JAMA Dermatology

<jats:sec><jats:title>Importance</jats:title><jats:p>The substantial morbidity and socioeconomic costs associated with actinic keratosis (AK) management represent major public health concerns. Anecdotal evidence suggests that human papillomavirus (HPV) vaccination may offer therapeutic and preventive effects against AK and keratinocyte carcinomas (KCs).</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To investigate the effect of HPV vaccination on burden of disease in immunocompetent patients with high numbers of AK.</jats:p></jats:sec><jats:sec><jats:title>Design, Setting, and Participants</jats:title><jats:p>The VAXAK trial was a parallel-design, double-blind, randomized sham-controlled clinical trial with 12 months’ follow-up. This single-center trial was conducted at the Department of Dermatology, Bispebjerg University Hospital in Copenhagen, Denmark, between May 2021 and June 2024. Eligible participants were immunocompetent adults with 15 or more clinical AK lesions in a 50 cm<jats:sup>2</jats:sup> to 100 cm<jats:sup>2</jats:sup> test area on the head, trunk, or extremities.</jats:p></jats:sec><jats:sec><jats:title>Interventions</jats:title><jats:p>Participants were randomized 1:1 to blinded, 9-valent alphapapillomavirus vaccine or sham vaccine (isotonic sodium chloride solution), each administered intramuscularly at 0, 2, and 6 months. Thick AKs (Olsen grade II-III) received cryotherapy at months 6 and 9; test areas were otherwise untreated during the study.</jats:p></jats:sec><jats:sec><jats:title>Main Outcomes and Measures</jats:title><jats:p>The preselected primary outcome was the percentage reduction in baseline AKs assessed 2, 6, 9, and 12 months after first vaccination. Secondary outcomes included total AK number, thick lesions, new AKs, and rate of incident KCs over 12 months.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Participants were selected by consecutive sampling of 163 screened patients following exclusion of 93 individuals due to ineligibility or patients opting out. Among 70 enrolled participants (median [IQR] age, 75.50 [69.00-79.00] years; 47 [67%] male), 69 completed the study. Median (IQR) AK reductions were higher in the HPV-vaccinated vs sham group, shown consistently over the study period (month 2: 35% [25%-44%] vs 25% [18%-33%]; <jats:italic>P</jats:italic> = .03; month 6: 47% [33%-53%] vs 29% [16%-44%]; <jats:italic>P</jats:italic> = .01; month 9: 58% [37%-63%] vs 42% [33%-56%]; <jats:italic>P</jats:italic> = .09; month 12: 58% [47%-69%] vs 47% [32%-65%]; <jats:italic>P</jats:italic> = .05). Total AK numbers were correspondingly lower in the HPV-vaccinated group (median [IQR] at month 6: 14.00 [11.00-16.00] vs 17.00 [12.00-23.00]; <jats:italic>P</jats:italic> = .01; month 12: 10.00 [6.00-24.00] vs 16.00 [8.50-21.00]; <jats:italic>P</jats:italic> = .02). Coincidingly, fewer thick AKs were observed in the HPV-vaccinated group (median [IQR] at month 6: 5.00 [3.00-7.00] vs 6.50 [3.75-10.00]; <jats:italic>P</jats:italic> = .02; month 12: 3.00 [2.00-5.00] vs 5.00 [2.50-8.50]; <jats:italic>P</jats:italic> = .049). In contrast, no significant differences in rates of new AKs (1-2 AK[s] per month) or KC numbers overall or per participant were identified during the 12-month trial.</jats:p></jats:sec><jats:sec><jats:title>Conclusions and Relevance</jats:title><jats:p>In this randomized clinical trial, standard alphapapillomavirus vaccination was found to reduce AK burden in immunocompetent individuals with multiple lesions. HPV-targeted vaccines may be useful for management of AK, a chronic, relapsing disease and the most common precancer in fair-skinned populations.</jats:p></jats:sec><jats:sec><jats:title>Trial Registration</jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov/study/NCT05202860">NCT05202860</jats:ext-link></jats:p></jats:sec>

Global epidemiology of actinic keratosis in the general population: a systematic review and meta-analysis.

Br J Dermatol

Trends in office visits for the five most common skin diseases in the United States.

J Clin Aesthet Dermatol

Current perspective on actinic keratosis: a review.

