Efficacy and safety of cemiplimab in cutaneous squamous cell carcinoma on chronic wounds: A French retrospective study

Abstract

Background

Chronic wounds increase the risk of the development of cutaneous squamous cell carcinoma (SCC), often resulting in poor prognosis in part because of delayed diagnosis. Cemiplimab, an anti-PD-1 agent, is recommended as first-line treatment for metastatic or locally advanced SCC not eligible for curative surgery, chemotherapy or radiation. However, its efficacy in SCC originating from chronic wounds remains uncertain.

Objective

This retrospective study assessed the efficacy and safety of cemiplimab in patients with SCC originating from chronic wounds.

Methods

We included patients receiving cemiplimab for SCC on chronic wounds between August 2018 and January 2021. The primary endpoint was progression-free survival (PFS) determined by Kaplan-Meier analysis. Secondary endpoints included response rate and safety.

Results

We included 17 patients, predominantly female (59 %), with median age 58 years (interquartile range 49–77). SCC typically originated from leg ulcers (47 %) and presented at locally advanced (41 %) or metastatic stage (41 %). With cemiplimab, often received as third-line therapy (41 %), the median PFS was 6.1 months (95 % confidence interval [CI], 2.97–7.70), with the best response rate 47 % and complete response rate 12 %. We found immune-related adverse events in 24 % of cases. Short PFS was associated with distant metastasis at treatment initiation.

Conclusion

Despite response rates comparable to other SCC types, median PFS was low with cemiplimab treatment for SCC originating from chronic wounds, likely due to the aggressive nature and/or high frequency of altered performance status. Anti-PD-1 therapy remains a primary treatment option for inoperable cases. Further prospective studies are warranted to confirm these findings and optimize treatment strategies.