Squamous Cell Carcinoma — SCE Dermatology MCQ
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Correct answer: B — Cemiplimab (anti-PD-1)
Cemiplimab (anti-PD-1), option B, is the correct answer because it is the only systemic therapy with a specific NICE technology appraisal for advanced cutaneous SCC when curative surgery or curative radiotherapy is not suitable. NICE TA802 states that cemiplimab is recommended for metastatic or locally advanced cutaneous SCC in adults when curative surgery or curative radiotherapy is not suitable, given as a PD-1 checkpoint inhibitor that restores antitumour T-cell activity in a tumour type with a high mutational burden and strong immunogenicity. The stem's discriminator (unresectable, not amenable to radiotherapy) is precisely the licensed and NICE-appraised population for cemiplimab, distinguishing it from agents used in other skin cancers or SCCs at other sites. Why the other options are wrong: D. Cisplatin-based chemotherapy: platinum chemotherapy has historically been used off-label but NICE explicitly noted it is not routinely used for advanced unresectable cSCC in the NHS, and best supportive care, not chemotherapy, was the appraised comparator. E. Pembrolizumab: this anti-PD-1 agent lacks a UK NICE technology appraisal for cutaneous SCC; it is approved for other tumour types (eg melanoma, NSCLC) but not licensed or NICE-recommended for cSCC. C. Vismodegib: this hedgehog pathway inhibitor is licensed for basal cell carcinoma, not squamous cell carcinoma, reflecting a different oncogenic driver pathway. A. Cetuximab (anti-EGFR): although EGFR is often overexpressed in cSCC and cetuximab has been used historically in some centres, it has no NICE technology appraisal or UK licence specifically for advanced cSCC and is not first-line per current guidance. Key point: NICE TA802 makes cemiplimab the NICE-approved first-line systemic option specifically for metastatic or locally advanced cutaneous SCC unsuitable for curative surgery or radiotherapy, ahead of chemotherapy or other biologics.
Reference: NICE Technology Appraisal Guidance TA802, Cemiplimab for treating advanced cutaneous squamous cell carcinoma, published 29 June 2022, https://www.nice.org.uk/guidance/ta802