How Checkpoint Inhibition Is Used in Locally Advanced Disease

Dr Dunn describes how she uses immune checkpoint inhibitors in locally advanced cutaneous squamous cell carcinoma, distinguishing neoadjuvant therapy from checkpoint blockade given as a replacement for curative therapy. In the neoadjuvant setting, treatment is administered to reduce tumor burden so that patients may become surgical or radiation candidates, or so that curative-intent treatment carries less morbidity. She notes that she views checkpoint inhibitors not as curative in themselves but along the lines of palliative treatment with the goal of durable disease control. Supporting data include a phase 1 neoadjuvant cemiplimab study of 79 patients with stage II to IV M0 disease, showing a 51% pathologic complete response rate and a 13% major pathologic response rate, and a phase 2 pembrolizumab study in which 63% of patients achieved a clinical or pathologic complete response with no recurrences after a median 18 months. Dr In adds perspective on bulky tumors, anatomically complex head and neck sites, and downstaging borderline-resectable disease.