Update of cetuximab for non-melanoma skin cancer

Abstract

Introduction: Non-melanoma skin cancer (NMSC) has become the most common malignancy in humans. Targeted therapies are recent developments for these tumors. Monoclonal antibody cetuximab has proven its efficacy and has improved tolerability compared to classical chemotherapy protocols, and this prompted us to analyze new data on the use of cetuximab in cutaneous NMSC.

Areas covered: The monoclonal antibody cetuximab against epidermal growth factor receptor (EGFR) has been investigated for its use in NMSC during the years between 2011 and 2013. A PUBMED research 2011 – 2013 has been conducted using the following terms: ‘Non-melanoma skin cancer AND cetuximab’, ‘cutaneous squamous cell carcinoma AND cetuximab’, and ‘basal cell carcinoma AND cetuximab’ and ‘cetuximab AND skin toxicity’. Available data were analyzed – irrespective of their level of evidence, that is, case reports and case series were included.

Expert opinion: Current evidence of cetuximab's efficacy in NMSC was mainly obtained in cutaneous squamous cell carcinoma (SCC) and to a lesser extent in basal cell carcinoma (BCC). Response rates vary for neoadjuvant, adjuvant, monotherapy and combined therapy with cetuximab. Limitations are the low number of patients treated (33 patients with SCC, 4 patients with BCC) and the low quality of studies reported. Management of cutaneous toxicities of EGFR inhibitors is necessary, and guidelines are available. Proactive therapy might also prevent skin toxicity of higher grades, with EGFR inhibitor cetuximab as an option for recurrent or advanced NMSC of the skin. It seems to be justified particularly in very high risk epithelial tumors. There is an urgent need for Phase III trials. In the future, combined drug therapy with other monoclonal antibodies and/or radiotherapy may further improve efficacy and response rates for NMSC.

Keywords::

• cetuximab
• epidermal growth factor receptor
• non-melanoma skin cancer
• skin toxicity
• targeted therapy