Cutaneous Squamous Cell Carcinoma Medication

Updated: Oct 11, 2017
  • Author: Talib Najjar, DMD, MDS, PhD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Medication

Medication Summary

Nonsurgical management for cutaneous squamous cell carcinoma (SCC) includes the use of systemic and topical chemotherapy. Various topical agents are used to treat patients with a history of extensive sun exposure or actinic keratosis and SCC in situ. The addition of chemotherapy to radiotherapy may also be beneficial in improving survival in squamous cell carcinoma of the head and neck but it is associated with adverse effects.

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Antineoplastics, Topical

Class Summary

Nonsurgical options for the treatment of cSCC include topical chemotherapy and topical immune response modifiers. The use of topical therapy and photodynamic therapies is generally limited to actinic keratoses and in situ lesions.

Fluorouracil topical (Efudex, Carac, Fluoroplex)

5-Fluorouracil (5-FU) is a classic antimetabolite anticancer drug with a chemical structure similar to endogenous intermediates or building blocks of DNA or RNA synthesis. This agent inhibits tumor cell growth through at least 3 different mechanisms that ultimately disrupt DNA synthesis or cellular viability. Topical 5-FU is approved for the treatment of multiple actinic or solar keratoses.

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Antineoplastics, EGFR Inhibitor

Class Summary

Multiple chemotherapeutic agents have been used to treat metastatic cSCC. Adaptation of traditional chemotherapeutics to local and regional administration techniques in treating head and neck cancers is being actively pursued to provide higher local concentrations of otherwise systemically toxic drugs.

Cetuximab (Erbitux)

Cetuximab is approved for the initial treatment of locally or regionally advanced SCC of the head and neck. Cetuximab when used alone is indicated for the treatment of recurrent or metastatic cases for which prior platinum-based therapy has failed. It is a chimeric immunoglobulin G1 monoclonal antibody that inhibits EGFRs and has been reported as successful in several case reports.

EGFR inhibitors are well tolerated, with relatively low risks, so they may be considered in cases not amenable to surgery or radiation or as an adjuvant in cases that pose a high risk of death. Current recommendations are to use cetuximab as an alternative to chemotherapy in patients who cannot tolerate chemotherapy.

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Topical Skin Products

Class Summary

The use of topical and photodynamic therapies is generally limited to actinic keratoses and in situ lesions.

Imiquimod (Aldara, Zyclara)

Imiquimod is approved by the FDA for the treatment of genital warts, actinic keratoses, and superficial basal cell carcinoma (BCC). This agent is an imidazoquinoline that enhances cell-mediated immune responses via the induction of proinflammatory cytokines; that is, it up-regulates interferon and other cytokines.

Diclofenac topical (Solaraze)

Diclofenac gel is approved by the FDA for the treatment of actinic keratoses. It is applied to lesion areas twice a day for 60-90 days.

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Antineoplastics, Alkylating

Class Summary

Cisplatin is another chemotherapeutic drug of choice for metastatic cSCC. Although this agent is one of the most successful in the treatment of cancer, it produces major toxicities to normal cells and organs at the concentrations necessary for effective treatment of malignancies.

Cisplatin (Platinol, Platinol AQ, CDDP)

Cisplatin is a platinum coordination compound that inhibits DNA synthesis, cross-links and denatures strands of DNA, and disrupts DNA function by covalently binding to DNA bases. It can also produce DNA intrastrand cross-linking and breakage. It has been used in the treatment of SCC of the head and neck.

Combination chemoradiotherapy using cisplatin and concurrent radiation treatment has improved locoregional control in locally advanced SCC. Chemoradiotherapy is now considered the standard of care in locally advanced disease following surgical resection, as well as in unresectable disease. Cisplatin-based combination chemotherapy with 5-FU, methotrexate, bleomycin, and doxorubicin all have been used to treat advanced SCC, with variable outcomes.

Carboplatin (Paraplatin)

Carboplatin is an analogue of cisplatin. This is a heavy-metal coordination complex that exerts its cytotoxic effect by platination of DNA, a mechanism analogous to alkylation, leading to interstrand and intrastrand DNA cross-links and inhibition of DNA replication. Carboplatin binds to protein and other compounds containing the SH group. It has been used in the treatment of advanced and recurrent head and neck SCC.

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Antineoplastics, Antimicrotubular

Class Summary

Antimicrotubular therapy may be used as part of combination therapy in patients with SCC.

Docetaxel (Taxotere)

Docetaxel is a semisynthetic taxane, a class of drugs that inhibits cancer cell growth by promoting assembly and blocking the disassembly of microtubules, thereby preventing cancer cell division and causing cell death. It is indicated in combination with cisplatin and 5-FU for induction therapy of locally advanced SCC of the head and neck before patients undergo chemoradiotherapy and surgery.

Paclitaxel

Paclitaxel is an antimicrotubule agent. Its mechanism of action includes tubulin polymerization and microtubule stabilization, which, in turn, inhibit mitosis and may result in breakage of chromosomes. It is used off-label in SCC of the head and neck.

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Antineoplastics, Antimetabolite

Class Summary

Antimetabolite therapy may be used as part of combination therapy in patients with SCC.

Methotrexate (Trexall)

Methotrexate is an antimetabolite that inhibits dihydrofolate reductase, thereby hindering DNA synthesis and cell reproduction in malignant cells. It has been used in combination with other chemotherapeutic agents for the treatment of cancers of the head and neck.

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Antineoplastics, Antibiotic

Class Summary

Bleomycin is used as palliative treatment of head and neck SCC.

Bleomycin

Bleomycin is a cytotoxic glycopeptide antibiotic whose main mechanism of action may include inhibition of DNA synthesis and possible inhibition of ribonucleic acid (RNA) and protein synthesis.

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