Иммунотерапия в комбинации с лучевой терапией при лечении пациентов с плоскоклеточным раком кожи

Abstract

Squamous cell skin cancer (SCC) is the second most common malignant neoplasm. The incidence of SCC continues to grow. As a rule, the tumor is characterized by a benign clinical course and is cured surgically, but in some cases, the development of locally common (and/or metastatic) forms is observed. For a long period of time, there were no methods of drug therapy of patients with such forms of SCC that would lead not only to a local effect, but also to an increase in life expectancy. In most cases, SCC is characterized by a high mutational load, the presence of PD-L1 expression, which potentially suggests a possible sensitivity of the tumor to immunotherapy. This knowledge contributed to the conduct of clinical studies of anti-PD-1 immunotherapy in locally common inoperable and/or metastatic forms of SCC. In the USA, in 2018, the first drug for the treatment of patients with locally advanced inoperable and/or metastatic form of SCC, cemiplimab, was approved for the first time. In 2020 another anti-PD-1 drug, pembrolizumab, was approved, which allowed expanding the possibilities of drug therapy for this category of patients. Despite the high frequency of objective responses against the background of anti-PD-1 immunotherapy in the first line (about 50%), a number of patients have stabilization of the disease or progression of the process. Stabilization of the disease is not enough for most patients, taking into account the peculiarities of clinical manifestations characteristic of SCC, which requires the search for new approaches and the use of immunotherapy with other treatment options to improve immediate and long-term results. The article presents a clinical case of a patient with locally advanced right shin SCC who received anti-PD-1 immunotherapy (nivolumab) in combination with radiation therapy as part of first-line therapy. On the background of such therapy, it was possible to achieve some success.