Samuel, R; Samson, A; Gilbert, DC; (2023) Improving Outcomes with Chemoradiotherapy in the Mucosal Squamous Cell Carcinomas – Immune Checkpoint Inhibition and Broken Promises. Clinical Oncology 10.1016/j.clon.2023.09.003. (In press).

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Abstract

Cancers arising at mucosal surfaces include cancers of worldwide significance: cancer of the cervix and head and neck squamous cell carcinomas (HNSCC), which comprise 20% of cancers in India [1], anal squamous cell cancer (ASCC; rising in incidence in high-income countries) and rare tumours where evidence-based approaches to treatment are limited (vulval, vaginal and penile cancers). They share biology and epidemiology, associated with high-risk subtypes of human papillomaviruses (HPV) [2] or chronic inflammation and tobacco exposure. They typically present with locally advanced disease and are treated with radical chemoradiotherapy (CRT) as they are relatively radio-sensitive and surgery brings significant morbidity and mortality (e.g. colostomy or tracheostomy). Relapses are not infrequent in patients presenting with locally advanced disease, typically at the primary site, although metastatic disease is increasingly seen. Although comprehensive prophylactic HPV vaccination and tobacco control programmes would be expected to significantly reduce their incidence (and vaccines are in development to help patients already affected with HPV [3]), incidence is likely to increase over the next 20 years before a reduction is seen. Improving outcomes for the locally advanced mucosal SCCs then presents a major challenge of global importance.

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