Case Report: Improvement in neurologic symptoms and remission following non-operative management of locally advanced cutaneous squamous cell carcinoma of the head and neck following cemiplimab therapy: two cases

Abstract

Background Cutaneous squamous cell carcinoma is a common skin malignancy in aging populations. Surgical resection and radiotherapy can result in significant morbidity, as well as functional and cosmetic impairments. PD-1 antibodies are promising treatments for locally advanced disease. Case presentation Two elderly men (aged 71 and 73) with locoregionally advanced head and neck tumors received neoadjuvant treatment with cemiplimab (350 mg IV every 3 weeks). Both patients presented with neurologic symptoms concerning for nerve involvement; however, perineural spread could not be identified radiographically or by limited biopsies. Both patients achieved a significant clinical response after only four doses of cemiplimab. After 4 additional doses, both patients underwent elective treatment discontinuation and surgery and radiotherapy were omitted. With over 12-month follow-up, both patients remained free of recurrence. Treatment was well-tolerated with only Grade 1 pruritus. Conclusion These observations are promising and suggest the feasibility of response-adapted management following cemiplimab therapy in selected patients with advanced squamous cell skin cancer with resolution of neurologic symptoms. This approach may allow for omission of surgery and radiotherapy in selected patients. Further investigation to define appropriate candidates for this approach appears warranted.