Squamous Cell Carcinoma, one of the most prevalent forms of skin cancer in Australia, and globally, impacts the lives of thousands of Queenslanders a year and can be fatal.
Surgery followed by radiotherapy is the cure but can negatively impact patients especially if performed in cosmetically appealing places like the face. Newer therapies such as immunotherapies have changed the way we manage people with this condition.
Thankfully, a new clinical trial at the PA Hospital (PAH) offers new hope.
The DESQUAMATE immunotherapy trial at the PA Hospital’s Clinical Trials unit is seeing incredible results in more than half of the trial patients, and is playing a role in turning the treatment of squamous cell carcinomas on its head.
PAH Oncologist Rahul Ladwa is thrilled with the responses he’s seeing in patients on the trial.
“The head and neck clinic at PA very much supported this study, and we found that nearly two thirds of the group had a fantastic response,” he said.
“They had what we call a clinical complete response, i.e., the tumour had disappeared on PET scans and when we did a biopsy in the area where the cancer once was, we didn't see any cancer cells.”
The key to the Metro South Health and Hospital services sponsored study run at the Princess Alexandra Hospital has been its patient centred focus, reducing invasive surgery and radiotherapy in nearly half the patients.
“We wanted to design a study that selected patients appropriately to avoid major surgery and radiation, so we designed a risk-adapted study where the management was altered according to the response following the introduction of immunotherapy,” A/Prof Ladwa said.
“We have seen long term responses to patients initially thought to be incurable, with immune therapies alone where people are living two or more years later with no evidence of active cancer.”
“Based on this we designed a study to incorporate the fantastic responses we were getting from immunotherapy into the multidisciplinary management of patients with operable disease, where surgery, and/or radiotherapy was given only if we were worried cancer was left behind to minimise toxicity from these treatments.
“Our patients were excited about this approach as these cancers are predominantly located inthe head and neck region, so any surgery is a significant undertaking especially in an older patients population.”
As well as celebrating the amazing responses the majority of patients are having, importantly, researchers and clinicians are learning more about why some patients aren’t responding through the trial.
“A part of our research is looking at those responders and non-responders to select those patients who do well. We monitor the patients doing well versus those that don't do well and look at where we can escalate their treatments,” A/Prof Ladwa said.
“We've got a lot of translational research coming through and hopefully we'll get a better idea of those people who don't respond to see if there is a biological reason why they are not responding?
“The most interesting thing here is that in patients who had a fantastic response such that we didn’t need to do surgery and radiation, the cancer has not recurred at 12 months.
“We're following them all long term, but I think these are the first people in the world that have ever had surgical operable disease where we've actively said to them, ‘we're not going to do surgery because you've had such a fantastic response’.
“I think what we're seeing now is a bit of a shift in the paradigm of how we treat, the second most common skin cancer in Queensland, which is an amazing outcome from a study designed by the head and neck team at the PA Hospital.
“These studies might guide future larger studies and ultimately the access to these medications on the PBS."
