Cemiplimab for locally advanced and metastatic basal cell carcinoma

ABSTRACT

Introduction

Locally advanced basal cell carcinoma (laBCC) represents approximatively 1% of all BCCs. Metastatic BCC (mBCC) is even more rare. Most cases are observed in immunocompromised patients, particularly solid organ transplant recipients (OTRs). When surgery and/or radiation therapy for laBCC or mBCC is not reasonable, oral hedgehog inhibitor (HHI) therapy may be initiated. LaBCC or mBCC patients with primary or secondary resistance, progression or intolerance to HHIs could benefit from programmed cell death protein-1 (PD-1) inhibitors as this has recently been published for cemiplimab, a recombinant IgG4 human monoclonal antibody anti-PD-1 for the intravenous treatment of laBCC and mBCC.

Areas covered

Principal studies evaluating the efficacy and safety of cemiplimab for laBCC and mBCC are presented and discussed.

Expert opinion

Cemiplimab is the first FDA (2021) approved anti-PD-1 antagonist for the systemic treatment of laBCC and mBCC which had previously shown disease progression on or intolerance to HHIs. Experts currently recommend cemiplimab as a first-line systemic alternative. As cemiplimab therapy is associated with a risk of organ graft rejection, advantages and disadvantages should be evaluated for every individual OTR patient with laBCC or mBCC, eligible for cemiplimab therapy.

KEYWORDS:

• Cemiplimab
• locally advanced basal cell carcinoma
• metastatic basal cell carcinoma
• programmed cell death protein-1
• programmed death ligand-1

Article highlights

• Locally advanced basal cell carcinoma (laBCC) and metastatic (m)BCC are rare but represent important therapeutic challenges.

• Cemiplimab is the first FDA-approved PD-1 inhibitor for the systemic treatment of laBCC after failure of hedgehog inhibitors (HHI).