Dr. Geiger on Challenges of Patients With CSCC Enrolled in KEYNOTE-630 Trial

Jessica Geiger, MD
Published: Monday, Aug 26, 2019



Jessica Geiger, MD, medical oncologist, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, discusses challenges with the patient population enrolled in the phase III KEYNOTE-630 trial exploring the use of adjuvant pembrolizumab (Keytruda) in cutaneous squamous cell carcinoma (CSCC).

In KEYNOTE-630, investigators are examining the potential curative benefits of the PD-1 inhibitor after surgical resection and radiotherapy in patients with high-risk, locally advanced CSCC. With this population, there are several challenges, says Geiger.

For example, patients with CSCC often have rapidly-growing tumors that present on the head and neck area. Disfigurement can result from the surgeries involved in the treatment of this disease and radiation to these locations are associated with a wide array of short- and long-term adverse events, explains Geiger. For example, if a patient receives radiation to the neck, swallowing can become difficult. Additionally, the development of scar tissue and fibrosis can impact the patient’s mobility and range of motion, she adds.

Also, patients with CSCC are often chronically immunosuppressed with hematologic diseases or were organ transplant recipients. However, immunosuppressed patients were ineligible to participate in KEYNOTE-360, as the addition of pembrolizumab could potentially lead to transplant rejection.

More data with pembrolizumab and other immunotherapy agents in CSCC will propel the field forward, says Geiger. The hope is that with more data, more can be done to help those who are chronically immunosuppressed as well, she adds. The KEYNOTE-630 trial has the potential to be practice-changing, she concludes, and it may open the door for further research in other areas and patient populations.
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Jessica Geiger, MD, medical oncologist, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, discusses challenges with the patient population enrolled in the phase III KEYNOTE-630 trial exploring the use of adjuvant pembrolizumab (Keytruda) in cutaneous squamous cell carcinoma (CSCC).

In KEYNOTE-630, investigators are examining the potential curative benefits of the PD-1 inhibitor after surgical resection and radiotherapy in patients with high-risk, locally advanced CSCC. With this population, there are several challenges, says Geiger.

For example, patients with CSCC often have rapidly-growing tumors that present on the head and neck area. Disfigurement can result from the surgeries involved in the treatment of this disease and radiation to these locations are associated with a wide array of short- and long-term adverse events, explains Geiger. For example, if a patient receives radiation to the neck, swallowing can become difficult. Additionally, the development of scar tissue and fibrosis can impact the patient’s mobility and range of motion, she adds.

Also, patients with CSCC are often chronically immunosuppressed with hematologic diseases or were organ transplant recipients. However, immunosuppressed patients were ineligible to participate in KEYNOTE-360, as the addition of pembrolizumab could potentially lead to transplant rejection.

More data with pembrolizumab and other immunotherapy agents in CSCC will propel the field forward, says Geiger. The hope is that with more data, more can be done to help those who are chronically immunosuppressed as well, she adds. The KEYNOTE-630 trial has the potential to be practice-changing, she concludes, and it may open the door for further research in other areas and patient populations.

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