Highlights
- •The relative efficacy of treatments for cutaneous squamous cell carcinoma is unclear.
- •Immune checkpoint blockade is superior to other systemic treatments.
- •Immune checkpoint blockade sets a new survival benchmark.
Abstract
Background
Cutaneous squamous cell carcinoma is a common type of skin cancer that may progress
to locally advanced or metastatic disease. Both disease stages are managed by a variety
of treatment options, including immune checkpoint blockade (ICB), targeted therapy
to epidermal growth factor, chemotherapy or treatment combinations. However, the comparative
efficacy of such treatments is unclear.
Methods
We performed a systematic literature search of Medline, Embase and Central to identify
eligible studies reporting Kaplan–Meier curves or individual patient data for overall
survival (OS) or progression-free survival (PFS). Kaplan–Meier curves were digitised
using the “‘WebPlotDigitizer” program. Individual patient data was subsequently remodelled
and pooled for distinct treatment groups.
Results
Overall, 22 independent studies were included of which n = 927 patients were evaluable
for PFS and n = 1054 for OS. ICB showed the highest median PFS (mPFS 9.9 months (95%
CI: 8.1–19.9)) and median OS (mOS not reached (95% CI: 31.5 months-not reached)) compared
to chemotherapy (mPFS 3.0 months (95% CI: 2.2–4.8), mOS 12.6 months (95% CI: 9.6–15.8)),
targeted therapy to epidermal growth factor (mPFS 4.9 months (95% CI: 4.4–5.6), mOS
12.7 months (95% CI: 11.9–14.9)) and combination therapies without ICB (mPFS 9.1 months
(95% CI: 8.0–12.1), mOS 18.1 months (95% CI: 16.3–22.8)). The survival benchmark with
ICB after 26 months for metastatic squamous cell carcinoma was 70.8% (95% CI: 61.5%–81.5%)
versus 37.9% (95% CI: 29.5%–48.8%) for the combination group and 17.1% (95% CI: 9.5%–30.8%)
for chemotherapy.
Conclusion
ICB is superior to other systemic treatments and sets a novel survival benchmark for
advanced cutaneous squamous cell carcinoma.
Keywords
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Article info
Publication history
Published online: May 17, 2022
Accepted:
March 28,
2022
Received in revised form:
March 1,
2022
Received:
December 17,
2021
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
