array:23 [
  "pii" => "S0365059623001836"
  "issn" => "03650596"
  "doi" => "10.1016/j.abd.2022.12.008"
  "estado" => "S300"
  "fechaPublicacion" => "2024-01-01"
  "aid" => "818"
  "copyright" => "Sociedade Brasileira de Dermatologia"
  "copyrightAnyo" => "2023"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "pt" => array:18 [
      "pii" => "S266627522300214X"
      "issn" => "26662752"
      "doi" => "10.1016/j.abdp.2023.08.003"
      "estado" => "S300"
      "fechaPublicacion" => "2024-01-01"
      "aid" => "818"
      "copyright" => "Sociedade Brasileira de Dermatologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "pt" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta &#8208; Terapia</span>"
        "titulo" => "Carcinoma espinocelular de pavilh&#227;o auricular irressec&#225;vel e com met&#225;stase locorregional&#58; relato do uso de cemiplimabe em paciente imunossuprimido"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "158"
            "paginaFinal" => "160"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1676
                "Ancho" => 2508
                "Tamanyo" => 471701
              ]
            ]
            "descripcion" => array:1 [
              "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Extensa les&#227;o tumoral acometendo pavilh&#227;o auricular e estruturas adjacentes&#46; &#40;B&#41; Les&#227;o cicatricial no pavilh&#227;o auricular ap&#243;s quatro meses de uso do cemiplimabe&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Tatiana Ferreira Fran&#231;a, Jo&#227;o Renato Vianna Gontijo, Eduardo Ferraz Veloso Junior, Enaldo Melo de Lima"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Tatiana Ferreira"
                "apellidos" => "Fran&#231;a"
              ]
              1 => array:2 [
                "nombre" => "Jo&#227;o Renato Vianna"
                "apellidos" => "Gontijo"
              ]
              2 => array:2 [
                "nombre" => "Eduardo Ferraz Veloso"
                "apellidos" => "Junior"
              ]
              3 => array:2 [
                "nombre" => "Enaldo Melo de"
                "apellidos" => "Lima"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0365059623001836"
          "doi" => "10.1016/j.abd.2022.12.008"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623001836?idApp=UINPBA00008Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S266627522300214X?idApp=UINPBA00008Z"
      "url" => "/26662752/0000009900000001/v1_202401040746/S266627522300214X/v1_202401040746/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "S036505962300212X"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2023.05.002"
    "estado" => "S300"
    "fechaPublicacion" => "2024-01-01"
    "aid" => "847"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Correspondence</span>"
      "titulo" => "Comment on &#8220;Elevation of transaminases after MMP&#174; session with methotrexate for alopecia areata treatment - how much do we know about the risks of systemic absorption of the technique&#63;&#8221;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "161"
          "paginaFinal" => "162"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1315
              "Ancho" => 1675
              "Tamanyo" => 438940
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0005"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Drug delivery with MMP&#174; technique&#46; This is a cross section of the reticular dermis demonstrating ink between the collagen fibers&#44; without bolus formation</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Samir Arbache, Sergio Henrique Hirata"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Samir"
              "apellidos" => "Arbache"
            ]
            1 => array:2 [
              "nombre" => "Sergio Henrique"
              "apellidos" => "Hirata"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275223002436"
        "doi" => "10.1016/j.abdp.2023.09.024"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223002436?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962300212X?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009900000001/v1_202401040817/S036505962300212X/v1_202401040817/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S0365059623002052"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2022.05.013"
    "estado" => "S300"
    "fechaPublicacion" => "2024-01-01"
    "aid" => "845"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter - Therapy</span>"
      "titulo" => "Successful treatment of erythrodermic pemphigus foliaceus with intravenous immunoglobulin"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "156"
          "paginaFinal" => "158"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1708
              "Ancho" => 2175
              "Tamanyo" => 312749
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0015"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Desquamation of the entire face before treatment&#46; &#40;B&#41; Complete resolution with therapy</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Hiram Larangeira de Almeida, Junior Wieczorek, Mahony Santana, Celina Leite"
          "autores" => array:4 [
            0 => array:3 [
              "nombre" => "Hiram Larangeira de"
              "apellidos" => "Almeida"
              "sufijo" => "Jr&#46;"
            ]
            1 => array:2 [
              "nombre" => "Junior"
              "apellidos" => "Wieczorek"
            ]
            2 => array:2 [
              "nombre" => "Mahony"
              "apellidos" => "Santana"
            ]
            3 => array:2 [
              "nombre" => "Celina"
              "apellidos" => "Leite"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275223002424"
        "doi" => "10.1016/j.abdp.2023.09.023"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223002424?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623002052?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009900000001/v1_202401040817/S0365059623002052/v1_202401040817/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter - Therapy</span>"
    "titulo" => "Unresectable auricular squamous cell carcinoma with locoregional metastasis&#58; use of cemiplimab in an immunosuppressed patient"
    "tieneTextoCompleto" => true