Clinical presentation of actinic keratoses and squamous cell carcinoma.

J Am Acad Dermatol

Gene expression patterns of normal human skin, actinic keratosis, and squamous cell carcinoma: a spectrum of disease progression.

Arch Dermatol

The natural history of actinic keratosis: a systematic review.

Ten-year follow-up of persons with sun-damaged skin associated with subsequent development of cutaneous squamous cell carcinoma.

JAMA Dermatol

Malignant transformation of solar keratoses to squamous cell carcinoma.

Lancet

Actinic keratosis diagnosis and increased risk of developing skin cancer: a 10-year cohort study of 17,651 patients in Sweden.

Acta Derm Venereol

Skin cancers in Medicare beneficiaries with actinic keratoses.

Use and cost of actinic keratosis destruction in the Medicare Part B fee-for-service population, 2007 to 2015.

The role of HPV in keratinocyte skin cancer development: a systematic review.

J Eur Acad Dermatol Venereol

Transcriptome sequencing demonstrates that human papillomavirus is not active in cutaneous squamous cell carcinoma.

J Invest Dermatol

Cutaneous papillomaviruses and non-melanoma skin cancer: causal agents or innocent bystanders?

Front Microbiol

An emerging issue in oncogenic virology: the role of beta human papillomavirus types in the development of cutaneous squamous cell carcinoma.

J Virol

Role of human papillomavirus in cutaneous squamous cell carcinoma: a meta-analysis.

Association between ß-genus human papillomavirus and cutaneous squamous cell carcinoma in immunocompetent individuals: a meta-analysis.

Human papillomavirus-DNA loads in actinic keratoses exceed those in non-melanoma skin cancers.

Incidence of skin cancer after renal transplantation in The Netherlands.

Transplantation

Skin cancer in kidney and heart transplant recipients and different long-term immunosuppressive therapy regimens.

Prevalence and awareness of actinic keratosis: barriers and opportunities.

Improved detection reveals active ß-papillomavirus infection in skin lesions from kidney transplant recipients.

Mod Pathol

Human papillomavirus infection and non-melanoma skin cancer in immunosuppressed and immunocompetent individuals.

J Med Virol

Cutaneous human papillomaviruses and the risk of keratinocyte carcinomas.

Cancer Res

The actinic keratosis virome: can we prevent squamous cell carcinoma with a vaccine?

Curr Probl Dermatol

HPV vaccination for prevention of skin cancer.

Hum Vaccin Immunother

Association of human papillomavirus vaccine with the development of keratinocyte carcinomas.

Reduction in actinic keratoses following 9-valent human papilloma virus vaccination.

Dermatol Ther

Protective vaccination against papillomavirus-induced skin tumors under immunocompetent and immunosuppressive conditions: a preclinical study using a natural outbred animal model.

PLoS Pathog

Cutaneous squamous cell carcinoma in situ on a fingernail treated with HPV vaccine.

J Drugs Dermatol

Combined systemic and intratumoral administration of human papillomavirus vaccine to treat multiple cutaneous basaloid squamous cell carcinomas.

Keratinocyte carcinomas in immunocompromised patients are reduced after administration of the nonavalent human papillomavirus vaccine.

HPV vaccination in immunosuppressed patients with established skin warts and non-melanoma skin cancer: a single-institutional cohort study.

Vaccines (Basel)

Systemic and intratumoral 9-valent human papillomavirus vaccine treatment for squamous cell carcinoma in situ in a renal transplant recipient.

JAAD Case Rep

Bowen disease of the nail apparatus with HPV16 positivity and resolution with human papillomavirus vaccination.

Intralesional 9-valent human papillomavirus as a treatment for facial squamous cell carcinoma.

The successful treatment of multiple cutaneous malignancies with HPV vaccination: case report.

Skin (Milwood)

Off-label 9-valent human papillomavirus vaccination for actinic keratosis: a case series.

Case Rep Dermatol

Quadrivalent HPV vaccine safety review and safety monitoring plans for nine-valent HPV vaccine in the United States.

CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials.

J Pharmacol Pharmacother

A double-blind, vehicle-controlled study evaluating masoprocol cream in the treatment of actinic keratoses on the head and neck.

