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Risk of second primary cancers in male breast cancer survivors (November 2022)

The risks for second primary cancers among male breast cancer survivors is being evaluated. In one study that included data from over 10,000 male breast cancer survivors, the standardized incidence ratio (SIR) of a second primary cancer, relative to healthy male controls, was 1.3; specifically, there were increased risks of colorectal (SIR 1.3), pancreatic (SIR 1.6), and thyroid (SIR 5.6) cancer [1]. Male breast cancer survivors should engage in cancer screening according to age, family history, and genetic risk factors, if present.

Neoadjuvant pembrolizumab for high-risk, node-positive melanoma (November 2022)

For patients with high-risk node-positive (Stage IIIB, IIIC, IIID) melanoma, neoadjuvant immunotherapy was effective in phase I and II trials, but randomized studies comparing this approach with adjuvant immunotherapy, the standard of care, were previously lacking. In a phase III trial of over 300 patients with resectable macroscopic stage IIIB-IV melanoma, neoadjuvant pembrolizumab improved two-year event-free survival (72 versus 49 percent) compared with primary surgical resection followed by adjuvant pembrolizumab [2]. Overall survival data are not mature. Based on these data, for patients with high-risk node-positive (stage IIIB, IIIC, IIID) melanoma and macroscopic disease that is resectable, we suggest initial therapy with neoadjuvant pembrolizumab rather than primary surgery.

Preoperative chemotherapy in bilateral Wilms tumor (November 2022)

Studies are investigating the strategy of preoperative chemotherapy followed by kidney parenchymal-sparing resection for patients with bilateral Wilms tumor. In long-term follow-up of a single arm, prospective study in almost 200 patients with bilateral Wilms tumor, this strategy was associated with a four-year overall survival rate of 95 percent [3]. It was greater for those with low-risk disease, intermediate-risk disease, and blastemal-type tumors than for those with high-risk diffuse anaplasia (>90 versus 72 percent). Fewer than 3 percent of patients required bilateral nephrectomy. For patients with bilateral Wilms tumor, we continue to suggest preoperative chemotherapy followed by kidney parenchymal-sparing resection rather than more extensive bilateral kidney resection.

Neoadjuvant cemiplimab for cutaneous squamous cell carcinoma (October 2022)

For patients with locally advanced cutaneous squamous cell carcinoma (SCC), the efficacy of neoadjuvant immunotherapy was not previously established. In a study of approximately 80 patients with resectable stage II, III, or IV cutaneous SCC, neoadjuvant cemiplimab followed by surgery resulted in a pathologic complete response rate of 51 percent and objective response rate of 68 percent [4]. It also reduced surgical morbidity in some patients (eg, orbital sparing). Based on these data, for patients with resectable cutaneous SCC at risk for significant surgical morbidity or disfigurement, we suggest neoadjuvant cemiplimab followed by surgery rather than surgery alone.

Breast implant-associated cancer (October 2022)

Breast implant-associated malignancies are rare, with most concern related to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The US Food and Drug Administration and the American Society of Plastic Surgery have recently focused on breast implant-associated squamous cell cancer (BIA-SCC), which can also occur in the capsule surrounding the implant [5]. Clinical features of BIA-SCC that differ from BIA-ALCL include its longer average time to onset after implantation, more aggressive behavior, and higher mortality. BIA-SCC is also associated with either smooth or textured implants, whereas BIA-ALCL is predominantly associated with textured implants. When treating patients who have late-onset peri-implant changes, seroma, or mass, it is essential to consider the possibility of BIA-SCC in addition to BIA-ALCL.

1. Allen I, Hassan H, Sofianopoulou E, et al. Risk of developing a second primary cancer in male breast cancer survivors: a systematic review and meta-analysis. Br J Cancer. 2022;127(9):1660. Epub 2022 Sep 17.

2. Patel S, Othus M, Prieto V, et al. LBA6 - Neoadjvuant versus adjuvant pembrolizumab for resected stage III-IV melanoma (SWOG S1801). Ann Oncol. 2022;33;7S.

3. Chintagumpala MM, Perlman EJ, Tornwall B, et al. Outcomes based on histopathologic response to preoperative chemotherapy in children with bilateral Wilms tumor: A prospective study (COG AREN0534). Cancer. 2022;128(13):2493. Epub 2022 Apr 5.

4. Gross ND, Miller DM, Khushalani NI, et al. Neoadjuvant Cemiplimab for Stage II to IV Cutaneous Squamous-Cell Carcinoma. N Engl J Med. 2022;387(17):1557. Epub 2022 Sep 12.

5. American Society of Plastic Surgeons statement on breast cancer-associated squamous cell carcinoma. 09/08/2022. https://www.plasticsurgery.org/for-medical-professionals/publications/psn-extra/ (Accessed on October 24, 2022).

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