Role of Chemotherapy and Immunotherapy in Advanced T3 or T4 Ocular Surface Squamous Neoplasia: A Review of the Current Literature

To report on the use of chemotherapy and immunotherapy for advanced T3 or T4 ocular surface squamous neoplasia (OSSN).

Surgical excision has traditionally been the mainstay of treatment for ocular surface squamous neoplasia (OSSN), with extensive disease involving the eyelid or orbit being managed with exenteration. In the past two decades, chemotherapy and immunotherapy agents have emerged as valuable treatment options for OSSN.

Of the 16 published cases, ten (63%) patients presented with T3 OSSN involving the eyelid and six (37%) patients with T4 OSSN. The fornix (81%) and palpebral conjunctiva (69%) were the most involved structures. Orbital involvement was evident in six (37%) cases. Complete tumor regression was observed in 33% (1 of 3) of patients treated with topical mitomycin C, 50% (3 of 6) with topical/subconjunctival injection interferon alpha-2b, 0% (0 of 3) with systemic chemotherapy (carboplatin or cisplatin/paclitaxel), and 100% (4 of 4) with systemic immune checkpoint inhibitors (cemiplimab or pembrolizumab). Recurrence and partial regression were more commonly observed in patients initially managed with topical and systemic chemotherapy. Our findings suggest that systemic immune checkpoint inhibitors may be an effective therapeutic option for advanced T3 or T4 OSSN involving the eyelid or orbit.