Treatment of nonmelanoma skin cancer: basal and squamous cell carcinoma

Various systemic therapies have been approved for basal and cutaneous squamous cell carcinoma. Compared to other tumor entities, these drugs elicit a high response rate with a long response duration. Treatment is intended for advanced tumor stages. Per definition, there is a difference here to many other tumor entities: for most cancer types (e.g., oral squamous cell carcinoma), the tumor stage is more clearly defined (recurrent/metastatic). This describes a palliative situation without treatment alternatives. For nonmelanoma skin cancers, the dimensions "non-rational" or "mutilating" also exist. Thus, the disease stage to be treated corresponds to a "difficult-to-treat tumor stage". This fact is reflected in the approval texts. For basal cell carcinoma, the Sonic Hedgehog inhibitors vismodegib and sonidegib are approved. Contraception for both sexes is an important requirement for both drugs. Since recurrence is not uncommon during the course of treatment (typical is at about 1 year), there is the option of consecutive treatment with cemiplimab. This consecutive treatment is also possible in the case of intolerance to Sonic Hedgehog inhibitors. Cemiplimab is also approved for cutaneous squamous cell carcinoma. Particularly the high response rates of over 50% in some cases render the PD1 inhibitors ideal candidates for new treatment algorithms (neoadjuvant, induction, etc.) for cutaneous squamous cell carcinoma and may lend new importance to surgical therapy.