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Steering committee develops evidence-based consensus on cSCC staging, workup, treatment

CHICAGO — In patients with advanced cutaneous squamous cell carcinoma, a multidisciplinary discussion on treatment options should include oncologists, radiation oncologists and the primary care physician in weighing risks and benefits to various approaches, according to Todd Schlesinger, MD, FAAD, FASMS, medical director at Dermatology and Laser Center of Charleston.

Schlesinger was part of a multidisciplinary steering committee which convened from the Expert Cutaneous Squamous Cell Carcinoma Leadership (EXCeL) program to help standardize patient characterization and develop evidence-based consensus statements for cutaneous squamous cell carcinoma (cSCC). The program’s recommendations were summarized here at the American Society for Dermatologic Surgery annual meeting.

“The EXCeL steering committee had a key focus on referral patterns and the use of the multidisciplinary team in cutaneous squamous cell carcinoma” Schlesinger said.

The committee included five dermatologists, three medical oncologists, two head and neck surgeons, two radiation oncologists and a patient advocacy representative.

The group discussed the definition of locally advanced vs. metastatic cSCC, current management options — including the integration of newly approved treatments such as immunotherapy for cSCC and the role of a multidisciplinary team.

The steering committee found consensus on the following topics: diagnosis and identification of patients not considered candidates for surgery; staging systems and risk stratification in cSCC; the role of radiation therapy, surgery and systemic therapy for advanced disease; referral patterns; survivorship care and inclusion of the patient’s perspective, according to the abstract.

The panel recommends using the American Joint Committee on Cancer (AJCC) and Brigham and Women’s Hospital (BWH) systems for tumor staging.

“The BWH tumor staging system may be used to estimate risk of recurrence and metastasis and identify patients who may benefit from radiologic nodal staging or increased surveillance for recurrence,” he said. “AJCC8-N2 identifies patients at increased risk of regional treatment failure after surgery and/or radiation. These patients may benefit from consideration of systemic therapy if such failure occurs or the nodal disease is inoperable.”

“Use of immunotherapy was recommended as first-line therapy because it has changed the paradigm. The inclusion of the multidisciplinary team is very important. It is hopeful that these evidence-based guidelines will help guide clinicians in the management of locally advanced and metastatic cutaneous squamous cell carcinoma,” Schlesinger said. – by Abigail Sutton

Reference:

Schlesinger TE, et al. A multidisciplinary expert-driven consensus on the evolving treatment of patients with advanced cutaneous squamous cell carcinoma. Presented at: American Society for Dermatologic Surgery Annual Meeting; Oct. 24-27, 2019; Chicago.

Disclosures: The EXCeL Initiative was funded by Sanofi-Genzyme and Regeneron. Schlesinger reports receiving investigator, grant/research support and honoraria, as well as consulting for AbbVie. He is a consultant, investigator, speaker, faculty member and has received grant/research support and honoraria from Aclaris Therapeutics. He is an investigator for Akros from which he received grant and research support. Schlesinger a consultant and investigator at Allergan from which he received grant, research support and honoraria. He serves on the Advisory Board at Almirall and receives honoraria. Please see ASDS final program for all of Schlesinger’s remaining financial disclosures.