Squamous carcinoma of the skin responding to erlotinib: Three cases

Abstract

16519 Background: Systemic therapies for squamous cell carcinoma of the skin (SCCS) include cytotoxic chemotherapy and immunotherapy with retinoids and interferon. Erlotinib is an orally available EGFR inhibitor which is generally well tolerated. This report describes three patients with SCCS in whom erlotinib treatment produced clinical benefit. Methods: Case report. Results: 1. A 40 year old lung transplant recipient with multifocal SCCS was diagnosed with lung metastases by CT scan and bronchoscopy. These lesions progressed during treatment with acitretin and interferon. He began erlotinib at 150 mg daily and one month later CT scan showed his lung metastases to have responded, with the largest lesion decreasing in size by 50%. He continued on erlotinib for his remaining 8 months of life, during which his lung lesions continued to regress. Unfortunately the SCCS on his face progressed while on erlotinib, and ultimately caused his death. 2. A 54 year old with SCCS of the face treated with orbital exenteration and neck dissection followed by chemoradiation for submental recurrence developed a new 2 cm submental mass. He began erlotinib at 150 mg daily with complete resolution of the mass over 1 month. PET scan was negative, and there was doubt as to whether the mass had actually been SCCS. Because of this the patient discontinued erlotinib, and 3 weeks later the mass recurred. It was biopsy confirmed to be SCCS, and erlotinib again produced a clinical CR. Two months later he stopped erlotinib prior to planned surgery, and the tumor again regrew. 3. A 41 year old developed SCCS of the left temple. This lesion repeatedly recurred despite irradiation and resection, ultimately involving the orbit and cranial nerves and causing significant pain. The lesion progressed during chemotherapy with cisplatin and capecitabine. The patient began erlotinib 150 mg daily and experienced a partial response, together with marked improvement in pain and quality of life. He has continued on erlotinib for three months to date. Conclusions: Erlotinib provided excellent palliation for these patients with SCCS who had failed other therapies. The sensitivity of these aggressive SCCS to erlotinib suggests that this drug might be used at earlier points in the treatment of such patients, possibly in combination with radiation. No significant financial relationships to disclose.