Dr Neil Gross Discusses the Implications of pCR on Additional Treatment in Skin Cancer

Neil D. Gross, MD, FACS, head and neck surgeon and director of clinical research in the Department of Head and Neck Surgery at The University of Texas MD Anderson Cancer Center, discusses the results of study he and his team conducted in the setting of resectable stage II to IV cutaneous squamous cell carcinoma.

One of this study’s principal findings was a 51% complete pathologic response (pCR) rate, and this can have implications on reducing the need for more extensive surgery and radiation, Gross stated.

Transcript

For those who may not view a 51% pathologic complete response rate as a good result, can you explain why this is a positive in the setting of advanced disease?

Comparing this study to the current standard of care, which is surgery and radiation, there’s a lot of room for improvement. The effects of surgery and standard radiation can be devastating [in the] long term. In this study, just over half of the patients had a complete pathologic response. So they could have a more limited surgery, and those patients are probably safe not having radiation as well. Another about 13% of patients in this study—so overall, about two-thirds of patients had a deep pathologic response; most of those were complete pathologic responses—a smaller percentage had a near complete pathologic response. Those patients also do exceedingly well. They seem to behave similarly well to the patients who have a complete response.

Now, there are about a third of patients who just don’t respond as well. They may have a partial response. There’re even some patients where the disease progresses. And that’s why in this study we included imaging assessment after 2 doses. So, as long as patients were responding and they were not having toxicity, they could go on to receive 4 doses. Some patients did stop after 2 doses and go on to have surgery, but most patients were able to complete all 4 doses of treatment. And I think if you scale this up into a larger group, there’s just a lot of room for potential benefit for about two-thirds of the patients treated using this approach.