    "saludo" => "<span class="elsevierStyleItalic">Dear Editor&#44;</span>"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "158"
        "paginaFinal" => "160"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Tatiana Ferreira Fran&#231;a, Jo&#227;o Renato Vianna Gontijo, Eduardo Ferraz Veloso Junior, Enaldo Melo de Lima"
        "autores" => array:4 [
          0 => array:3 [
            "nombre" => "Tatiana Ferreira"
            "apellidos" => "Fran&#231;a"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "Jo&#227;o Renato Vianna"
            "apellidos" => "Gontijo"
            "email" => array:1 [
              0 => "joaorenatogontijo@gmail.com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Eduardo Ferraz Veloso"
            "apellidos" => "Junior"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Enaldo Melo de"
            "apellidos" => "Lima"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Dermatology Unity&#44; Hospital das C&#237;nicas&#44; Universidade Federal de Minas Gerais&#44; Belo Horizonte&#44; MG&#44; Brazil"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Hospital Mater Dei&#44; Belo Horizonte&#44; MG&#44; Brazil"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1676
            "Ancho" => 2508
            "Tamanyo" => 472890
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Extensive tumor affecting the auricular pinna and adjacent structures&#46; &#40;B&#41; Cicatricial lesion on the pinna after four months using cemiplimab&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 81-year-old male agricultural worker&#44; with hypertension complicated with nephropathy and renal transplantation in 2005&#44; using sirolimus&#44; was submitted to radiotherapy and hormone blockade therapy in 2017 for prostate cancer&#46; He had a past history of multiple basal cell carcinomas and squamous cell carcinomas &#40;SCCs&#41;&#46; He developed a moderately differentiated&#44; ulcerated&#44; and infiltrating SCC in the right auricular pinna &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; considered unresectable due to recurrence after four surgical interventions&#44; with involvement of the perichondrium&#44; cervical lymph nodes&#44; and salivary glands&#44; demonstrated by anatomopathological examination&#46; Screening for distant metastasis through PET-CT was negative&#44; and he was classified as T3N2bM1&#46; He received intravenous cemiplimab&#44; 350&#8239;mg every 21 days&#44; and 20 sessions of radiotherapy &#40;RT&#41;&#44; 20 fractions of 250 cGy&#44; a total dose of 50&#8239;Gy&#44; in the tumor and auricular pinna&#44; with complete involution of the neoplasm and regional involvement in four months &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#44; evaluated clinically and through a second PET-CT&#46; There were no adverse effects to the medication&#46; He evolved with progression of the prostate cancer&#44; confirmed by anatomopathological examination&#44; and died 14 months after the use of cemiplimab&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Around 5&#37; of SCCs are classified as advanced neoplasia when they present as locally advanced or metastatic and not amenable to curative surgery and&#47;or curative radiotherapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Until recently&#44; chemotherapy and epidermal growth factor receptor inhibitors were the only options available for these cases&#44; with low efficacy&#44; nonsustained response rates&#44; and various side effects&#44; being considered palliative treatments&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Cemiplimab is the first approved systemic treatment for SCC that improves survival&#46; This is a fully human anti-PD-1 IgG4 antibody&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> An indirect comparison of treatments concluded that it is the systemic therapy with the strongest evidence of clinical benefit for advanced cases and improved survival&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The high mutation burden present in SCCs from exposure to ultraviolet radiation has been associated with the effectiveness of PD-1 inhibition in several advanced solid neoplasms&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Furthermore&#44; the strong association between immunosuppression and tumor risk has suggested that immunosurveillance plays an important role in tumor control&#44; and approaches to enhance the anti-tumor immune system may be effective&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">PD-1 is a transmembrane inhibitory protein present in immune cells&#44; and blocking it increases the anti-tumor activity of T-cells&#44; promoting immunological control and the death of cancer cells&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">It is not possible to precisely determine the isolated effect of the PD-1 inhibitor in the case described herein&#44; due to the concomitant use of RT&#46; However&#44; there was resolution of enlarged cervical lymph nodes that were not irradiated&#44; possibly due to the medication effect&#46; In phase 2 studies with patients with locally advanced SCC&#44; 55&#37; of them also underwent radiotherapy prior to starting the medication&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The advent of new drugs for the treatment of cutaneous neoplasms has shown promising results&#44; with evidence of clinically significant effects&#44; acceptable safety&#44; and tolerability profile in patients with advanced SCC who are not candidates for surgery or RT&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Long-term studies including immunosuppressed patients are required to assess the outcomes in these patients and to determine the efficacy and side effects of cemiplimab in this population&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Tatiana Ferreira Fran&#231;a&#58; Drafting and editing of the manuscript&#59; critical review of important intellectual content and approval of the final version of the manuscript&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Jo&#227;o Renato Vianna Gontijo&#58; Intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; drafting and editing of the manuscript&#59; critical review of important intellectual content and approval of the final version of the manuscript&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Eduardo Ferraz Veloso Junior&#58; Intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; drafting and editing of the manuscript&#59; critical review of important intellectual content and approval of the final version of the manuscript&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Enaldo Melo de Lima&#58; Intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; drafting and editing of the manuscript&#59; critical review of important intellectual content and approval of the final version of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:4 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Financial support"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Authors&#39; contributions"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conflicts of interest"