Development of a ß-HPV vaccine: updates on an emerging frontier of skin cancer prevention.

J Clin Virol

Guidelines of care for the management of actinic keratosis.

Long-term recurrence rates of actinic keratosis: a systematic review and pooled analysis of randomized controlled trials.

Conventional vs. daylight methyl aminolevulinate photodynamic therapy for actinic keratosis of the face and scalp: an intra-patient, prospective, comparison study in Italy.

Daylight-mediated photodynamic therapy of moderate to thick actinic keratoses of the face and scalp: a randomized multicentre study.

Management of actinic keratosis at specific body sites in patients at high risk of carcinoma lesions: expert consensus from the AKTeam of expert clinicians.

A comparison of invasive squamous cell carcinoma greater than 1 year after treatment with 5-fluorouracil, imiquimod, or photodynamic therapy with aminolevulinic acid.

Comparative effectiveness of treatment of actinic keratosis with topical fluorouracil and imiquimod in the prevention of keratinocyte carcinoma: a cohort study.

Long-term management of advanced basal cell carcinoma: current challenges and future perspectives.

Cancers (Basel)

Recalcitrant cutaneous warts treated with recombinant quadrivalent human papillomavirus vaccine (types 6, 11, 16, and 18) in a developmentally delayed, 31-year-old white man.

Recalcitrant plantar warts treated with recombinant quadrivalent human papillomavirus vaccine.

Quadrivalent human papillomavirus vaccination: a promising treatment for recalcitrant cutaneous warts in children.

Intralesional versus intramuscular bivalent human papillomavirus vaccine in the treatment of recalcitrant common warts.

A papillomavirus-like particle (VLP) vaccine displaying HPV16 L2 epitopes induces cross-neutralizing antibodies to HPV11.

Vaccine

Human papillomavirus vaccines and the potential for cross-protection between related HPV types.

Gynecol Oncol

Cellular immune responses to HPV-18, -31, and -53 in healthy volunteers immunized with recombinant HPV-16 L1 virus-like particles.

Virology

Cellular immune responses to human papillomavirus (HPV)-16 L1 in healthy volunteers immunized with recombinant HPV-16 L1 virus-like particles.

J Infect Dis

Human papillomavirus neutralizing and cross-reactive antibodies induced in HIV-positive subjects after vaccination with quadrivalent and bivalent HPV vaccines.

Immunity to commensal papillomaviruses protects against skin cancer.

Nature

Commensal papillomavirus immunity preserves the homeostasis of highly mutated normal skin.

Cancer Cell

Human papillomavirus type 16 (HPV-16) virus-like particle L1-specific CD8+ cytotoxic T lymphocytes (CTLs) are equally effective as E7-specific CD8+ CTLs in killing autologous HPV-16-positive tumor cells in cervical cancer patients: implications for L1 dendritic cell-based therapeutic vaccines.

A Phase 1 study of a recombinant viruslike particle vaccine against human papillomavirus type 11 in healthy adult volunteers.

Cross-reactivity, epitope spreading, and de novo immune stimulation are possible mechanisms of cross-protection of nonvaccine human papillomavirus (HPV) types in recipients of HPV therapeutic vaccines.

Clin Vaccine Immunol

METTL3-mediated HPV vaccine enhances the effect of anti PD-1 immunotherapy to alleviate the development of cutaneous squamous cell carcinoma.

An Bras Dermatol

Spontaneous regression rates of actinic keratosis: a systematic review and pooled analysis of randomized controlled trials.

Sci Rep

Reduction of solar keratoses by regular sunscreen use.

N Engl J Med

A randomized controlled trial to assess sunscreen application and beta carotene supplementation in the prevention of solar keratoses.

Topical immunotherapy for actinic keratosis and field cancerization.

Actinic keratosis metrics.

Arch Dermatol Res

Epidemiology of solar keratoses.

Reliability of counting actinic keratoses before and after brief consensus discussion: the VA topical tretinoin chemoprevention (VATTC) trial.

The clinical landscape of HPV vaccination in preventing and treating cutaneous squamous cell carcinoma.

