Cutaneous Squamous Cell Carcinoma: Managing Advanced Disease in the Era of Immunotherapy

Format: Webcourse

Credit(s): 1.00 (60 min)

Release Date: Jun 30, 2019

Expiration Date: Jun 30, 2020

Credit Type(s):

CME / AMA PRA Category 1 Credit™

PROGRAM OVERVIEW

Most cases of cutaneous squamous cell carcinoma (cSCC), a common cancer, are recognized early and treated successfully with surgery. A small percentage of patients develop advanced or metastatic disease, in which case data to guide treatments are sparse and management depends on a patient’s level of disability and comorbidities. Because patients with de novo or post-surgical advanced or metastatic cSCC are rare, oncologists aren’t always acquainted with pathophysiology, recommendations for diagnostic evaluations, disease staging, management strategies, or agents in clinical trials. Research is contributing to a greater understanding of tumor molecular markers (e.g. overexpression of EGFR) and the role of the programmed death-1 (PD-1) pathway, and has led to the use of targeted agents and the first FDA-approved agent (a PD-1 inhibitor) to treat advanced and metastatic cSCC.

This activity will help clinicians recognize and thoroughly evaluate and stage patients with cSCC who are at high risk of advanced or metastatic disease. Participants should then be able to use this information, in conjunction with expert recommendations and the multidisciplinary team, to develop treatment plans. Up-to-date knowledge of cSCC pathophysiology, including the role of mutations, EGFR overexpression, and the immune system, will give clinicians an understanding of where newly approved and in-development agents fit in treatment strategies.

AGENDA

Welcome and Introductions
Staging of cSCC
Current Understanding of the Pathophysiology of Advanced/Metastatic cSCC
Evolving Paradigm for Managing Advanced/Metastatic cSCC
Activity Roundup

TARGET AUDIENCE

This activity is intended for oncologists, oncology nurses, pharmacists, and other healthcare professionals involved in the treatment and care of patients with cSCC.

EDUCATIONAL OBJECTIVES

This program is designed to address ACGME and NAM competencies, including delivering patient-centered care and practicing evidence-based medicine.

At the conclusion of this activity, participants should be able to:

Outline the diagnostic evaluation of patients with cSCC
Describe commonly used systems for staging cSCC
Review the current understanding of the pathophysiology of advanced and metastatic cSCC
Review current recommendations for developing individualized management plans for advanced and metastatic cSCC, including the need for a multidisciplinary team
Describe the efficacy and safety of immune-targeted agents newly approved for the management of cSCC

ACCREDITATION

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of USF Health and Rockpointe. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

CREDIT DESIGNATION

USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

For information about accreditation of this activity, please email: cpdsupport@health.usf.edu.

FACULTY

Emily Stamell Ruiz, MD, MPH
Director, Dana‐Farber/Brigham and Women’s High‐Risk Skin Cancer Clinic
Associate Physician, Dana‐Farber/Brigham and Women’s Cancer Center
Instructor in Dermatology, Harvard Medical School
Boston, MA

Emily Stamell Ruiz, MD, MPH is Director of the Dana-Farber/Brigham and Women’s High-Risk Skin Cancer Clinic, an Associate Physician at the Mohs and Dermatologic Surgery Center at Dana-Farber/Brigham and Women’s Cancer Center, and an Instructor in Dermatology at Harvard Medical School. Dr. Ruiz received her undergraduate degree from Duke University, her medical degree from New York University School of Medicine, and her Master of Public Health degree from Harvard School of Public Health. She completed an internship in internal medicine at New York University School of Medicine, a dermatology residency at Albert Einstein College of Medicine, and a fellowship in micrographic surgery and dermatologic oncology at Brigham and Women’s Hospital. Dr. Ruiz’s research focuses on the burden of skin cancer through health services research and nonmelanoma skin cancer outcomes studies.

Ann W. Silk, MD, MS
Medical Oncologist
Dana-Farber Cancer Institute
Boston, MA

Ann W. Silk, MD, MS is a medical oncologist specializing in the care of patients with advanced skin cancers at Dana‐Farber Cancer Institute, including squamous cell carcinoma, Merkel cell carcinoma, basal cell carcinoma, and melanoma. She conducts clinical trials using immuno‐therapeutics such as immune checkpoint inhibitors, cytokine therapy, and oncolytic viral therapy. Dr. Silk received her medical doctorate and master’s degree in clinical research at the University of Pittsburgh in 2008. She completed a clinical fellowship in hematology and oncology at the University of Michigan in 2014. She joined the faculty at Dana‐Farber Cancer Institute in 2019.

