2066 - Survival Outcomes Associated with Disease Recurrence in Patients with Cutaneous Squamous Cell Carcinoma Treated with Multimodal Therapy
Presenter(s)
R. Fodor1, K. Brito2, C. A. Reddy3, N. M. Woody4, S. R. Campbell5, J. A. Miller6, K. Burkitt6, J. L. Geiger7, A. Vidimos8, S. A. Koyfman4, B. Bassiri Gharb9, and T. A. Sussman10; 1Cleveland Clinic Lerner College of Medicine, Cleveland, OH, 2Cleveland Clinic Foundation, Cleveland, OH, 3Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, 4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, 5Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, 6Cleveland Clinic, Cleveland, OH, 7Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, 8Department of Dermatology, Cleveland Clinic Foundation, Cleveland, OH, 9Cleveland Clinic Department of Plastic Surgery, Cleveland, OH, 10Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
Purpose/Objective(s): Patients with high-risk cutaneous squamous cell carcinoma (cSCC) who recur after treatment with surgery and postoperative radiotherapy have historically had poor outcomes. With the introduction of immunotherapy as a highly effective therapeutic modality in these patients, we sought to evaluate its impact on survival and the relative outcomes in immune intact and immune suppressed patients.
Materials/Methods: Patients treated with surgery and radiotherapy for primary or recurrent stage I-IV cSCC from 1995 to 2024 were included in this IRB-approved study. Patients with disease recurrence of any kind (e.g., local, regional, distant) were included for analysis. Immune suppressed patients included organ transplant recipients, patients with hematologic malignancies and/or those on chronic immunosuppressive medications. Salvage surgery or immunotherapy use was collected when applicable. Overall survival was calculated using the Kaplan-Meier method from the time of recurrence and overall survival rates were compared using the log-rank test. Univariate and multivariate analyses were performed using Cox proportional hazards regressions to identify factors associated with overall survival.
Results: This study included 68 patients (59 female, 9 male), 30 (44.1%) of whom were immune suppressed while 38 (55.9%) were immune intact. Most tumors (60, 88%) were located in the head and neck; 29 (43%) were node positive. Most patients underwent wide local excision (83.8%) and intensity-modulated radiotherapy (72%), while 13 (19%) were treated with concurrent systemic therapy. Median follow-up time was 24.2 months (0.2-242). Overall, two-year overall survival after recurrence was 51.3% (95% CI: 39.3%-63.2%). Two-year overall survival was significantly higher in immune intact compared to immune suppressed patients [63% (95% CI: 47.6-78.4%) vs. 36.7% (95% CI: 19.4-53.9%); p=0.005] and patients who received salvage immunotherapy compared to those who did not [71% (95% CI: 51.5-90.6%) vs 42.6% (95% CI: 28.4-56.7%); p=0.01]. Patients who received salvage surgery had better two-year overall survival; however, this was not statistically significant [64.5% (95% CI: 47.7-81.4%) vs. 40.1% (95% CI: 24.2-56.0%); p=0.24]. On multivariate analysis, only immune suppressed status (HR 1.9; 95% CI 1.07-3.38; p=0.029) and the lack of immunotherapy (HR 2.2; 95% CI 1.02-4.53; p=0.044) were independently associated with an increased risk of death.
Conclusion: In patients with recurrent cSCC after surgery and radiotherapy, the use of salvage immunotherapy significantly prolongs survival and is changing the natural history of this disease. In contrast, immune suppressed patients, especially those who are not eligible for immunotherapy, have exceedingly high mortality rates, and represent an area of unmet need that is ripe for novel therapeutics.