Systemic treatment of locally advanced nonmetastatic cutaneous squamous cell carcinoma: a review of the literature

Background There is a small subset of locally advanced nonmetastatic cutaneous squamous cell carcinoma (cSCC) for which local therapy is not curative or feasible, making systemic therapy a possible treatment option. Objectives To calculate overall response rates (ORR), median time to response (TTR) and median duration of response (DOR) of locally advanced nonmetastatic cSCC to systemic therapy [targeted agents, biological response modifiers (BRM) and chemotherapy]. Patients and methods Medline and PubMed were searched for reports of nonmetastatic locally advanced cSCC treated with systemic therapy from 1970 to 2011. No limits were placed on study design. ORR, TTR and DOR were calculated for systemic therapy overall and for each treatment category. Results Twenty- eight observational studies yielded 119 patients for analysis. The ORR for systemic therapy was 72% (TTR 9 weeks, DOR 42 weeks). Targeted therapy and BRM achieved ORR of 100% (TTR 12 weeks, DOR 20 weeks) and 86% (TTR 10 weeks, DOR 20 weeks), respectively, and oral chemotherapy, intravenous chemotherapy and intra- arterial chemotherapy achieved ORR of 20% (TTR 10 weeks, DOR 24 weeks), 68% (TTR 3 weeks, DOR 44 weeks) and 100% (TTR 15 weeks, DOR 112 weeks), respectively. A limitation of this study was that no controlled data were identified and sample sizes were small. Conclusions Systemic treatment leads to objective responses in locally advanced cutaneous SCC that are not amenable to local cure.