The substantial morbidity and socioeconomic costs associated with actinic keratosis (AK) management represent major public health concerns. Anecdotal evidence suggests that human papillomavirus (HPV) vaccination may offer therapeutic and preventive effects against AK and keratinocyte carcinomas (KCs).
To investigate the effect of HPV vaccination on burden of disease in immunocompetent patients with high numbers of AK.
The VAXAK trial was a parallel-design, double-blind, randomized sham-controlled clinical trial with 12 months' follow-up. This single-center trial was conducted at the Department of Dermatology, Bispebjerg University Hospital in Copenhagen, Denmark, between May 2021 and June 2024. Eligible participants were immunocompetent adults with 15 or more clinical AK lesions in a 50 cm2 to 100 cm2 test area on the head, trunk, or extremities.
Participants were randomized 1:1 to blinded, 9-valent alphapapillomavirus vaccine or sham vaccine (isotonic sodium chloride solution), each administered intramuscularly at 0, 2, and 6 months. Thick AKs (Olsen grade II-III) received cryotherapy at months 6 and 9; test areas were otherwise untreated during the study.
The preselected primary outcome was the percentage reduction in baseline AKs assessed 2, 6, 9, and 12 months after first vaccination. Secondary outcomes included total AK number, thick lesions, new AKs, and rate of incident KCs over 12 months.
Participants were selected by consecutive sampling of 163 screened patients following exclusion of 93 individuals due to ineligibility or patients opting out. Among 70 enrolled participants (median [IQR] age, 75.50 [69.00-79.00] years; 47 [67%] male), 69 completed the study. Median (IQR) AK reductions were higher in the HPV-vaccinated vs sham group, shown consistently over the study period (month 2: 35% [25%-44%] vs 25% [18%-33%]; P = .03; month 6: 47% [33%-53%] vs 29% [16%-44%]; P = .01; month 9: 58% [37%-63%] vs 42% [33%-56%]; P = .09; month 12: 58% [47%-69%] vs 47% [32%-65%]; P = .05). Total AK numbers were correspondingly lower in the HPV-vaccinated group (median [IQR] at month 6: 14.00 [11.00-16.00] vs 17.00 [12.00-23.00]; P = .01; month 12: 10.00 [6.00-24.00] vs 16.00 [8.50-21.00]; P = .02). Coincidingly, fewer thick AKs were observed in the HPV-vaccinated group (median [IQR] at month 6: 5.00 [3.00-7.00] vs 6.50 [3.75-10.00]; P = .02; month 12: 3.00 [2.00-5.00] vs 5.00 [2.50-8.50]; P = .049). In contrast, no significant differences in rates of new AKs (1-2 AK[s] per month) or KC numbers overall or per participant were identified during the 12-month trial.
In this randomized clinical trial, standard alphapapillomavirus vaccination was found to reduce AK burden in immunocompetent individuals with multiple lesions. HPV-targeted vaccines may be useful for management of AK, a chronic, relapsing disease and the most common precancer in fair-skinned populations.
ClinicalTrials.gov Identifier: NCT05202860.

Human Papillomavirus Vaccination and Actinic Keratosis Burden: The VAXAK Randomized Clinical Trial.

