Drug therapy for non-melanoma skin cancer

Drug therapy is sometimes used to treat non-melanoma skin cancer. The drugs can be given in different ways.

Drug therapy is given for different reasons. You may have drug therapy to:

• destroy cancer cells on the skin or in the body
• slow or stop the growth and spread of cancer
• shrink a tumour before other treatments such as surgery or radiation therapy (called neoadjuvant therapy)
• destroy cancer cells left behind after surgery (called adjuvant therapy)
• relieve or control symptoms of advanced non-melanoma skin cancer (called palliative therapy)

Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of drug therapy. You may also receive other treatments.

Topical therapy uses a cream or gel to put drugs directly on the skin. The topical therapy drugs used for non-melanoma skin cancer are imiquimod (Aldara, Zyclara) and 5-fluorouracil (5-FU, Efudex, Actikerall).

Imiquimod is a type of immunotherapy drug called an immune response modifier. It uses your immune system to help destroy cancer cells. It may be used to treat small, superficial basal cell carcinoma (BCC) on the neck, trunk, arms or legs. It may also be used for squamous cell carcinoma (SCC) in situ. Imiquimod is usually put on the tumour and nearby area once a day for several weeks. Find out more about immunotherapy.

5-fluorouracil is a chemotherapy drug used to treat a specific area on the skin. Topical 5-fluorouracil is mainly used for precancerous conditions of the skin such as actinic keratosis. It may also be used for superficial BCC or SCC in situ.

Targeted therapy uses drugs to target specific molecules (such as proteins) on or inside cancer cells. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells.

Vismodegib (Erivedge) is a targeted therapy drug called a hedgehog signalling pathway inhibitor. The hedgehog signalling pathway helps cells develop and grow. It is usually turned off (inactive) in adults. But sometimes changes (mutations) in certain proteins make the pathway and proteins too active. The proteins then send signals that cause BCC to develop, grow and spread quickly. Vismodegib targets the proteins and blocks the signals.

Sonidegib (Odomzo) is another hedgehog signalling pathway inhibitor that may be offered and it works the same way as vismodegib.

Vismodegib and sonidegib can be used to treat metastatic BCC or locally advanced BCC when surgery or radiation therapy can't be used. These drugs are given daily as a pill by mouth (orally). They are usually given as long as the drugs are working or unless the side effects outweigh the benefits of having the treatment.

Find out more about targeted therapy. Ask your healthcare team questions about targeted therapy.

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. This works to kill cancer cells and stop cancer cells from growing and spreading.

Cemiplimab (Libtayo) is an immunotherapy drug called an immune checkpoint inhibitor. The immune system normally stops itself from attacking normal cells in the body by using specific proteins called checkpoints, which are made by some immune system cells. Skin cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. Immune checkpoint inhibitors block the checkpoint proteins so immune system cells (called T cells) can attack and kill the cancer cells.

Cemiplimab is used for metastatic SCC or locally advanced SCC when surgery or radiation therapy can't be used. It is also used to treat locally advanced BCC that was already treated with either vismodegib or sonidegib (Hedgehog pathway inhibitors).

Cemiplimab is given by a needle into a vein every 2 or 3 weeks. It is usually given as long as the drug is working or unless the side effects outweigh the benefits of having the treatment.

Find out more about immunotherapy. Ask your healthcare team questions about immunotherapy.

Systemic chemotherapy uses anticancer (cytotoxic) drugs that travel through the bloodstream to destroy cancer cells.

Systemic chemotherapy is usually only used for locally advanced or non-melanoma skin cancer that has spread (metastasized). Some common chemotherapy drugs used are cisplatin and paclitaxel. These are given with a needle into a vein (intravenously). For some cases of advanced or metastatic SCC, other drugs may be combined with chemotherapy, such as interferon alfa (Intron A, Wellferon) or retinoid drugs. There is no standard chemotherapy treatment plan for non-melanoma skin cancer.

Find out more about chemotherapy. Ask your healthcare team questions about chemotherapy.

Side effects can happen with any type of treatment for non-melanoma skin cancer, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

Drug therapy may cause side effects because it can damage healthy cells as it kills cancer cells. Side effects can develop any time during, immediately after or a few days or weeks after drug therapy. Sometimes late side effects develop months or years after drug therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of drug therapy will depend mainly on the type of drug, the dose, how it’s given and your overall health. Some common side effects of drug therapy used for non-melanoma skin cancer include the following.

Topical therapy may cause these side effects:

• red, itchy skin in the treated area
• burning and pain in the treated area
• swelling (edema)
• discharge from the wound

Common side effects of vismodegib and sonidegib, targeted therapy drugs, include:

• muscle and bone pain, including muscle cramps
• hair loss
• taste changes
• loss of appetite and weight loss
• fatigue
• nausea and vomiting

Common side effects of cemiplimab, an immunotherapy drug, include:

• pain in the abdomen
• constipation
• loss of appetite
• cough
• diarrhea
• fatigue

Systemic chemotherapy may cause these side effects:

• nausea and vomiting
• fatigue
• low blood cell counts
• diarrhea
• kidney damage
• hearing problems, including ringing in the ears
• hair loss
• muscle and bone pain

Tell your healthcare team if you have these side effects or others you think might be from drug therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.