For patients with borderline resectable CSCC, upfront anti-PD-1 therapy is used not just for efficacy but as a strategy to preserve function. This approach can prevent life-altering surgeries, such as eye removal, offering a chance for both cure and improved quality of life.
The immunosuppressed population with CSCC faces a significantly higher risk of recurrence, metastasis, and death. Dr. Gross highlights this group as being particularly challenging and underserved by current research, indicating a critical need for more dedicated clinical data and tailored treatment strategies.
The varied manifestations of advanced CSCC—local, nodal, or perineural—create a heterogeneous patient population. This complexity has led to its exclusion from major cancer databases and made it a "blind spot" for industry, slowing research despite the disease's prevalence.
Despite enthusiasm, Dr. Gross cautions against universally adopting neoadjuvant immunotherapy for advanced CSCC. He argues its safety and superiority over standard upfront surgery are unknown, underscoring the critical need for phase 3 randomized trials to validate this approach before it becomes a standard of care.