Human Papillomavirus Vaccination and Actinic Keratosis Burden

<jats:sec id="ab-doi240070-4"><jats:title>Importance</jats:title><jats:p>Therapies for individual keratinocyte carcinomas (KCs) do not prevent the onset of new KCs in a field of sun damage, and therefore the KC burden remains unchanged.</jats:p></jats:sec><jats:sec id="ab-doi240070-5"><jats:title>Objective</jats:title><jats:p>To investigate the association of immune checkpoint inhibitors (ICIs) with changes in field cancerization evaluated by the number of actinic keratoses (AKs) and KCs at baseline compared with 12 months after starting ICI therapy.</jats:p></jats:sec><jats:sec id="ab-doi240070-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This prospective cohort study was performed at the outpatient oncology clinic of a single tertiary public hospital in Brisbane, Australia, from April 1, 2022, to November 30, 2023. Consecutive immunocompetent adults starting therapy with an inhibitor for programmed cell death 1 (PD-1) or programmed cell death ligand 1 (PDL-1) for any active cancer, with a planned treatment duration of at least 6 months, and who exhibited clinical AKs on their forearms were eligible. Those with immunosuppression, concurrent chemotherapy or radiotherapy, or recent topical fluorouracil use were excluded.</jats:p></jats:sec><jats:sec id="ab-doi240070-7"><jats:title>Exposures</jats:title><jats:p>Intravenous ICI therapy, either PD-1 or PDL-1 inhibitors with or without a cytotoxic T-lymphocyte–associated protein 4 inhibitor, with therapy duration determined by the treating oncologist.</jats:p></jats:sec><jats:sec id="ab-doi240070-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Clinical AKs were counted and photographed before and 3, 6, and 12 months after starting ICI therapy. KC numbers were evaluated based on histopathology reports of all skin lesions excised 12 months before and after starting ICI therapy. Participants’ medical history, primary cancer tumor response using Response Evaluation Criteria in Solid Tumors, and adverse events were recorded.</jats:p></jats:sec><jats:sec id="ab-doi240070-9"><jats:title>Results</jats:title><jats:p>A total of 23 participants were recruited, of whom 17 (73.9%) were male, with a mean (SD) age of 69.7 (9.6) years. No participants withdrew; however, 4 died during the study due to disease progression. The mean (SD) AK number significantly decreased from 47.2 (33.8) at baseline to 14.3 (12.0) at 12 months (<jats:italic>P</jats:italic> &amp;amp;lt; .001). Younger patients (8 of 12 [66.7%] vs 4 of 12 [33.3%]; <jats:italic>P</jats:italic> = .007) and those with a history of blistering sunburn (12 of 12 [100%] vs 0; <jats:italic>P</jats:italic> = .005) were more likely to reduce their AK numbers by 65% or greater. KC total numbers decreased from 42 in the 12 months before starting ICI therapy to 17 in the 12 months after. The number of cutaneous squamous cell carcinomas decreased from 16 to 5 in the same period.</jats:p></jats:sec><jats:sec id="ab-doi240070-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>This pilot cohort study found that ICIs used for any cancer were associated with a significant reduction of AKs, suggesting potential as an immunopreventive strategy for high-risk individuals. Given the known effects of other chemopreventive agents on KCs, further investigation into ICIs managing field cancerization is required, especially considering toxicity and cost.</jats:p></jats:sec>

The incidence and multiplicity rates of keratinocyte cancers in Australia.

Med J Aust

The kinetics of skin cancer: progression of actinic keratosis to squamous cell carcinoma.

Dermatol Surg

The risk of progression to invasive disease.

From keratinocyte to cancer: the pathogenesis and modeling of cutaneous squamous cell carcinoma.

J Clin Invest

Field cancerization: definition, epidemiology, risk factors, and outcomes.

European consensus-based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, epithelial UV-induced dysplasia and field cancerization on behalf of European Association of Dermato-Oncology, European Dermatology Forum, European Academy of Dermatology and Venereology and Union of Medical Specialists (Union Européenne des Médecins Spécialistes).

Epidermal mutation accumulation in photodamaged skin is associated with skin cancer burden and can be targeted through ablative therapy.

Sci Adv

Comparative genomics provides etiologic and biological insight into melanoma subtypes.

Cancer Discov

Actinic keratosis with atypical basal cells (AK I) is the most common lesion associated with invasive squamous cell carcinoma of the skin.

Immune checkpoint inhibitors in cancer therapy.

Curr Oncol

Neoadjuvant cemiplimab for stage II to IV cutaneous squamous-cell carcinoma.

Neoadjuvant cemiplimab and surgery for stage II-IV cutaneous squamous-cell carcinoma: follow-up and survival outcomes of a single-arm, multicentre, phase 2 study.

Lancet Oncol

PD-1 blockade with cemiplimab in advanced cutaneous squamous-cell carcinoma.

Cemiplimab in locally advanced cutaneous squamous cell carcinoma: results from an open-label, phase 2, single-arm trial.

Phase 2 study of cemiplimab in patients with metastatic cutaneous squamous cell carcinoma: primary analysis of fixed-dosing, long-term outcome of weight-based dosing.

J Immunother Cancer

Immune checkpoint inhibitor therapy for advanced cutaneous squamous cell carcinoma in Australia: a retrospective real world cohort study.

Pembrolizumab monotherapy for recurrent or metastatic cutaneous squamous cell carcinoma: a single-arm phase II trial (KEYNOTE-629).

J Clin Oncol

New Response Evaluation Criteria in Solid Tumours: revised RECIST guideline (version 1.1).

