Immunotherapy is rapidly changing the treatment of Cutaneous Squamous Cell Carcinoma, a skin cancer that has traditionally been treated mainly with surgery. Experts say immune checkpoint inhibitors are now shifting systemic therapy from a last-resort option to a treatment used earlier in the disease course.
Doctors are increasingly using immunotherapy before surgery, a strategy known as neoadjuvant therapy. This approach can shrink tumors and make surgery less extensive, and in some cases may reduce the need for radiation after surgery. A strong response to early immunotherapy can also allow surgeons to operate on tumors that were previously considered unresectable. The PD-1 inhibitor Cemiplimab (Libtayo) is now included in National Comprehensive Cancer Network guidelines for certain borderline resectable cases.
Treatment decisions are now often made through a multidisciplinary approach involving dermatologic surgeons, medical oncologists, and radiation oncologists. Several immunotherapy drugs are approved for advanced disease, including Cemiplimab, Pembrolizumab (Keytruda), and the newer PD-L1 inhibitor Cosibelimab. While progress has been significant, challenges remain, as about half of patients do not respond to immunotherapy, and treatment options are still limited for immunosuppressed patients such as organ transplant recipients.