Comparative efficacy analysis identifies immune checkpoint blockade as a new survival benchmark in advanced cutaneous squamous cell carcinoma

• Published in: European journal of cancer (1990) Vol. 170; pp. 42 - 53
• Main Authors: Petzold, Anne, Steeb, Theresa, Wessely, Anja, Schatton, Tobias, Berking, Carola, Heppt, Markus V.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2022; Elsevier Science Ltd
• Subjects: Benchmarks; Cancer; Chemotherapy; Cutaneous neoplasm; Cutaneous squamous cell carcinoma; Epidermal growth factor; Growth factors; Immune checkpoint; Immune checkpoint blockade; Indirect comparison; Individual patient data; Metastases; Metastasis; Overall survival; Patients; PD-1 therapy; Progression-free survival; Skin cancer; Squamous cell carcinoma; Survival; Cutaneous neoplasm; Cutaneous squamous cell carcinoma; Immune checkpoint blockade; Individual patient data; PD-1 therapy; Overall survival; Progression-free survival; Indirect comparison; Skin cancer
• ISSN: 0959-8049; 1879-0852; 1879-0852
• DOI: 10.1016/j.ejca.2022.03.035

Cutaneous squamous cell carcinoma is a common type of skin cancer that may progress to locally advanced or metastatic disease. Both disease stages are managed by a variety of treatment options, including immune checkpoint blockade (ICB), targeted therapy to epidermal growth factor, chemotherapy or treatment combinations. However, the comparative efficacy of such treatments is unclear. We performed a systematic literature search of Medline, Embase and Central to identify eligible studies reporting Kaplan–Meier curves or individual patient data for overall survival (OS) or progression-free survival (PFS). Kaplan–Meier curves were digitised using the “‘WebPlotDigitizer” program. Individual patient data was subsequently remodelled and pooled for distinct treatment groups. Overall, 22 independent studies were included of which n = 927 patients were evaluable for PFS and n = 1054 for OS. ICB showed the highest median PFS (mPFS 9.9 months (95% CI: 8.1–19.9)) and median OS (mOS not reached (95% CI: 31.5 months-not reached)) compared to chemotherapy (mPFS 3.0 months (95% CI: 2.2–4.8), mOS 12.6 months (95% CI: 9.6–15.8)), targeted therapy to epidermal growth factor (mPFS 4.9 months (95% CI: 4.4–5.6), mOS 12.7 months (95% CI: 11.9–14.9)) and combination therapies without ICB (mPFS 9.1 months (95% CI: 8.0–12.1), mOS 18.1 months (95% CI: 16.3–22.8)). The survival benchmark with ICB after 26 months for metastatic squamous cell carcinoma was 70.8% (95% CI: 61.5%–81.5%) versus 37.9% (95% CI: 29.5%–48.8%) for the combination group and 17.1% (95% CI: 9.5%–30.8%) for chemotherapy. ICB is superior to other systemic treatments and sets a novel survival benchmark for advanced cutaneous squamous cell carcinoma. •The relative efficacy of treatments for cutaneous squamous cell carcinoma is unclear.•Immune checkpoint blockade is superior to other systemic treatments.•Immune checkpoint blockade sets a new survival benchmark.