Learning Objectives

  • To review immunotherapeutic strategies in cutaneous oncology
  • Provide an overview of relevant immune therapies in skin cancer
  • Discuss relevant immune pathways


Advisory/Consultant Roles

  • Pfizer
  • Merck Sharpe & Dome
  • Merck KGaA/EMD Serono
  • Sanofi Genzyme
  • Regeneron
  • Checkpoint Therapeutics
  • Castle Biosciences
  • Incyte Corporation
  • Bristol Myers Squib


  • Checkpoint Therapeutics
  • Avstera Therapeutics Corp


  • Regeneron
  • Kartos Therapeutics
  • NeoImmuneTech
  • Xilio Therapeutics Inc

Pre-Lecture Quiz

  • Take out cell phone
  • Open text message app

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Overview of Immunotherapy

  • The term “Immunotherapy” represents a set of therapeutic strategies designed to enhance anti-tumor immunity
  • The approach dates back, at least, to 1891 when William B. Coley, a sarcoma surgeon at Memorial Hospital in New York, injected strepotococcal organisms into a patient with inoperable cancer

Current IO Strategies

  • Today, a variety of approaches exist, for example:

    • Cytokine-directed therapy
    • TLR agonism
    • Immune-checkpoint blockade
    • Oncolytic viral therapy
    • Bispecific T-cell engagers
    • Chimeric Antigen Receptor (CAR) T cells
    • Tumor-Infiltrating Lymphocytes (TILs)

Immunotherapy in Skin Cancer

Case HPI

  • Male in the 8th decade of life
  • Presents with a 2.8 cm poorly differentiated peri-orbital CSCC

Case Work Up

  • Outside PET-CT showed no evidence of regional or metastatic disease

How would you manage this patient?

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Let’s Review

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Case - HPI

  • 71-year-old Fitzpatrick skin type 2 male with no significant PMH presents with this lesion on his chest x 3 months

Case - Work Up

  • Excisional biopsy performed.
  • Pathology revealed a 4.1 mm thick, non-ulcerated, superficial spreading melanoma. Mitotic rate 9 per mm2. LVI present. Tumor infiltrating lymphocytes present, non-brisk. No microsatelites.
  • Subsequent PET-CT and brain MRI demonstrated no regional or distant metastases.

Case - Management

  • WLE with 2 cm margins
    • no tumor on ink
  • SLNBx with 0/2 nodes positive
  • BRAF Wild Type
  • Stage ?
    • 4.1 mm thick
    • no ulceration
    • Neg SLNBx
    • No mets
    • Stage IIB (T4aN0M0)
  • Prognosis (10 year MSS)?
    • T4aN0M0: 83%
    • T3bN0M0: 81%










What are your next steps in management?

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  • Immunotherapy is a term that encompasses several therapeutic strategies that utilize the immune system as a therapy against cancer
  • In skin cancer, the most relevant immunotherapeutic strategies in 2022 include:

IO in Skin Cancer

IO Mechanism Examples
Checkpoint Inhibition CTLA-4: Ipilimumab
PD-1: Pembrolizumab, Nivolumab, Cemiplimab, Retifanlimab
PD-L1: Avelumab, Atezolizumab
LAG-3: Relatlimab
Bispecific T-cell engagers Tebentafusp
Oncolytic Viruses Talimogene laherparepvec
Cytokine Therapy Interferon Alfa-2a, Interferon Alfa-2b, Interleukin-2
TLR Agonism Imiquimod

Post Lecture Quiz

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