Cemiplimab in the treatment of metastatic basal cell carcinoma.

Metastatic basal cell carcinoma (mBCC) is a rare but aggressive form of skin cancer that poses significant therapeutic challenges. Historically, systemic treatment options were limited, with hedgehog pathway inhibitors (HHIs) providing modest efficacy, but poor tolerability long term. This review explores cemiplimab, an immune checkpoint inhibitor targeting PD-1, as a novel therapeutic agent for mBCC. We examine its pharmacologic profile, clinical efficacy in clinical trials, safety and tolerability, and real-world performance. A comprehensive literature review was conducted using PubMed and clinical trial registries to assess cemiplimab's role in mBCC treatment, including its comparison to HHIs and potential in combination or neoadjuvant strategies. Cemiplimab has emerged as a transformative therapy for patients with mBCC who are intolerant to or have progressed on HHIs. Despite lower response rates compared to cutaneous squamous cell carcinoma, cemiplimab offers meaningful and durable disease control with a favorable safety profile and preservation of quality of life. Ongoing research into predictive biomarkers, neoadjuvant use, and combination regimens may further enhance its clinical utility.