        ]
        3 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-10-06"
    "fechaAceptado" => "2022-12-29"
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#8902;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Hospital Mater Dei&#44; Belo Horizonte&#44; MG&#44; Brazil&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1676
            "Ancho" => 2508
            "Tamanyo" => 472890
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Extensive tumor affecting the auricular pinna and adjacent structures&#46; &#40;B&#41; Cicatricial lesion on the pinna after four months using cemiplimab&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cemiplimab in locally advanced cutaneous squamous cell carcinoma&#58; results from an open-label&#44; phase 2&#44; single-arm trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;R&#46; Migden"
                            1 => "N&#46;I&#46; Khushalani"
                            2 => "A&#46;L&#46;S&#46; Chang"
                            3 => "K&#46;D&#46; Lewis"
                            4 => "C&#46;D&#46; Schmults"
                            5 => "L&#46; Hernandez-Aya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1470-2045(19)30728-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Oncol"
                        "fecha" => "2020"
                        "volumen" => "21"
                        "paginaInicial" => "294"
                        "paginaFinal" => "305"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31952975"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "PD-1 blockade with cemiplimab in advanced cutaneous squamous-cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;R&#46; Migden"
                            1 => "D&#46; Rischin"
                            2 => "C&#46;D&#46; Schmults"
                            3 => "A&#46; Guminski"
                            4 => "A&#46; Hauschild"
                            5 => "K&#46;D&#46; Lewis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1805131"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2018"
                        "volumen" => "379"
                        "paginaInicial" => "341"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29863979"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Review of indications of FDA-approved immune checkpoint inhibitors per NCCN guidelines with the level of evidence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46;K&#46; Vaddepally"
                            1 => "P&#46; Kharel"
                            2 => "R&#46; Pandey"
                            3 => "R Garje"
                            4 => "A&#46;B&#46; Chandra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cancers &#40;Basel&#41;"
                        "fecha" => "2020"
                        "volumen" => "12"
                        "paginaInicial" => "738"
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673608604237"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparative efficacy of cemiplimab versus other systemic treatments for advanced cutaneous squamous cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Keeping"
                            1 => "Y&#46; Xu"
                            2 => "C&#46;I&#46; Chen"
                            3 => "S&#46; Cope"
                            4 => "A&#46; Mojebi"
                            5 => "A&#46; Kuznik"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2217/fon-2020-0823"
                      "Revista" => array:6 [
                        "tituloSerie" => "Future Oncol"
                        "fecha" => "2021"
                        "volumen" => "17"
                        "paginaInicial" => "611"
                        "paginaFinal" => "627"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33052055"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Real world data of cemiplimab in locally advanced and metastatic cutaneous squamous cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Baggi"
                            1 => "P&#46; Quaglino"
                            2 => "M&#46; Rubatto"
                            3 => "R&#46; Depenni"
                            4 => "M&#46; Guida"
                            5 => "P&#46;A&#46; Ascierto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejca.2021.08.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cancer"
                        "fecha" => "2021"
                        "volumen" => "157"
                        "paginaInicial" => "250"
                        "paginaFinal" => "258"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34536948"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/03650596/0000009900000001/v1_202401040817/S0365059623001836/v1_202401040817/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "96904"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letter &#8211; Therapy"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009900000001/v1_202401040817/S0365059623001836/v1_202401040817/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623001836?idApp=UINPBA00008Z"
]
Share
Journal Information
Vol. 99. Issue 1.
Pages 158-160 (1 January 2024)
Visits
3511
Vol. 99. Issue 1.
Pages 158-160 (1 January 2024)
Letter - Therapy
Full text access
Unresectable auricular squamous cell carcinoma with locoregional metastasis: use of cemiplimab in an immunosuppressed patient
Visits
3511
Tatiana Ferreira Françaa, João Renato Vianna Gontijoa,b,
Corresponding author
joaorenatogontijo@gmail.com

