The future of skin cancer treatment has never been brighter. Kevin S. Emerick, MD, co-director of the Multidisciplinary Cutaneous Oncology Center at Mass Eye and Ear, explained how immunotherapy could forever change the way doctors treat non-melanoma skin cancers, the most common form of the disease.
In the United States alone, more than four million people are diagnosed with skin cancer each year, according to the American Academy of Dermatology. These cancers are typically caused by exposure to ultraviolet (UV) rays, primarily from the sun. Doctors encourage people to apply sunscreen that is at least SPF 30, wear protective clothing, and find shade while outdoors to reduce the risk of skin cancer.
Approximately 17,500 people die from skin cancer each year. Melanoma, which is the rarest form of skin cancer, accounts for half of those deaths. The other half are attributed to non-melanoma skin cancers, such as basal cell and squamous cell carcinoma. These non-melanoma skin cancers account for more than 80 percent of total cases.
While protecting yourself from the sun is vitally important in reducing risk, skin cancer can be easily treated if caught in its early stages. Unfortunately, there are few options for patients with skin cancers that have become more advanced. Once surgery and radiation have been eliminated as options, survival rates drastically plummet.
Immunotherapy is now being increasingly utilized to treat advanced, non-melanoma skin cancers, which could soon buck this trend and offer a brighter outlook for patients.
“Immunotherapy is a complete game-changer for treating skin cancers,” Dr. Emerick told Focus. “It’s a paradigm shift that has the potential to change the way we discuss the prognoses of patients for years to come.”
How is skin cancer normally treated?
Skin cancer can be treated using non-invasive procedures when caught early. These methods are fairly well-known and include cryotherapy, which freezes cancer cells, and topical chemotherapy ointments. Mohs surgery, a minimally invasive procedure that removes thin layers of skin tissue, can also be used for low-risk, early-stage skin cancers.
Few, if any, deaths occur from early-stage skin cancers thanks to the effectiveness of these treatments, according to Dr. Emerick. However, skin cancers run the risk of growing back if not completely removed. When left undetected for too long, those cancer cells can spread and become untreatable. Additionally, there is a subset of tumors with a more aggressive makeup that can spread. At that point, treatment options such as radiation and surgery are limited.
“When you think of cancer, you typically think of surgery, radiation, and chemotherapy as the only ways to cure the disease,” Dr. Emerick said. “But, for skin cancers, we don’t have a single chemotherapy that is effective in providing a cure. By the time these cancers metastasize and are more advanced, there really aren’t too many treatment options left.”
How immunotherapy changes the future of treating non-melanoma skin cancer
Immunotherapy gives doctors reason to believe a more definitive cure for skin cancers is on the horizon. Unlike chemotherapy, which uses medication to kill tumors at the expense of healthy cells, immunotherapy uses medication to train the body’s immune system to target cancer cells.
Skin cancer cells can disguise themselves from the body’s immune system by disarming the immune system’s T-cells, which normally serve as a natural defense against tumors. Immunotherapy medications produce antibodies that alert the immune system when cancer cells and T-cells interact. Once the interaction is identified, the immune system activates its natural response against the cancer cells.
The first immunotherapy medications were approved 10 years ago for melanoma. Two years ago, those medications were approved to treat cutaneous squamous cell carcinoma. So far, these medications have been extraordinarily successful, said Dr. Emerick. A 2018 clinical trial published in the New England Journal of Medicine, showed that 50 percent of advanced squamous cell carcinoma patients who couldn’t be cured with radiation or surgery responded positively to an immunotherapy drug called Cemiplimab.
“Fifty percent might not sound great, but prior to two years ago, that number was zero,” Dr. Emerick said. “This has had a major impact on the conversations we’re having with patients. It’s giving them a lot more hope and a lot more optimism.”
Immunotherapy: A path to personalized cancer care
With a clinical trial of the drug Cemiplimab underway in the Non-Melanoma Skin Cancer Program at Mass Eye and Ear/Mass General Hospital, Dr. Emerick believes immunotherapy could lead to a more personalized approach to treating skin cancer.
The program features a team of dermatologists, medical oncologists, radiologists, Mohs surgeons, and other specialists focused solely on researching and treating non-melanoma skin cancers. The current clinical trial aims to treat advanced squamous cell carcinoma patients by administering immunotherapy before the planned surgical procedure. This can help decrease the amount of surgery performed and guide the need for treatment after surgery.
“We want to get to the point where we can give a single dose of a medication to a patient with advanced disease, perform a small procedure, and determine whether we need to explore different treatments depending on how the patient responds,” Dr. Emerick explained. “We talk about personalized medicine for breast cancer, colon cancer, lung cancer. It should be no different for skin cancer.”
What makes Dr. Emerick even more excited is immunotherapy’s potential to evolve over time with future research. His partnerships with David Miller, MD, PhD, a dermatologist and oncologist at Mass General Hospital, and Vinod Saladi, PhD, an assistant scientist in the Mike Toth Head and Neck Cancer Research Center at Mass Eye and Ear, could produce research that helps doctors better understand the natural history and pathways of skin cancers, which would lead to more personalized treatments.
“When you think about it, we are just in our infancy with these medications,” Dr. Emerick said. “When you’re surrounded by some of the brightest people in the world, there are endless possibilities as to how we can innovate with these medications and find cures we once thought couldn’t be possible.”
Visit the Skin Cancer Centers web page for more information.
About Our Expert
Kevin S. Emerick, MD, is Co-Director of the Multidisciplinary Cutaneous Oncology Center. He is a board-certified ENT surgeon who specializes in head and neck cancer, as well as skin cancer. Request an appointment with Dr. Emerick or call the Non-Melanoma Skin Cancer Multidisciplinary Clinic at 617-573-4084.