Advancements in Skin Cancer Treatment Using Immunotherapy

One in five Americans will develop skin cancer in their lifetime. Skin cancer affects 5.4 million people each year, and that number continues to grow. In 2023, it was estimated to be about 97,610 new cases, 7,990 of which would result in death [1]. Skin cancer is one of the deadliest cancers, which generally develops in middle-aged adults and is most frequently diagnosed in those aged 65-74. There are four types of skin cancer: Basal cell Carcinoma (BCS), Squamous cell Carcinoma (SCC), Melanoma, and Merkel-Cell Carcinoma (MCC). Basal cell Carcinoma is the most common type of skin cancer and the least dangerous. Squamous cell Carcinoma is generally common and tends to spread. Melanoma is the most well-known skin cancer and can spread incredibly quickly. Lastly, Merkel-Cell Carcinoma is a less common yet highly aggressive type of skin cancer. Early stages of skin cancer, or unregulated cell division, much like various other types of cancers, are often treatable and reversible using surgeries and treatments. Radiation therapy and chemotherapy both take a heavy toll on individuals receiving those treatments. In many ways, immunotherapy is more effective and is the superior alternative to other therapies.

Immunotherapy is a treatment where doctors attempt to alter someone’s immune system to fight a disease, most commonly cancer. It teaches the immune system to recognize cancer cells and kill them. Immunotherapy can kill cancer cells while leaving normal cells unharmed. It can also boost the immune system to find and kill even more cancer cells. Immunotherapy is mainly used to treat advanced cancers that have not responded to any other types of treatment or recurrent cancer. Immunotherapy has been widely used; however, its implications for skin cancer are more recent. First, immune checkpoint inhibitors target and inhibit checkpoints on the immune cells. By blocking the checkpoints, immunotherapy can teach the immune system to differentiate the cancerous cells from the normal immune ones.

Immunotherapy can also administer cytokines to induce the immune system’s response. In addition to blocking immune checkpoints, PD-1 also needs to be stopped. Programmed Cell Death Protein 1 (PD-1) inhibits immune responses using white blood cells (T-cells) [5]. Immunotherapy can be administered intravenously (IV), orally in a pill or capsule, topically as a cream, or intravesically through the bladder. Lastly, it can be injected into tumors [3].

Immunotherapy seems to be the more commonly chosen alternative for therapies to treat cancer, including chemotherapy. Chemotherapy is more often used for cancer, as it is a very aggressive treatment method. It can weaken the patient and kill other types of cells besides cancer cells, such as hair and somatic cells. This occurs because chemotherapy attacks rapid cell growth, which is often cancerous; however, rapid cell proliferation is found in hair follicles.

Chemotherapy attacks cancerous cells and tumors; immunotherapy stimulates the immune system to work diligently to fight cancer independently. While both therapies have proven effective at killing cancerous cells, chemotherapy has significantly more limitations. These limitations are more bodily, such as fatigue, nausea, and pain. One of immunotherapy’s most prominent restrictions is its expense. Compared to chemotherapy, it has no severe side effects on individuals, leading to the exorbitant treatment cost [4].

However, recent research has concluded that a combination approach of using both chemotherapy and immunotherapy would be the most effective treatment for fighting cancer [2]. Both immunotherapy and chemotherapy have their benefits and limitations; however, combining them is the most effective solution since it can remedy them. Using a combination would boost the efficacy of cancer treatment by simultaneously targeting cancer cells through chemotherapy and strengthening the immune system’s ability to fight cancer through immunotherapy [2]. A combination approach could also reduce the overall cost of both therapies as only certain aspects of each treatment are used, not the entire treatment plan. Therefore, a two-pronged therapy plan that combines immunotherapy and chemotherapy would not only be cost-effective but also be the superior option for the patient’s overall well-being.

References

1. Apalla, Zoe, et al. “Skin Cancer: Epidemiology, Disease Burden, Pathophysiology, Diagnosis, and Therapeutic Approaches.” Dermatology and Therapy, vol. 7, no. Suppl 1, Feb. 2017, pp. 5–19. PubMed Central, https://doi.org/10.1007/s13555-016-0165-y.

2. Bailly, Christian, et al. “Combined Cytotoxic Chemotherapy and Immunotherapy of Cancer: Modern Times.” NAR Cancer, vol. 2, no. 1, Mar. 2020, p. zcaa002. DOI.org (Crossref), https://doi.org/10.1093/narcan/zcaa002.

3. Kang, Alison, et al. “Updates on Immunotherapy for the Treatment of Skin Cancer.” Current Dermatology Reports, vol. 7, no. 4, Dec. 2018, pp. 311–20. Springer Link, https://doi.org/10.1007/s13671-018-0246-5.

4. Khayyati Kohnehshahri, Mahsa, et al. “Current Status of Skin Cancers with a Focus on Immunology and Immunotherapy.” Cancer Cell International, vol. 23, no. 1, Aug. 2023, p. 174. Springer Link, https://doi.org/10.1186/s12935-023-03012-7.

5. “Melanoma of the Skin - Cancer Stat Facts.” SEER, https://seer.cancer.gov/statfacts/html/melan.html. Accessed 7 Feb. 2024.