Recurrent vulvar squamous cell carcinoma: Outcomes across the treatment spectrum—Are we making progress?

person Claudia Meloche University of Ottawa, Ottawa, ON, Canada info_outline Claudia Meloche, Trish Dinh, Johanna Spaans, Tinghua Zhang, Johanne I Weberpals

Authors person Claudia Meloche University of Ottawa, Ottawa, ON, Canada info_outline Claudia Meloche, Trish Dinh, Johanna Spaans, Tinghua Zhang, Johanne I Weberpals Organizations University of Ottawa, Ottawa, ON, Canada, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada, The Ottawa Hospital Research Institute, Ottawa, ON, Canada, Division of Gynecologic Oncology, Ottawa Hospital Research Institute, Ottawa, ON, Canada Abstract Disclosures Research Funding No funding sources reported Background: No standard treatment exists for recurrent vulvar squamous cell carcinoma (VSCC) and the prognosis is poor. This retrospective study reports on outcomes of recurrent and progressive VSCC patients (pts) across various treatments. Methods: This was a single-center retrospective cohort study conducted at the Ottawa Hospital (Ottawa, Canada). Pts with histologically proven VSCC treated between 2000-2023 were identified, and the study population comprised pts who either recurred or progressed after/during first-line therapy. Clinicopathologic data were collected, and descriptive statistics were performed according to pt demographics, tumor characteristics and treatment modality. Median progression free survival (PFS) and overall survival (OS) were determined by treatment type. The outcomes of unique cases treated with novel therapies are also highlighted. Results: There were 311 pts with a diagnosis of VSCC. Ninety-five pts with recurrent/progressive disease formed the study population with a median age of 72 years and 52% having at least stage III disease at initial diagnosis according to FIGO 2021 staging. The prevailing treatment at time of diagnosis was surgery (74%), with 40% of pts also undergoing radiation, chemotherapy, or a combination of both. Location of disease progression or recurrence was regional 53 (56%), inguinal 31 (33%) and distant 11(12%). There were 60 pts (63)% who had one recurrence, as well as 18 pts (19%) and 3 pts (3%) with two and three recurrences, respectively. Of all patients, 14/95 (15%) showed evidence of early progression following treatment. Treatment for first recurrence included: radiation (18.9%), surgery (16.8%), no treatment (16.8%), chemotherapy (11.6%), chemoradiation (9.4%), surgery with radiation (7.3%) surgery and chemoradiation (2.1%), surgery and chemotherapy (1.1%), and investigational therapy (1.1%). The most common chemotherapy regimen used was cisplatin, while the predominant surgical procedure performed was radical vulvectomy. Two pts received Pembrolizumab for treatment of recurrent disease. One pt received a combination of carboplatinum, paclitaxel and bevacizumab followed by maintenance pembrolizumab for 55 cycles (PFS 27.1 months, mo). A second pt was treated for a second recurrence with carbo-taxol followed by single agent pembrolizumab for 27 cycles with stable disease (PFS 15.7 mo). The mPFS after treatment of first recurrence was 11.6 mo for surgery, 8.7 mo for radiation, 8 mo for chemotherapy, 3.2 mo for chemoradiation, and 2.2 mo for no treatment. Among VSCC pts with recurrent or progressive disease, the median OS from all causes was 21 mo. Conclusions: Pts with recurrent/progressive VSCC who underwent surgery had the most favorable outcomes. Significant promise was shown with pembrolizumab and highlights the need for immunotherapy clinical trials for this rare and fatal woman’s cancer.