Eur J Cancer

Chemoprevention of cutaneous squamous cell carcinoma and its precursors in solid organ transplant recipients using topical sirolimus: a randomized, double-blind, placebo-controlled pilot trial.

Risk of invasive cutaneous squamous cell carcinoma after different treatments for actinic keratosis: a secondary analysis of a randomized clinical trial.

Randomized trial of four treatment approaches for actinic keratosis.

Randomized controlled trial of acitretin versus placebo in patients at high-risk for basal cell or squamous cell carcinoma of the skin (North Central Cancer Treatment Group Study 969251).

Cancer

A phase 3 randomized trial of nicotinamide for skin-cancer chemoprevention.

Evaluation of the use of capecitabine for the treatment and prevention of actinic keratoses, squamous cell carcinoma, and basal cell carcinoma: a systematic review.

Multinational analysis of estimated health care costs related to extended-interval fixed dosing of checkpoint inhibitors.

JAMA Netw Open

Patterns and timing of sunlight exposure and risk of basal cell and squamous cell carcinomas of the skin—a case-control study.

BMC Cancer

JCO Precis Oncol

Immune-checkpoint inhibitors: long-term implications of toxicity.

Nat Rev Clin Oncol

Dermatologic reactions to immune checkpoint inhibitors: skin toxicities and immunotherapy.

Am J Clin Dermatol

Cutaneous manifestations associated with immune checkpoint inhibitors.

Front Immunol

Artificial white light vs daylight photodynamic therapy for actinic keratoses: a randomized clinical trial.

Therapies for individual keratinocyte carcinomas (KCs) do not prevent the onset of new KCs in a field of sun damage, and therefore the KC burden remains unchanged.
To investigate the association of immune checkpoint inhibitors (ICIs) with changes in field cancerization evaluated by the number of actinic keratoses (AKs) and KCs at baseline compared with 12 months after starting ICI therapy.
This prospective cohort study was performed at the outpatient oncology clinic of a single tertiary public hospital in Brisbane, Australia, from April 1, 2022, to November 30, 2023. Consecutive immunocompetent adults starting therapy with an inhibitor for programmed cell death 1 (PD-1) or programmed cell death ligand 1 (PDL-1) for any active cancer, with a planned treatment duration of at least 6 months, and who exhibited clinical AKs on their forearms were eligible. Those with immunosuppression, concurrent chemotherapy or radiotherapy, or recent topical fluorouracil use were excluded.
Intravenous ICI therapy, either PD-1 or PDL-1 inhibitors with or without a cytotoxic T-lymphocyte-associated protein 4 inhibitor, with therapy duration determined by the treating oncologist.
Clinical AKs were counted and photographed before and 3, 6, and 12 months after starting ICI therapy. KC numbers were evaluated based on histopathology reports of all skin lesions excised 12 months before and after starting ICI therapy. Participants' medical history, primary cancer tumor response using Response Evaluation Criteria in Solid Tumors, and adverse events were recorded.
A total of 23 participants were recruited, of whom 17 (73.9%) were male, with a mean (SD) age of 69.7 (9.6) years. No participants withdrew; however, 4 died during the study due to disease progression. The mean (SD) AK number significantly decreased from 47.2 (33.8) at baseline to 14.3 (12.0) at 12 months (P < .001). Younger patients (8 of 12 [66.7%] vs 4 of 12 [33.3%]; P = .007) and those with a history of blistering sunburn (12 of 12 [100%] vs 0; P = .005) were more likely to reduce their AK numbers by 65% or greater. KC total numbers decreased from 42 in the 12 months before starting ICI therapy to 17 in the 12 months after. The number of cutaneous squamous cell carcinomas decreased from 16 to 5 in the same period.
This pilot cohort study found that ICIs used for any cancer were associated with a significant reduction of AKs, suggesting potential as an immunopreventive strategy for high-risk individuals. Given the known effects of other chemopreventive agents on KCs, further investigation into ICIs managing field cancerization is required, especially considering toxicity and cost.

Immune Checkpoint Inhibitors in Field Cancerization and Keratinocyte Cancer Prevention.

Immune Checkpoint Inhibitors in Field Cancerization and Keratinocyte Cancer Prevention

Papers