Anti-EGFR antibody added to ongoing anti-PD-1 antibody treatment for metastatic cutaneous squamous cell carcinoma of the face: two case reports

Eton, Omar Hsu Emily Patel Akshay Cartun Richard Earle Jonathan Mnayer Laila Yu Peter Kotowitz Jennifer

467 Figure 1Panitumumab + pembrolizumab for metastatic cutaneous SCC #1Dramatic durable response in 22 metastases on face and also scabbing then healing on scalp where there was no evidence of tumor but history of prior resected.squamous cell and basal cell carcinomas, suggesting effective prevention of future such lesions[Figure omitted. See PDF]Abstract 467 Figure 2Panitumumab + pembrolizumab for metastatic cutaneous SCC #2Durable response lasting a year after 6 months of treatment in a 90 yo woman[Figure omitted. See PDF]ConclusionsThe excellent tolerance of multiple cycles of out-patient combination treatment in these two consecutive patients with the same diagnosis, coupled with the observed durable anti-tumor clinical activity lasting now over a year - all support further exploration of panitumumab in combination with anti-PD-1 antibody treatment. A randomized trial would be needed to establish whether outcomes are truly better with the combination. Deciding on hyperprogression v pseudoprogression while getting anti-PD-1 antibody treatment remains a challenge. Laboratory studies would evaluate how such specific signal transduction inhibition by panitumumab might interfere with immune suppressive mechanisms in metastases, rendering them more sensitive to an induced anti-tumor cellular immune response by an anti-PD-1 antibody. Finally such combination treatment should help reduce the need for increasingly cosmetically and functionally altering surgeries.Ethics Approval‘Per our Hartford Health Care IRB, case series of three or less patients does not constitute research.’ConsentWritten informed consent was obtained from the patient for publication of this abstract and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.ReferencesChen A1,2, Ali N3,4, Boasberg P5,6, Ho AS7,8. Clinical Remission of Cutaneous Squamous Cell Carcinoma of the Auricle with Cetuximab and Nivolumab. J Clin Med 2018 Jan 10;7(1). pii: E10.Foote MC, McGrath M, Guminski A, Hughes BG, Meakin J, Thomson D, Zarate D, Simpson F, Porceddu SV Phase II study of single-agent panitumumab in patients with incurable cutaneous squamous cell carcinoma. Ann Oncol 2014 Oct;25(10):2047–52.Ferris RL, Gillison ML, Harris J, et al. Safety evaluation of nivolumab concomitant with cetuximab-radiotherapy for intermediate and high-risk local-regionally advanced head and neck squamous cell carcinoma (HNSCC): RTOG 3504. Oral presentation at: 2018 ASCO Annual Meeting;June 1–5, 2018;Chicago, IL.Jong Chul Park, Lori J. Wirth, Keith Flaherty, Donald P. Lawrence, Shadmehr Demehri, Stefan Kraft, Immune checkpoint inhibition in advanced cutaneous squamous cell carcinoma: Clinical response and correlative biomarker analysis. Journal of Clinical Oncology36, no. 15_suppl (May 20 2018) 9564.FDA approves pembrolizumab for cutaneous squamous cell carcinoma. FDA website. Published June 24, 2020. fda.gov/drugs/drug-approvals-and-databases/fda-approves-pembrolizumab-cutaneous-squamous-cell-carcinoma.Edith Borcoman, MD, Amara Nandikolla, MD, Georgina Long, BSc, PhD, MBBS, FRACP, Sanjay Goel, MD, and Christophe Le Tourneau, MD, PhD. Patterns of Response and Progression to Immunotherapy American Society of Clinical Oncology Educational Book 38 (May 23, 2018) 169–1787.Migden MR, Rischin D, Schmults CD, Guminski A, Hauschild A, Lewis KD, Chung CH, Hernandez-Aya L, Lim AM, Chang ALS, Rabinowits G, Thai AA, Dunn LA, Hughes BGM, Khushalani NI, Modi B, Schadendorf D, Gao B, Seebach F, Li S, Li J, Mathias M, Booth J, Mohan K, Stankevich E, Babiker HM, Brana I, Gil-Martin M, Homsi J, Johnson ML, Moreno V, Niu J, Owonikoko TK, Papadopoulos KP, Yancopoulos GD, Lowy I, Fury MG. PD-1 Blockade with Cemiplimab in Advanced Cutaneous Squamous-Cell Carcinoma. N Engl J Med 2018 Jul 26;3 9(4):341–351.Eve Maubec, Marouane Boubaya, Peter Petrow, Nicole Basset-Seguin, Jean-Jacques Grob, Brigitte Dreno,. Pembrolizumab as first line therapy in patients with unresectable squamous cell carcinoma of the skin: Interim results of the phase 2 CARSKIN trial. Journal of Clinical Oncology 36, no. 15_suppl (May 20 2018) 9534.Burtness B, et al. First-line pembrolizumab a new standard for recurrent, metastatic head and neck squamous cell carcinoma. Abstract LBA8_PR. Presented at: European Society for Medical Oncology Congress;Oct. 19–23, 2018;Munich. 10. Teruki Yanagi,* Shinya Kitamura, and Hiroo Hata. Novel Therapeutic Targets in Cutaneous Squamous Cell Carcinoma. Front Oncol 2018;8: 79.