Corresponding author.
, Eduardo Ferraz Veloso Juniorb, Enaldo Melo de Limab
a Dermatology Unity, Hospital das Cínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
b Hospital Mater Dei, Belo Horizonte, MG, Brazil
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Full Text
Dear Editor,

An 81-year-old male agricultural worker, with hypertension complicated with nephropathy and renal transplantation in 2005, using sirolimus, was submitted to radiotherapy and hormone blockade therapy in 2017 for prostate cancer. He had a past history of multiple basal cell carcinomas and squamous cell carcinomas (SCCs). He developed a moderately differentiated, ulcerated, and infiltrating SCC in the right auricular pinna (Fig. 1A), considered unresectable due to recurrence after four surgical interventions, with involvement of the perichondrium, cervical lymph nodes, and salivary glands, demonstrated by anatomopathological examination. Screening for distant metastasis through PET-CT was negative, and he was classified as T3N2bM1. He received intravenous cemiplimab, 350 mg every 21 days, and 20 sessions of radiotherapy (RT), 20 fractions of 250 cGy, a total dose of 50 Gy, in the tumor and auricular pinna, with complete involution of the neoplasm and regional involvement in four months (Fig. 1B), evaluated clinically and through a second PET-CT. There were no adverse effects to the medication. He evolved with progression of the prostate cancer, confirmed by anatomopathological examination, and died 14 months after the use of cemiplimab.

