Adjuvant Cemiplimab for High-Risk CSCC: Risk Stratification in Practice

In an interview with Targeted Oncology, Vishal A. Patel, MD, FAAD, FACMS, associate professor of Dermatology and of Medicine (Hematology/Oncology) at George Washington (GW) University School of Medicine and Health Sciences and director, Cutaneous Oncology Program at GW Cancer Center, details 2 scenarios where oncologists should consider the use of cemiplimab, now FDA-approved, in adjuvant treatment of cutaneous squamous cell carcinoma (CSCC).

Watch part 1, part 2, part 3, and part 4 of Dr Patel’s interview.

Case 1 describes a patient with a large primary lesion and suspected lymph node involvement that worsens upon detailed pathology. Initial imaging may suggest only one or two nodes, but final dissection reveals 3 positive lymph nodes, including a node measuring 2 cm, along with facial nerve involvement. Meeting multiple C-POST trial (NCT03969004) criteria, this patient would be recommended for postoperative radiation therapy, with adjuvant cemiplimab strongly advised.

Case 2 highlights the importance of full histologic evaluation, presenting a case where a tumor resection reveals bone invasion or presence of in-transit metastases, constituting high-risk features that put the patient at substantial risk for recurrence.

In part 1 of the interview, Dr Patel emphasized the significance of the intentional selection of inclusion criteria utilized within the C-POST trial, as these may help guide the decision-making process in determining which patients are at high risk for recurrence. In part 2, he also underscored the importance of approaching the treatment decision with a nuanced lens, factoring in patients’ individual circumstances to maximize the benefits of treatment with this agent.

“It is important for the oncologist to consider those nuances, [which] can help improve the outcomes of those patients that may fall through the cracks and have not received off-label neoadjuvant therapy, or those patients that we worry may have a harder time receiving salvage systemic therapy later,” said Dr Patel in the interview.

These cases illustrate scenarios where final pathology often reveals a higher risk of recurrence than anticipated, requiring oncologists to appropriately risk-stratify and apply the C-POST inclusion criteria to determine if patients will benefit from adjuvant cemiplimab.

Read the full interview here.