Synchronous cutaneous Squamous Cell Carcinoma and Chronic lymphocytic leukemia: limits of innovative therapy concepts

Introduction:

Patients with chronic lymphocytic leukemia (CLL) have 5 times more risk to develop squamous cell carcinoma (SCC) because of immunsuppression. The forms of SCC are very aggressive with a high incidence of recurrence. The SCC is treated with local therapy (operation, radiation) and the CLL with systemic therapy (chemo- or immuntherapy). Tyrosine kinase inhibitors (BTKi) and immune checkpoint inhibitors (ICI) are increasingly used as a systemic therapy. Despite multimodal treatment the combination of the two diseases results often to recurrencies.

Case/Method:

A 81-year-old man with known CLL and a complete resected SCC of the skin on the head parietally presented with a tumor relapse on the left parietal area and new swollen lymph nodes on both sides of the neck. A neck dissection was performed. Histologically showed a manifestation of SCC and CLL. After presentation of the case in our interdisciplinary tumor conference, the patient was treated with resection of the tumor of the left parietal area, followed by adjuvant radiation therapy. Subsequently followed a therapy with the BTKi Ibrutinib for the CLL and Paclitaxel for the SCC. The patient showed a progression of the SCC. A treatment with the ICI Nivolumab was started. After 3 cycles, a relapse of the SCC appeared on the skin of the head in multiple areas. Another tumour resection and an electrochemotherapy were performed. Unfortunately, the CLL continued to progress, so that a concept of best supportive care was decided.

Results/Conclusions:

Patients with SCC and CLL have a higher risk of recurrency and a higher morbidity than the immuncompetent ones. Innovative therapy concepts, like ICIs, show an effect in 50% of advanced SCC but no effect in resistant CLL. New treatments should be evaluated.

Publication History

Publication Date:
23 April 2019 (online)