Identifying Patients With High-Risk Disease

Dr Whitman and Dr In discuss the FDA approval of adjuvant cemiplimab for patients with high-risk cutaneous squamous cell carcinoma who have completed surgery and adjuvant radiation yet remain at elevated risk for recurrence. The faculty review the C-POST trial that supported the approval, including the magnitude of the hazard ratio for disease-free survival, and describe how the results have changed practice. Dr In addresses which patients meet the high-risk definition, including those with nodal involvement, extracapsular extension, and perineural invasion, and how he identifies candidates in routine practice. The discussion turns to a persistent awareness gap, with many patients completing definitive local therapy without ever being referred for consideration of adjuvant systemic treatment. Dr In also draws a sharp distinction between cutaneous squamous cell carcinoma and mucosal head and neck squamous cell carcinoma, cautioning that the two behave differently and respond differently to checkpoint blockade.