Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Immune-checkpoint inhibitors for locally-advanced and metastatic cutaneous squamous-cell carcinomas in a real-world Australian cohort (#221)

Luke S McLean 1 2 , Annette M Lim 1 2 , Mathias Bressel 2 3 , Jenny Lee 4 5 , Rahul Ladwa 6 7 , Brett G.M. Hughes 7 8 , Alexander Guminski 9 , Samantha Bowyer 10 , Karen Briscoe 11 , Sam Harris 12 , Craig Kukard 13 , Rob Zielinski 14 15 , Muhammad Alamgeer 16 17 , Matteo Carlino 18 19 20 , Jeremy Mo 18 , John J Park 21 , Muhammad A Khattak 22 23 , Fiona Day 24 , Danny Rischin 1 2
  1. Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  2. The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
  3. Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  4. Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
  5. Department of Clinical Medicine, Macquarie University, Sydney, New South Wales, Australia
  6. Department of Medical Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  7. School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  8. Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  9. Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
  10. Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
  11. Department of Medical Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
  12. Department of Medical Oncology, Bendigo Health, Bendigo, VIC, Australia
  13. Department of Medical Oncology, Central Coast Cancer Centre, Gosford, New South Wales, Australia
  14. Department of Medical Oncology, Central West Cancer Centre, Orange, New South Wales, Australia
  15. Western Sydney University, Sydney, New South Wales, Australia
  16. Department of Medical Oncology, Monash Health, Clayton, VIC, Australia
  17. Monash University, Clayton, Victoria, Australia
  18. Department of Medical Oncology, Blacktown and Westmead Hospitals, Sydney, New South Wales, Australia
  19. Melanoma Institute of Australia, Sydney, New South Wales, Australia
  20. The University of Sydney, Sydney, New South Wales, Australia
  21. Department of Medical Oncology, Nepean Cancer Care Centre, Kingswood, New South Wales, Australia
  22. Department of Medical Oncology, Fiona Stanley Hospital, Perth, Western Australia, Australia
  23. Edith Cowan University, Perth, Western Australia, Australia
  24. Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia

Aims:

Immunotherapy has revolutionised the management of advanced cutaneous squamous cell carcinoma (CSCC)1-5. However, the stringent inclusion criteria of clinical trials results in key populations with advanced CSCC being excluded in the key registrational studies. This includes the elderly, the immunocompromised, those with autoimmune disease and organ transplant recipients. This has generated interest in reviewing real-world populations treated with immunotherapy via access schemes, however, to date many of these reports have been limited by small patient numbers6-9. To our knowledge this is the largest real-world report of advanced CSCC patients treated with immunotherapy.

Methods:

This was a multi-centre national retrospective review performed across 15 Australian institutions of patients with advanced CSCC who received immunotherapy via an access program. The primary endpoint was the best overall response rate (ORR) as per standardised assessment criteria using the hierarchy of Response Evaluation Criteria in Solid Tumors 1.1, modified World Health Organisation clinical response criteria or Positron Emission Tomography Response Criteria 1.0. We assessed toxicity as per Common Terminology Criteria for Adverse Events version 5 and correlated baseline clinico-pathological features with both overall (OS) and progression free survival (PFS).

Results:

286 patients were analysed. Median age was 75.2 years (range 39.3-97.5); 81% were male, 31% immunocompromised, 9% had an autoimmune disease and 21% were ECOG 2+. ORR was 63% with 28% complete responses, 35% partial responses, 22% stable disease and 16% with progressive disease. Median follow-up was 12 months. The 12-month OS and PFS were 78% (95%CI 72-83) and 65% (95%CI 58-70) respectively. In multivariate analysis poorer ECOG and immunocompromised status were associated with worse OS and PFS. 19% of patients reported grade 2+ immune-related adverse events. 

Conclusions:

This study demonstrates that immunotherapy is effective and well-tolerated in a real-world cohort of advanced CSCC patients. Comparable efficacy was seen to what has been demonstrated in clinical trials with similar toxicity.  

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