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Patients diagnosed with metastatic basal cell carcinoma (BCC) have a poor prognosis. The current standard of care for adults with locally advanced or metastatic BCC who are not candidates for surgery or radiation therapy is treatment with hedgehog pathway inhibitors (HHIs). For patients who progress while on this therapy, further treatment options are limited. There is also a need for real-world clinical practice data on the clinical characteristics, management, disease progression, and survivorship of these patients. The ongoing CemiplimAb-rwlc Survivorship and Epidemiology (CASE) study is a phase IV, multicenter, prospective, noninterventional survivorship and epidemiology cohort study evaluating the effectiveness and safety of cemiplimab, a fully human immunoglobulin G4 monoclonal antibody that blocks the interaction between the programmed cell death-1 (PD-1) receptor and its ligands. This paper describes one cohort of the CASE study of patients with locally advanced or metastatic BCC who have failed or are intolerant of HHIs or for whom HHI therapy is not appropriate. Outcome measures of the study include response to treatment, quality of life, safety, treatment patterns, patient experience, and survival. This study could provide a more complete characterization of this patient population and fill knowledge gaps related to real-world treatment utilization and patient outcomes. Clinical Trial registration: NCT03836105 [ABSTRACT FROM AUTHOR]

Aim: To independently confirm that the 40-gene expression profile (40-GEP) test can identify patients with high-risk cutaneous squamous cell carcinoma who are more or less likely to benefit from adjuvant radiation therapy (ART). Materials & methods: Primary cutaneous squamous cell carcinoma tumors from two academic centers received retrospective 40-GEP testing and were analyzed for 5-year metastasis-free survival and projected time to event. Results: Random sampling of matched patient pairs (n = 52 ART-treated; 371 no ART) showed a median 50% decrease in 5-year progression rate for ART-treated patients (vs no ART) with 40-GEP Class 2B. Class 2A was associated with a modest ART benefit, but not Class 1. Conclusion: The 40-GEP identified patients most likely to benefit from ART (Class 2B) and those that can consider deferring treatment (Class 1). Tweetable Abstract Independent validation study: 40-GEP identifies patients with cutaneous squamous cell carcinoma who would be most likely to benefit from adjuvant radiation therapy. Article highlights Select patients with completely resected high-risk squamous cell carcinoma are eligible for and undergo adjuvant radiation therapy (ART), but criteria for ART is heterogenous. Identifying patients with the highest risk of disease progression who would most benefit from ART is a clinical challenge. The 40-gene expression profile (40-GEP) test was recently reported to predict a benefit from ART for patients receiving a Class 2B result, and a low likelihood of benefit for a Class 1 result that together with low metastatic risk suggests these patients may consider deferring treatment. This validation study utilized an independent cohort of patients with high-risk cutaneous squamous cell carcinoma tumors matched on clinicopathological factors to compare disease progression rates and projected time to metastasis (using a "life expectancy" algorithm) for patients who received ART to those who did not. Patients with a 40-GEP Class 2B result showed a median ∼50% decrease in disease progression between ART-treated and untreated tumors and a significant deceleration in projected time to metastases. No differences were observed for Class 1 between ART treated and untreated tumors. The results validate the 40-GEP test as having predictive value in identifying patients benefitting from ART and those that can safely defer, and can guide difficult management decisions when patients and their physicians are considering the risks of side effects and benefit of ART. Previous work has shown that deferring ART in 40-GEP Class 1 patients can save $784 million annually in direct healthcare costs. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients who have undergone solid-organ transplant are at higher risk of developing aggressive cutaneous squamous cell carcinoma (CSCC), which is associated with increased morbidity and mortality. There has been a major shift in the management landscape of locally advanced and metastatic CSCC with the introduction of immunotherapy. Despite this, the management of patients with a history of immunosuppression including solid-organ transplant recipients (SOTRs) remains challenging due to safety and efficacy concerns. This review addresses the unique aspects of biology and clinical care of this patient population and highlights recent advances. The management of advanced cutaneous squamous cell carcinoma (CSCC) has been revolutionized by the introduction of immunotherapy. Yet, successful treatment with immunotherapy relies on an adequate antitumor immune response. Patients who are solid-organ transplant recipients (SOTRs) have a higher incidence of CSCC compared to the general population. This review discusses the current knowledge of epidemiology, pathophysiology, and management of patients with CSCC who are immunocompromised because of their chronic exposure to immunosuppressive medications to prevent allograft rejection. First, we discuss the prognostic impact of immunosuppression in patients with CSCC. Next, we review the risk of CSCC development in immunosuppressed patients due to SOT. In addition, we provide an overview of the biological immune disruption present in transplanted immunosuppressed CSCC patients. We discuss the available evidence on the use of immunotherapy and provide a framework for the management approach with SOTRs with CSCC. Finally, we discuss potential novel approaches that are being investigated for the management of immunosuppressed patients with CSCC. [ABSTRACT FROM AUTHOR]

Background: Prior to the Food and Drug Administration approval of cemiplimab in 2018, the median overall survival (OS) for adult patients with advanced CSCC receiving systemic therapy was approximately 8 to 15 months. Limited real-world data are available on cemiplimab for this indication in the US. Patients and Methods: This retrospective cohort study included US patients with advanced CSCC initiating cemiplimab monotherapy in a real-world database (2018– 2021). A clinical trial–like sub-cohort was identified using select criteria. Time to treatment discontinuation (TTD), time to next treatment (TTNT), and OS were estimated using Kaplan–Meier methods. Cox proportional hazard models were used to examine prognostic factors associated with OS in the main cohort. Results: The main cohort included 622 patients (n = 240 in the trial-like cohort). In the main cohort, the median age was 78 years, 77.8% were male, 21.4% were immunocompromised/immunosuppressed, and 63.8% had metastatic CSCC. Median (95% CI) TTD and TTNT were 8.0 (6.6– 9.0) months and 16.4 (13.3– 21.0) months, respectively, in the main cohort. Median (95% CI) OS was 24.8 (21.8– 29.1) months in the main cohort (not reached in the trial-like cohort). In multivariable analyses, age < 60 years (hazard ratio [HR], 0.37), Eastern Cooperative Oncology Group performance status < 3– 4 (HR range, 0.13– 0.57), and primary CSCC location in the head and neck only versus extremities only (HR, 0.59) were associated with better OS. Similar OS was observed between patients who had immunosuppressing/immunocompromising conditions and those without. Conclusion: These findings confirm the effectiveness of cemiplimab among a heterogenous, real-world advanced CSCC patient population and substantiate the efficacy of cemiplimab observed in clinical trials. [ABSTRACT FROM AUTHOR]

Aim: Since use of major cutaneous surgeries/reconstructions among patients with cutaneous squamous cell carcinoma (CSCC) is not well described, we sought to quantify major cutaneous surgeries/reconstructions among patients with CSCC who were newly diagnosed and for those treated with systemic therapy, stratified by immune status. Methods: We used the Optum® Clinformatics® Data Mart database (2013–2020) and Kaplan–Meier estimators to assess risk of surgeries/reconstructions. Results: 450,803 patients were identified with an incident CSCC diagnosis, including 4111 patients with CSCC who initiated systemic therapy. The respective 7-year risks of major cutaneous surgeries/reconstructions were 10.9% (95% CI: 10.7–11.0) and 21.8% (95% CI: 17.6–25.8). Overall risk of major cutaneous surgeries/reconstructions was higher in patients who were immunocompromised than those who were immunocompetent. Conclusion: Approximately one in nine patients with CSCC will undergo ≥1 major cutaneous surgeries/reconstructions within 7 years of diagnosis; the risk increases in patients who initiate systemic therapy and among those who are immunocompromised. Cutaneous squamous cell carcinoma (CSCC) is one of the two most common cancers, and numbers of new cases are increasing each year by 3–7%. A small number of advanced cases require systemic treatments (drugs given by mouth or injection), such as chemotherapy or immunotherapy. Patients with CSCC may require major skin surgeries and reconstructions. Little is known about how these skin procedures are used to treat patients with CSCC, particularly those with a weakened immune system. This analysis used USA insurance data of patients from 2013 to 2020 to assess how they were treated with surgeries, based on patients' immune status and whether they had started systemic treatment for CSCC. Among the 450,803 patients identified with a new CSCC diagnosis, the chances of having a procedure over a 7-year period was 10.9% (around one in nine). For 4111 patients with CSCC who started systemic therapy, this was 21.8% (around one in five). The chances of having a procedure were also significantly higher in patients with a weakened immune system (14.0%, around one in seven), compared with those without. However, this study was potentially limited by the following: the study population might not fully represent the CSCC population, the risk of surgery might be underestimated and information about patients' tumors (e.g., staging) was lacking. These results suggest there is an unmet need for systemic treatments that can reduce the burden of skin surgeries and reconstructions in CSCC. Around 1 in 9 patients with CSCC undergo ≥1 major cutaneous surgeries and reconstruction within 7 years of diagnosis; risk increases in patients who initiate systemic therapy and the immunocompromised. Therapies that minimise this risk are needed. [ABSTRACT FROM AUTHOR]