Figure 1.

(A) Extensive tumor affecting the auricular pinna and adjacent structures. (B) Cicatricial lesion on the pinna after four months using cemiplimab.

(0.45MB).

Around 5% of SCCs are classified as advanced neoplasia when they present as locally advanced or metastatic and not amenable to curative surgery and/or curative radiotherapy.1,2 Until recently, chemotherapy and epidermal growth factor receptor inhibitors were the only options available for these cases, with low efficacy, nonsustained response rates, and various side effects, being considered palliative treatments.1

Cemiplimab is the first approved systemic treatment for SCC that improves survival. This is a fully human anti-PD-1 IgG4 antibody.3 An indirect comparison of treatments concluded that it is the systemic therapy with the strongest evidence of clinical benefit for advanced cases and improved survival.4

The high mutation burden present in SCCs from exposure to ultraviolet radiation has been associated with the effectiveness of PD-1 inhibition in several advanced solid neoplasms.1,2 Furthermore, the strong association between immunosuppression and tumor risk has suggested that immunosurveillance plays an important role in tumor control, and approaches to enhance the anti-tumor immune system may be effective.1

PD-1 is a transmembrane inhibitory protein present in immune cells, and blocking it increases the anti-tumor activity of T-cells, promoting immunological control and the death of cancer cells.3

It is not possible to precisely determine the isolated effect of the PD-1 inhibitor in the case described herein, due to the concomitant use of RT. However, there was resolution of enlarged cervical lymph nodes that were not irradiated, possibly due to the medication effect. In phase 2 studies with patients with locally advanced SCC, 55% of them also underwent radiotherapy prior to starting the medication.1

The advent of new drugs for the treatment of cutaneous neoplasms has shown promising results, with evidence of clinically significant effects, acceptable safety, and tolerability profile in patients with advanced SCC who are not candidates for surgery or RT.5 Long-term studies including immunosuppressed patients are required to assess the outcomes in these patients and to determine the efficacy and side effects of cemiplimab in this population.

Financial support

None declared.

Authors' contributions

Tatiana Ferreira França: Drafting and editing of the manuscript; critical review of important intellectual content and approval of the final version of the manuscript.

João Renato Vianna Gontijo: Intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; drafting and editing of the manuscript; critical review of important intellectual content and approval of the final version of the manuscript.

Eduardo Ferraz Veloso Junior: Intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; drafting and editing of the manuscript; critical review of important intellectual content and approval of the final version of the manuscript.

Enaldo Melo de Lima: Intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; drafting and editing of the manuscript; critical review of important intellectual content and approval of the final version of the manuscript.

Conflicts of interest

None declared.

References
[1]
M.R. Migden, N.I. Khushalani, A.L.S. Chang, K.D. Lewis, C.D. Schmults, L. Hernandez-Aya, et al.
Cemiplimab in locally advanced cutaneous squamous cell carcinoma: results from an open-label, phase 2, single-arm trial.
Lancet Oncol, 21 (2020), pp. 294-305
[2]
M.R. Migden, D. Rischin, C.D. Schmults, A. Guminski, A. Hauschild, K.D. Lewis, et al.
PD-1 blockade with cemiplimab in advanced cutaneous squamous-cell carcinoma.
N Engl J Med, 379 (2018), pp. 341-351
[3]
R.K. Vaddepally, P. Kharel, R. Pandey, R Garje, A.B. Chandra.
Review of indications of FDA-approved immune checkpoint inhibitors per NCCN guidelines with the level of evidence.
Cancers (Basel), 12 (2020), pp. 738
[4]
S. Keeping, Y. Xu, C.I. Chen, S. Cope, A. Mojebi, A. Kuznik, et al.
Comparative efficacy of cemiplimab versus other systemic treatments for advanced cutaneous squamous cell carcinoma.
Future Oncol, 17 (2021), pp. 611-627
[5]
A. Baggi, P. Quaglino, M. Rubatto, R. Depenni, M. Guida, P.A. Ascierto, et al.
Real world data of cemiplimab in locally advanced and metastatic cutaneous squamous cell carcinoma.
Eur J Cancer, 157 (2021), pp. 250-258

Study conducted at the Hospital Mater Dei, Belo Horizonte, MG, Brazil.

Copyright © 2023. Sociedade Brasileira de Dermatologia
Download PDF
Idiomas
Anais Brasileiros de Dermatologia
Article options
Tools
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.