Improved survival over time with immunotherapy in locally advanced and metastatic cutaneous squamous cell carcinomas

Abstract

Abstract Purpose Cutaneous squamous cell carcinoma (cSCC) is the second cancer in white-skinned populations. Few data exist about cSCC epidemiology, even less on advanced cases (acSCC). Our objectives were to analyze acSCC patients, to describe their characteristics, management, and outcomes over time. Methods A monocentric retrospective study was conducted over 5 years, including all patients who started a systemic therapy for acSCC. Patient’s characteristics, cSCC management, response to therapy, and survival were recorded. Patients were stratified in 2 periods (1 and 2). A subgroup analysis was performed comparing patients who received immunotherapy (group 1) to those who didn’t (group 2). Results The study included 127 patients, number of patients increased by an average of 19.7% per year. Most patients were males (88/127), elderly (mean 81.6 years), with comorbidities, 27.6% were immunocompromised. Median overall survival (OS) was better in the period 2 (20 months) compared to the period 1 (10 months)(HR [95% CI] = 0.62 [0.39; 0.98] p = 0.04). The risk of progression increased with age and immunosuppression. Of the 64 patients who received second-line therapy, 38 had immunotherapy (group 1) and 26 received other therapies (group 2). Immunotherapy reduced mortality and progression by respectively 71% (p = 0.004) and 67% ( p = 0.002). Conclusions Patients with acSCC are very frail and elderly. OS but not PFS increased with time, with a 2-fold improvement between period 1 and period 2. Access to immunotherapy in majority in period 2 did reduce mortality. Immunosuppression and advanced age were associated with lower PFS.