Department of Medical Oncology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia.
School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Clinical Campus, Darlinghurst, New South Wales, Australia.
Exp Dermatol. 2024 Jan;33(1):e14978. doi: 10.1111/exd.14978. Epub 2023 Nov 16.
Patients with advanced cutaneous squamous cell carcinoma (cSCC) who are not eligible for or who fail to respond to anti-PD1 immunotherapy have few treatment options. Epidermal growth factor receptor (EGFR) inhibitors have been investigated as a therapeutic option for advanced cSCC; however, data are limited to small single-arm trials or retrospective studies. A systematic review and meta-analysis was conducted to PRISMA guidelines (CRD42023394300). Studies reporting on outcomes of EGFR inhibition in advanced cSCC were identified. Objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and adverse event (AE) rate were pooled using a random effects model and the inverse variance method. Twelve studies (six prospective, six retrospective) were identified, representing 324 patients. Pooled ORR was 26% (95% confidence interval [CI] 18-36), median PFS was 4.8 months (95% CI 3.9-6.6) and median OS was 11.7 months (95% CI 9.2-14.1). Any grade AEs occurred in 93% of patients (95% CI 85-97) while grade 3 and higher AEs occurred in 30% (95% CI 14-54). These results were similar between anti-EGFR monoclonal antibodies (MAbs) and tyrosine kinase inhibitors (TKIs). EGFR inhibitors can be considered in patients with advanced cSCC who are contraindicated for or progress on first-line anti-PD1 immunotherapy. Future studies should evaluate their activity and safety following anti-PD1, identify predictive biomarkers for their efficacy and explore combination approaches.
患有晚期皮肤鳞状细胞癌（cSCC）且不符合抗 PD-1 免疫治疗条件或对其无反应的患者，治疗选择有限。表皮生长因子受体（EGFR）抑制剂已被研究作为晚期 cSCC 的治疗选择；然而，数据仅限于小型单臂试验或回顾性研究。根据 PRISMA 指南（CRD42023394300）进行了系统评价和荟萃分析。确定了报告 EGFR 抑制在晚期 cSCC 中疗效的研究。使用随机效应模型和逆方差法，汇总了客观缓解率（ORR）、无进展生存期（PFS）、总生存期（OS）和不良事件（AE）发生率。确定了 12 项研究（6 项前瞻性研究，6 项回顾性研究），代表 324 名患者。汇总的 ORR 为 26%（95%CI 18-36），中位 PFS 为 4.8 个月（95%CI 3.9-6.6），中位 OS 为 11.7 个月（95%CI 9.2-14.1）。任何级别 AEs 的发生率为 93%（95%CI 85-97），而 3 级及以上 AEs 的发生率为 30%（95%CI 14-54）。抗 EGFR 单克隆抗体（Mab）和酪氨酸激酶抑制剂（TKI）之间的结果相似。对于不适合一线抗 PD-1 免疫治疗或进展的晚期 cSCC 患者，可以考虑使用 EGFR 抑制剂。未来的研究应评估其在抗 PD-1 后的活性和安全性，确定其疗效的预测生物标志物，并探索联合方法。
