Cemiplimab may reduce the need for exenteration in patients with orbital tumors

The programmed cell death-1 (PD-1) inhibitor cemiplimab was studied under real-world conditions for its efficacy in treating squamous cell carcinoma with orbital invasion.

Study design

Cemiplimab is currently approved in the US for the treatment of locally advanced or metastatic cutaneous squamous cell carcinoma and basal cell carcinoma, and for certain cases of non–small cell lung cancer. This Israeli retrospective case series looked at 13 patients with biopsy proven cutaneous periocular locally advanced squamous cell carcinoma with orbital involvement who were treated with cemiplimab at 1 of 4 tertiary care centers. The median treatment duration was 5 months and the median follow-up time was 15 months.

Outcomes

Patients had a median age of 76 years. Five patients had lymph node involvement, 4 had metastatic disease, and 3 had perineural invasion. Nine patients responded to treatment: 7 had a complete response and 2 had a partial response. Of the 7 patients with complete response, 6 had no recurrence, with an average follow-up time of 6.1 months. Eight patients experienced adverse events, most of which were mild; however, 1 patient died of myocarditis, which was considered to be a treatment-related death.

Limitations

This was a small sample size, and the follow-up period was relatively short. The authors did not note if the tumors were positive or negative for PD-1, which may affect response.

Clinical significance

Orbital invasion of squamous cell carcinoma has traditionally necessitated orbital exenteration for complete tumor excision. The advent of immunotherapy has improved treatment for this form of cancer, obviating the need for orbital exenteration in many cases. This study gives further support for the use of cemiplimab for extensive cutaneous squamous cell carcinoma.

Financial Disclosures: Dr. Richard Allen discloses no financial relationships.