Therapeutic target
Improvement of prognosis
Therapy recommendations
- First-line therapy: complete excision (excision in toto; removal of the skin lesion in healthy tissue), with sentinel lymph node biopsy (SLND; sentinel lymph node removal) if necessary.
- Metastatic or unresectable squamous cell carcinoma of the skin (PEK of the skin).
- Cytostatic therapy (cisplatin + 5-fluorouracil (5-FU)), alternatively monotherapy with 5-FU.
- If necessary, also EGFR inhibitors (EGFR: “epidermal growth factor receptor” e.g. cetuximab ) or immune checkpoint blockers (nivolumab, pembrolizumab and cemiplimab).
- Radiotherapy (radiotherapy) may be indicated in individual cases (see below “Radiotherapy”).
- In metastatic or inoperable squamous cell carcinoma (PEK) of the skin, a combination of chemotherapy and radiotherapy may be performed.
- See also under “Further therapy“.
Note: Whether adjuvant radiotherapy is necessary for high-risk PEK excised in healthy individuals is considered controversial. Randomized trials on this question are lacking.
Agents (main indication)
Cytostatic agents
The following agents are used:
- Methotrexate
- Cisplatin* + 5-fluorouracil; alternatively, monotherapy with 5-FU; if necessary + radiotherapy (radiotherapy, radiatio).
* Response rates of > 50%.
Monoclonal antibodies
- EGFR inhibitors (EGFR: “epidermal growth factor receptor”; e.g., cetuximab) [= targeted therapy; response rates: 25-45%] or
- Immune checkpoint blockers [immunotherapy: e.g., antibodies against PD-1 (nivolumab, pembrolizumab, and cemiplimab* )]Mode of action: Binding of PD-L1 ligand to tumor cells of the PEK of the skin suppresses the cytotoxic activity of T cells against this target.
* The FDA has assigned cemiplimab special “breakthrough therapy” status (response rates of 47-50%).
No dosing information is provided here because therapy regimens are constantly changing.