cSCC) numbers among the most common types of skin cancer and is known as one of the cancer entities with the highest mutational burden among all solid tumours. Due to the positive correlation between mutational burden and response rate to inhibitors of the programmed cell death 1 (PD-1), those inhibitors are considered promising candidates for the systemic therapy of cSCC. Recently, the PD-1 inhibitors pembrolizumab, nivolumab and cemiplimab demonstrated efficacy in the systemic treatment of locally advanced or metastatic cSCC leading to the approval of cemiplimab by the FDA (U.S. Food and Drug Administration) in 2018 and the EMA (European Medicines Agency) in 2019. Patients with haematological malignancies tend to develop skin cancers of high aggressiveness, enhanced cumulative recurrence rate and higher rates of metastases with subsequent death. Chronic lymphocytic leukaemia (CLL) is the most frequent type of leukaemia in the United States and Europe with the majority of patients older than 50 years of age. This neoplasm predominantly originates from B -cells leading to an impaired immune system of the patient. Although CLL is a B-cell malignancy, studies have also described the involvement of T cells in the pathogenesis and progression of the disease with contradictory findings on the effects of PD-1 inhibitors in CLL. Due to their underlying hematologic malignancy, these patients have commonly no access to PD-1 inhibitor trials for treatment of advanced cSCC. We report on two patients with locally advanced or metastatic cSCC. Both patients had been suffering from a CLL for many years without indication for treatment. Despite a potential immunosuppressive state of the patients due to their CLL, both were treated with the PD-1 inhibitor pembrolizumab resulting in different therapy outcomes.
皮肤鳞状细胞癌（cSCC）是最常见的皮肤癌类型之一，也是所有实体瘤中突变负担最高的癌症实体之一。由于突变负担与程序性细胞死亡 1（PD-1）抑制剂的反应率之间存在正相关，因此这些抑制剂被认为是 cSCC 系统治疗的有前途的候选药物。最近，PD-1 抑制剂 pembrolizumab、nivolumab 和 cemiplimab 在局部晚期或转移性 cSCC 的系统治疗中显示出疗效，导致 cemiplimab 于 2018 年获得美国食品和药物管理局（FDA）的批准，于 2019 年获得欧洲药品管理局（EMA）的批准。患有血液系统恶性肿瘤的患者往往会发展出侵袭性更高、累积复发率更高、转移率更高且随后死亡的皮肤癌。慢性淋巴细胞白血病（CLL）是美国和欧洲最常见的白血病类型，大多数患者年龄大于 50 岁。这种肿瘤主要起源于 B 细胞，导致患者的免疫系统受损。尽管 CLL 是一种 B 细胞恶性肿瘤，但研究也描述了 T 细胞在疾病的发病机制和进展中的参与，并且关于 PD-1 抑制剂在 CLL 中的作用存在相互矛盾的发现。由于他们的基础血液恶性肿瘤，这些患者通常无法参加 PD-1 抑制剂治疗晚期 cSCC 的试验。我们报告了两名患有局部晚期或转移性 cSCC 的患者。两名患者均患有 CLL 多年，且无需治疗。尽管由于他们的 CLL，患者存在潜在的免疫抑制状态，但他们都接受了 PD-1 抑制剂 pembrolizumab 的治疗，治疗结果不同。
