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Comparative efficacy analysis identifies immune checkpoint blockade as a new survival benchmark in advanced cutaneous squamous cell carcinoma

  • Anne Petzold
    Affiliations
    Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

    Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN) and Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
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  • Theresa Steeb
    Affiliations
    Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

    Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN) and Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
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  • Anja Wessely
    Affiliations
    Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

    Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN) and Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
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  • Tobias Schatton
    Affiliations
    Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

    Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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  • Author Footnotes
    1 equal authorship contribution.
    Carola Berking
    Footnotes
    1 equal authorship contribution.
    Affiliations
    Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

    Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN) and Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
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  • Author Footnotes
    1 equal authorship contribution.
    Markus V. Heppt
    Correspondence
    Corresponding author: Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany.
    Footnotes
    1 equal authorship contribution.
    Affiliations
    Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

    Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN) and Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany

    Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
    Search for articles by this author
  • Author Footnotes
    1 equal authorship contribution.

      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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