Outcomes of continuing neoadjuvant-intent immunotherapy for advanced, resectable cutaneous squamous cell carcinoma post-operatively.

Abstract

e18085 Background: Cutaneous Squamous Cell Carcinoma (cSCC) of the head and neck is mediated by ultraviolet radiation and associated with multifocal disease within a cancerized field. Methods: We investigated adjuvant immunotherapy for preventing surgical site recurrence and development of new lesions through retrospective chart review of 15 patients treated with neoadjuvant-intent Programed Cell Death Protein-1 immune checkpoint inhibitor therapy from 2022 to 2024. Results: Neoadjuvant course averaged 89 days (n = 14, excluding 1 outlier). By the end of neoadjuvant courses, 2 patients had biopsies that showed lack of residual disease, avoiding further resections. 12/15 completed resection. 4/12 resections had a positive surgical margin, of which 1 was re-excised with negative margins. The remaining 3 patients continued adjuvant immunotherapy without additional surgery. 1 additional patient with negative surgical margins chose to continue adjuvant. 3/4 adjuvant patients had wound complications, which led to 1 death from sepsis. The patient without wound complications had surgical site recurrence. None of the adjuvant patients developed additional remote cSCCs, although the preventative benefits of adjuvant course may be limited compared to a shorter neoadjuvant course. Only 1/11 neoadjuvant patients developed another site cSCC. Conclusions: Our results are consistent with prior studies on the effective use of four cycles of neoadjuvant immunotherapy. We provide insights into patient preferences for choosing immunotherapy and avoiding surgery, highlighting promising effects of adjuvant therapy for patients with positive margins. Additionally, we discuss improving wound healing to further improve outcomes of adjuvant immunotherapy. Results. Overall Mean(n = 15) Neoadjuvant therapy only(n = 11) Neoadjuvant and Adjuvant Therapy(n = 4) Age/Sex 72 (12 male; 3 female) Site 6 scalp; 2 ear; 6 cheek; 1 nose Number of infusions 6.4 4 13 Overall treatment course (days) 120 63 277 Endpoint of Immunotherapy 8 surgeries; 1 side effect; 1 resistant disease progression; 1 costs 2 end at 1 year treatment time course; 1 died; 1 resistant disease progression Surgery 12 resections; 2 biopsies showing complete response without residual cSCC; 1 rejected surgery Time (days) from starting immunotherapy to time of procedure (resection or punch biopsy) 89 (n=14, excluded outlier of 301 in patient with salvage resection therapy); Complete pathological response seen in 2 patients Positive surgical margin (n = 4) 1 (re-excision margins negative) 3 (of which 1 had re-excision margins negative) Mean Follow-up Time (months) 6 5.9 6.5