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EGF‐R Inhibitors for Squamous Cell Carcinoma

The orbit, adnexa, and periocular area remain some of the more difficult areas to manage in relation to surgical resection for cutaneous carcinomas such as squamous cell carcinoma (SCC). SCC represents about one fifth of nonmelanoma skin cancers in the United States and is the second most common cancer overall among whites, with its incidence increasing.1 Mortality from the disease is documented at 1.5%,2 and like many nonmelanoma skin cancers, it often presents in sensitive areas of the head and neck. Because of the relatively larger surgical margins that SCC typically requires, the eye, brain, and the structures required to preserve their function are often at risk (Fig. 1). Nonsurgical treatments such as radiotherapy and chemotherapy with cisplatin, 5-fluorouracil, bleomycin, and doxorubicin are often poorly tolerated. This is due to patient comorbidities and the associated adverse events, which are especially prevalent among the older population in which SCC is most common. Epidermal growth factor receptor (EGFR), also known as erbB1, is a tyrosine kinase transmembrane growth factor receptor which has been noted to be overexpressed in many cancers. Recent advances with targeted therapy for noncutaneous SCC of the head and neck with EGFR inhibitors have allowed use to be expanded for cutaneous manifestations of the disease. Although still limited in use to refractory or recurrent cases or those with metastatic disease, this new treatment modality acts to expand the limited options available in those cases where excisional surgery would be difficult to complete due to the associated morbidity and mortality. These agents can be separated into 2 general groups based on their mechanisms of action. EGFR tyrosine kinase inhibitors act by binding the intracellular tyrosine kinase region of EGFR,