Surgeon Perspective on
Skin Cancer Medical Therapy

In collaboration with Sanofi,
the survey sought to:

Quantify referrals for medical therapy.
Understand the decision-making process for referrals.
‍
Eighteen surgeons and four dermatologists who treat mCSCC and laCSCC surgically responded with representation across Canada. Below are some key findings.

Patient volumes and rate of referral to medical therapy for CSCC subtypes

Majority of respondents have similar % of new patients with mCSCC and laCSCC. More patients with mCSCC were referred to a medical oncologist than those diagnosed with laCSCC.

Average % new patients in the last 3 months is 60% for mCSCC and 69% for laCSCC. The average # of patients referred to medical oncologists in the last 3 months is 63% for mCSCC and 41% for laCSCC.

Ranking factors in the decision to refer CSCC patients to medical therapy

Respondents ranked poor surgical or radiation candidacy as the top factor in referring to medical therapy. In follow up questions the patient’s age and frailty were identified as key factors in surgical candidacy. The characteristics of systemic therapy also ranked highly.

The highest ranked factor is 'the patient is a poor surgery or radiation candidate'. Second is systemic therapy can increase the success rate of subsequent surgeries. Third is systemic therapy results in less disfiguration than surgery. Fourth is systemic therapy is more tolerable than surgery. Fifth is there are additional surgical options at my disposal. The lowest ranked factor is 'the patient prefers systemic therapy vs. surgery.'

Ranking factors in the decision to not operate on CSCC patients

When asked about operating on CSCC patients, resectability was the top ranked factor in decisions to not operate.

The highest ranked factor is that the tumour is unresectable due to large tumour burden. Second, the tumour or metastasis is not possible (ie. there's lymph node involvement and is not resectable). Third is that surgery will cause major anatomical disfiguration. Lastly, the lowest ranking factor is that there is a high likelihood of recurrence after surgery.

Patient A:

Female
65-years old
Diagnosed with cutaneous squamous cell carcinoma

History:

Had a lesion on her right temple, which was cleared via Mohs procedure.
She was being followed by her head and neck surgeon, and
2 years post-excision, presented with a 3 cm ipsilateral parotid mass affecting the frontal branch of the facial nerve causing paralysis.

Majority, 59%, selected surgery. 32% selected medical therapy and 18% chose other.

All the ENT surgeon respondents selected surgery as the treatment for the patient profile. Plastic surgeons and dermatologists opted for surgery and medical therapy, with plastic surgeons showing more preference for surgery. Other therapies included radiation therapy and conducting more investigations.

All respondents were asked how much value a new medical therapy for CSCC, LIBTAYO, would provide for the patient case. It was seen as providing some value, with the dermatologist respondents seeing more.

As the treatment landscape for CSCC evolves, patients will benefit from inter disciplinary communication that raises the awareness of treatment options.

On a scale of 1 to 5, the value of LIBTAYO for patient A on average is 3.3 for respondents of the survey.

Scoring the value of LIBTAYO for the patient case:

Otolaryngologists: 2.9
Plastic Surgeons: 3.3
Dermatologists: 4.0

Surgeon Perspective on Skin Cancer Medical Therapy

In collaboration with Sanofi,the survey sought to: