Co esponding au ho : Se ge Emmanuel Bambule
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
Ce uximab-based managemen o me as a ic cu aneous squamous cell ca cinoma in a
hea ansplan ecipien : A case epo and li e a u e e iew
Se ge Emmanuel Bambule 1, 2. *, F ancia Holguin 3, Hube Pheulpin 3, Pie e Zuech 3, La isa Ma ano schi 3,
Gab iela Tossen 3 and Ge aldine Salme on 3
1 Medical Oncology depa men , Facul y o Medicine and Pha macy o Casablanca, Mo occo.
2 In e nal Medicine depa men , Facul y o Medicine, Uni e si y o Kinshasa, DRC.
3 Hema ology and Medical Oncology depa men , Poissy In e communal Hospi al Cen e , F ance.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 812-817
Publica ion his o y: Recei ed on 06 July 2025; e ised on 09 Augus ; accep ed on 12 Augus 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.2.2931
Abs ac
Backg ound: Solid o gan ansplan ecipien s ace a highe isk o cu aneous squamous cell ca cinoma (cSCC) due o
long- e m immunosupp ession. Managing me as a ic cSCC in hese pa ien s is challenging because immune checkpoin
inhibi o s (ICIs) may cause g a ejec ion.
Case P esen a ion: A 67-yea -old male hea ansplan ecipien de eloped mul iple cSCCs wi h lung me as ases
du ing his illness. A e su ge y and adio he apy, disease p og ession p omp ed sys emic he apy wi h ca bopla in and
ce uximab. The pa ien achie ed a comple e me abolic esponse a e se en cycles, wi h no g a ejec ion o se e e side
e ec s. Ce uximab main enance he apy sus ained he esponse.
Conclusion: Ce uximab o e s a sa e and e ec i e ea men o ad anced cSCC in hea ansplan ecipien s, a oiding
he isks o ICIs. This case shows ha Ce uximab can be a good al e na i e ea men .
Keywo ds: Cu aneous squamous cell ca cinoma; Hea ansplan a ion; Immunosupp ession; Ce uximab
1. In oduc ion
Hea ansplan a ion imp o es su i al in pa ien s wi h end-s age hea disease, bu long- e m immunosupp ession
inc eases he isk o cance s, especially cu aneous squamous cell ca cinoma (cSCC). cSCC accoun s o app oxima ely
10% o cases in hea ansplan ecipien s and is o en mo e agg essi e, wi h a highe chance o me as asis compa ed
o he gene al popula ion [1]. These umo s commonly occu on he head and neck[2] . Immune checkpoin inhibi o s
(ICIs), a e e ec i e in non- ansplan pa ien s, a e isky o ansplan ecipien s due o po en ial g a ejec ion[3–5].
Ce uximab, an an i-EGFR monoclonal an ibody, is a p omising al e na i e, bu i s use in hea ansplan pa ien s is no
well s udied. This case epo desc ibes a hea ansplan ecipien wi h me as a ic cSCC success ully ea ed wi h
ce uximab, demons a ing a ailo ed ea men app oach.
2. Case p esen a ion
A 67-yea -old male, wi h no his o y o smoking, alcohol use, o amily cance , unde wen hea ansplan a ion in 2021
o end-s age ischemic ca diomyopa hy. He was main ained on ac olimus (6 mg/day, mycophenola e mo e il (500
mg/day), and p ednisone (5 mg/day). In May 2022, ac inic ke a oses on his o ehead and e ex we e ea ed wi h
pho odynamic he apy and c yo he apy, wi h egula de ma ological ollow-up.
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813
In Oc obe 2022, h ee exophy ic, ulce a i e lesions appea ed on he le o ehead, le e ex, and igh w is . (Figu e
1)
Figu e 1 Ulce a i e, and exophy ic skin lesion loca ed on he do sal aspec o he igh w is
Biopsies con i med well-di e en ia ed cSCC, s aged pe he 8 h AJCC edi ion:
• Righ w is : pT2 R0, no ascula emboli o pe ineu al in asion
• Le e ex: pT2 R1 (deep ma gin), pe ineu al in asion p esen .
• Le o ehead: pT1 R0, ascula emboli and pe ineu al in asion p esen s.
In Janua y 2023, su gical excision and local lap econs uc ion we e pe o med. In aope a i e ine needle aspi a ion
o a le ce ical lymph node showed me as a ic cSCC. A PET-CT in Ma ch 2023 e ealed hype me abolic le ce ical
lymphadenopa hy (le el Va) and a pos su gical in lamma o y on al ocus. Re-excision o he e ex lesion and lymph
node dissec ion (15 nodes) con i med me as a ic sp ead wi h capsula up u e. Adju an ce ical adio he apy (69.96
Gy in 33 ac ions) was gi en om May o June 2023.
In Janua y 2024, PET-CT de ec ed h ee bila e al pleu opulmona y nodules (12 mm igh uppe lobe, 10 mm le uppe
lobe, 19 mm igh lowe lobe) ( igu e 2 and igu e 3), ea ed wi h s e eo ac ic adio he apy in Ma ch 2024.
Figu e 2 Hype me abolic pulmona y nodule o 19 mm in igh lowe lobe
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 812-817
814
Figu e 3 Hype me abolic pulmona y nodule nodule o 12 mm in igh uppe lobe
In Oc obe 2024, a new 15 mm le lowe lobe nodule and igh basal condensa ion (SUVmax 2.9) appea ed. (Figu e 4)
Figu e 4 hype me abolic pulmona y nodule (le ) and Pulmona y condensa ion in he apical segmen o he igh
lowe lobe (Righ )
A e mul idisciplina y discussion, sys emic he apy began wi h ca bopla in (AUC5) and ce uximab (400 mg/m² loading
dose, hen 250 mg/m² weekly), alongside educed immunosupp ession ( ac olimus 4 mg/day). A e se en cycles, a
Ma ch 2025 PET-CT showed a comple e mo pho-me abolic esponse. Ce uximab main enance (500 mg e e y wo
weeks) sus ained he esponse, con i med by a June 2025 PET-CT.
Side e ec s included g ade II acnei o m ash, xe osis wi h digi al issu es, and g ade I hypomagnesemia, managed wi h
doxycycline, emollien and healing c eams, and o al magnesium supplemen a ion. No g a ejec ion o ca dio ascula
oxici y occu ed, and he pa ien con inues ce uximab main enance.
3. Discussion
Managing me as a ic cSCC in hea ansplan ecipien s is complex, equi ing bo h cance con ol and g a p o ec ion.
cSCC is a common cance a e a hea ansplan (10% o cases), o en head and neck-based (70%) and mo e me as a ic
han in no ansplan pa ien s[1,2].
Immunosupp ession wi h ac olimus, mycophenola e mo e il, and p ednisone p e en s g a ejec ion bu p omo es
umo g ow h by inhibi ing T-cell ac i a ion[6]. In his case, immunosupp ession likely d o e cSCC de elopmen , as he
pa ien had no signi ican UV ch onic exposu e.
Tac olimus may inc ease skin cance isk compa ed o si olimus, which could o e p o ec i e e ec s[1], aising
impo an conside a ions o long- e m immunosupp essi e s a egies.
ICIs like cemiplimab a e e ec i e o ad anced cSCC in he gene al popula ion, wi h 47–50% esponse a es[7,8],bu
hey ca y a 41% g a ejec ion isk in ansplan pa ien s, including 20% in hea ansplan cases[9].
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 812-817
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PD-1 inhibi o s (ni olumab, pemb olizumab) ca y highe ejec ion isks han CTLA-4 inhibi o s like ipilimumab,
hough he la e is less e ec i e o cSCC [9]. Immunosupp essan s may also a enua e ICI e icacy [3–5].
O he he apies such as bispeci ic an ibodies o CAR-T cells, also isk ejec ion [10,11].
Ce uximab, a ge ing EGFR, o e exp essed in 80–100% o cSCCs ,inhibi s umo g ow h and angiogenesis wi hou
comp omising g a in eg i y [12].
In his case, ca bopla in-ce uximab achie ed a comple e esponse, sus ained wi h ce uximab main enance. Li e a u e
suppo s hese indings: a s udy o 10 cSCC pa ien s ineligible o immuno he apy epo ed an 80% disease con ol a e
wi h ce uximab, including 10% comple e esponses[13]. Two phase II ials showed 78% and 69% disease con ol a es
wi h ce uximab, espec i ely, wi h be e ou comes when combined wi h ca bopla in [14,15].
Side e ec s we e manageable, ollowing guidelines [16]. The able below summa izes ce uximab ole ance in ansplan
ecipien s wi h a ious cance s and immunosupp essi e egimens.
Table 1 Ce uximab Tole ance in T ansplan Recipien s
cance
Type
T ansplan
Immunosupp ession
Cance
ea men
Ad e se E en s
Mydin e al.
[18]
Pi i o m
sinus SCC
Li e
Mycophenola e,
ac olimus
Ce uximab +
adio he apy
Acnei o m ash and
g ade III dysphagia
JA, e al.
[19]
Me as a ic
cSCC
Lung
Si olimus
Ce uximab
mono he apy
G ade 5 Toxici y
Holguin e al
.[20]
Case I :
La yngeal
SCC
Li e
Tac olimus,
mycophenola e,
e e olimus
Pacli axel +
Ce uximab
G ade III neu openia
Case II :
La yngeal
SCC
Li e
Tac olimus
Ce uximab +
adio he apy
GGT and PAL ele a ion ,
Acnei o m ash and
hypomagnesemia
Kalapu akal SJ
e al. [21]
cSCC, Basal
cell
ca cinoma
Kidney
Mycophenola e
Ce uximab
mono he apy
No g ade 3 and 4
oxici ies
Julian A.
Ma in-
Ace edo e al
[13]
Ad anced o
me as a ic
cSCC
Kidney
Cyclospo ine,
p ednisone
Tac olimus
Tac olimus,
mycophenola e
Ce uximab
mono he apy
Acnei o m Rash (g ade
1–2),
Hypomagnesemia
(g ade 1–2)
Li e
Tac olimus,
mycophenola e
Ce uximab +
adio he apy
Hypomagnesemia,
Acnei o m ash (g ade
1–2)
Hea
Tac olimus, p ednisone
Ce uximab +
adio he apy
G ade 5 oxici y
Immunosupp ession was adjus ed ( ac olimus educed o 4 mg/day, mycophenola e discon inued), wi h close
ca diology and oncology collabo a ion ensu ing ea men success.
The sus ained comple e esponse indica es subs an ial e icacy o Ce uximab-based egimens in solid o gan ansplan
ecipien s wi h ad anced cSCC [17].
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 812-817
816
4. Conclusion
cSCC is a common and se ious complica ion in hea ansplan ecipien s, a ec ing up o 10% due o
immunosupp ession. Ce uximab is a sa e and e icacious ea men op ion, a oiding he g a ejec ion isks o ICIs. This
s udy and he suppo ing li e a u e sugges ha ce uximab could be a ea men o choice o ad anced CSC in ansplan
pa ien s, p o ided i is ollowed app op ia ely.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
S a emen o e hical app o al
The p esen esea ch wo k does no con ain any s udies pe o med on animals/humans subjec s by any o he au ho s.
S a emen o in o med consen
In o med consen was ob ained om all indi idual pa icipan s included in he s udy.
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