PD-1 Inhibitors in Elderly and Immunocompromised Patients with Advanced or Metastatic Cutaneous Squamous Cell Carcinoma

SIMPLE SUMMARY: This article assesses the efficacy and safety of cemiplimab and pembrolizumab within a complex cohort of cancer patients diagnosed with locally advanced cutaneous squamous cell carcinoma or metastatic cutaneous squamous cell carcinoma. This cohort encompassed individuals with immunosuppressive conditions such as transplant recipients, hematological disorders, and relevant comorbidities, and it included elderly cancer patients. Notably, these specific populations have traditionally been excluded from clinical trials. As a result, our aim is to present the insights garnered from our medical center, highlighting the effectiveness and safety of PD-1 inhibitors in the treatment of advanced cSCC of the skin among elderly and immunosuppressed patients. ABSTRACT: Cutaneous squamous cell carcinoma (cSCC) of the skin is the second most common form of skin cancer, with aging and prolonged exposure to ultraviolet rays being the main causes of the disease. Cemiplimab and pembrolizumab recently gained regulatory approval for the treatment of locally advanced and metastatic cSCC—conditions that are not treatable by surgical resection and/or radiotherapy. Although the results from the clinical trials have been promising, these studies have not included immunosuppressed, elderly patients. In this study, we included all immunocompromised and immunocompetent patients over the age of 75 years diagnosed with locally advanced or metastatic cSCC and treated with cemiplimab or pembrolizumab. The median duration of follow-up from cSCC diagnosis was 35.6 months, 82.9% of patients were male, and the median age was 83 years old. The median progression-free survival was 8.94 months. The incidence of treatment-related adverse events was 85.6%, the majority of which were grades 1 or 2. The disease control rate was 91.4%, the complete response rate was 17.1%, the partial response rate was 51.4%, the stable disease rate was 23%, and the progressive disease rate was 8.7%. Based on this study, cemiplimab and pembrolizumab for the treatment of locally advanced or metastatic cSCC in elderly, immunocompromised patients are efficacious, with acceptable safety profiles.