Treatment approaches in immunosuppressed patients with advanced cutaneous squamous cell carcinoma.

Autor: Willenbrink TJ; Division of Dermatology, Department of Internal Medicine, The University of Texas at Austin-Dell Medical School, Austin, TX, USA., Jambusaria-Pahlajani A; Division of Dermatology, Department of Internal Medicine, The University of Texas at Austin-Dell Medical School, Austin, TX, USA., Arron S; Department of Dermatology, University of California, San Francisco, CA, USA., Seckin D; Department of Dermatology, Faculty of Medicine, Baskent University, Ankara, Turkey., Harwood CA; Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK., Proby CM; Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK.
Jazyk: angličtina
Zdroj: Journal of the European Academy of Dermatology and Venereology : JEADV [J Eur Acad Dermatol Venereol] 2019 Dec; Vol. 33 Suppl 8, pp. 57-60.
DOI: 10.1111/jdv.15843
Abstrakt: Immunosuppression, both iatrogenic and disease-related, is associated with a greatly increased incidence of cutaneous SCC (cSCC) and with aggressive cSCC and worse disease outcomes. Consequently, rapid access to skin cancer services and prudent surgical choices, such as circumferential margin assessment, is essential when treating advanced cSCC in an immunosuppressed patient. For high-risk cancers and control of cSCC multiplicity, additional strategies should be actively considered within the multidisciplinary clinical care team. These include minimization or revision of immunosuppressive medications, systemic chemoprevention (including retinoids, nicotinamide, capecitabine) and adjuvant therapies such as radiotherapy. Unfortunately, there is a relative paucity of good evidence for many of these treatments in the immunosuppressed. Systemic treatments for metastatic cSCC are often contraindicated in organ transplant recipients, notably checkpoint inhibitor immunotherapy. There are also toxicity concerns with some conventional chemotherapies and EGFR inhibitors. Until recently, clinical trials have largely excluded immunosuppressed individuals. Development of more effective treatment for advanced cSCC in this high-risk group and prospective clinical trials are now research priorities.
(© 2019 European Academy of Dermatology and Venereology.)
Databáze: MEDLINE
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