DISCLOSURE/CONFLICT OF INTEREST STATEMENT

USF Health endorses the standards of the ACCME that require everyone in a position to control the content of an accredited educational activity to disclose all financial relationships with commercial interests that are related to the content of the educational activity. All accredited activities must be balanced, independent of commercial bias, and promote improvements or quality in healthcare. All recommendations involving clinical medicine must be based on evidence accepted within the medical profession.

A conflict of interest is created when individuals in a position to control the content of an accredited educational activity have a relevant financial relationship with a commercial interest which therefore may bias his/her opinion and teaching. This may include receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, stocks, or other financial benefits.

USF Health will identify, review, and resolve all conflicts of interest that speakers, authors, or planners disclose prior to an educational activity being delivered to learners. Disclosure of a relationship is not intended to suggest or condone bias in any presentation, but is made to provide participants with information that might be of potential importance to their evaluation of a presentation. USF Health does not endorse any products or services.

Program Faculty Disclosures

The program faculty reported the following relevant financial relationships that they or their spouse/partner have with commercial interests:

Emily Stamell Ruiz, MD, MPH: Nothing to disclose

Ann W. Silk, MD, MS: Consultant/Independent Contractor: Merck; Grant/Research Support: Bristol-Myers Squibb, Merck

Non-faculty Content Contributors Disclosures

Non-faculty content contributors and/or reviewers reported the following relevant financial relationships that they or their spouse/partner have with commercial interests:

Terry Ann Glauser, MD, MPH; Blair St. Amand; USF Health CPD Staff; Chetasi Talati, MD: Nothing to disclose

FDA DISCLOSURE

The contents of some CME/CE activities may contain discussions of non-approved or off-label uses of some agents mentioned. Please consult the prescribing information for full disclosure of approved uses.

SYSTEM REQUIREMENTS

In order to view this presentation, your computer must have audio capabilities (working speakers or headphones) and must have an internet browser capable of playing an HTML5 video.

INSTRUCTIONS FOR PARTICIPANTS AND OBTAINING CME CREDIT

There is no fee for this activity. To receive credit, participants must take the pre-test, view this CME activity in its entirety, and then complete the post-test, with a score of 80% or better, and evaluation. The estimated time for completion of this activity is 1 hour. To receive their certificates, participants must demonstrate mastery of the presented material via the post-test. Participant is allowed to take the post-test 2 times.

COURSE TRANSCRIPT

I’d like to begin the talk by reviewing the epidemiology and incidents of cutaneous squamous-cell carcinoma in the United States. Cutaneous squamous-cell carcinoma is the second most common cancer in our country. It’s second after basal cell carcinoma. In fact, newer incidents estimates are found at the number of cutaneous squamous-cell carcinomas diagnosed each year is almost the same as that of basal cells. This is primarily due to arising incidents with an increase of over 250% from the 1980s to the 2000s. Squamous-cell carcinoma is not captured in National Cancer registries. However, it is estimated that approximately one million tumors are treated each year. While most tumors have an excellent prognosis and are cured with surgery alone, a small subset will develop a poor outcome. Approximately 5% of tumors will develop a local recurrence, 4% will develop a nodal metastasis and 2% of patients will die from their disease. Slide 6 – Risk Factors for and Staging of cSCC Since cutaneous squamous-cell carcinomas are so common, it is important to risk-stratify tumors, so that we can identify those at risk for poor outcomes. There are certain risk factors that increase poor outcomes. Some are used as part of the current primary tumor staging systems. Slide 7 – Risk Factors for Local Recurrence and Metastases Important tumor risk factors can be divided into anatomic and histologic features. In the coming slides, I will review the different risk factors listed on this slide. Slide 8 – Anatomic Risk Factors Tumor diameter has been shown to increase both recurrence, metastasis and death from disease. Tumors above 2 cm have a three times of recurrence, six times risk of metastasis, and 19 times increase in disease-specific death. The NCCN guidelines categorize a number of locations as high risk, although it is important to note that the current primary tumor staging systems do not consider location as a risk factor. Studies have shown, however, that tumors on the ear and lip have a 1.3 times risk of local recurrence, 2.3 times risk of metastases, and over 4.5 times risk of disease-related death. For a full transcript, click here.