Targeted drugs and immunotherapy for skin cancer

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack cancer. They are called immunotherapies.

Some drugs work in more than one way. So they are targeted as well as working with the immune system. 

The main targeted drugs and immunotherapy for skin cancer are:

• imiquimod (Aldara) cream 
• cemiplimab (Libtayo)
• vismodegib (Erivedge)

This page is about targeted drugs and immunotherapy for non melanoma skin cancer

When do you have targeted and immunotherapy drugs for skin cancer?

For skin cancer you might have one of the following treatments:

Imiquimod cream

You might have imiquimod cream as a treatment if you have basal cell carcinoma (BCC) in the top layer of skin or actinic keratosis. Actinic keratosis is a skin condition that can develop into a squamous cell carcinoma (SCC) over time.

Cemiplimab (Libtayo)

Cemiplimab (Libtayo) is a type of immunotherapy called a checkpoint inhibitor. 

You might have cemiplimab for SCC if:

• it is locally advanced or has spread to other parts of the body 
• you can’t have surgery or radiotherapy

Locally advanced means the cancer has spread to deeper layers of skin or nearby lymph nodes and you can't have surgery. 

Vismodegib (Erivedge)

You might have vismodegib under the cancer drugs fund if you have lots of basal cell carcinomas (BCCs). 

Vismodegib has a drug license for basal cell carcinoma (BCC) that has spread to another part of the body (metastatic). Or for BCC that is locally advanced and surgery or radiotherapy are not possible.

But it is not available on the NHS for locally advanced or metastatic BCC. We have more information about this below. 

Types of targeted drugs and immunotherapy for skin cancer

Imiquimod cream (Aldara)

Imiquimod cream uses your body’s natural defences to help kill the skin cancer cells. It works by releasing a number of chemicals called cytokines. One of these cytokines is called interferon.

Interferon is a protein that the body makes as part of the immune response. Interferon is also used as a cancer treatment. It is thought that imiquimod makes cells produce more interferon which destroys the skin cancer cells.

Cemiplimab (Libtayo)

Cemiplimab (Libtayo) is a type of immunotherapy called a checkpoint inhibitor.

Cemiplimab works by blocking a protein that stops the immune system from working properly and attacking cancer cells. It helps to make your immune system find and kill cancer cells.  

Vismodegib (Erivedge)

Vismodegib (Erivedge) is a type of targeted drug called a cancer growth blocker. It works by targeting and switching off a group of proteins. This stops the growth of the cancer.

Are these drugs available in the UK?

New cancer drugs are licensed for use in a particular way.  For example, a drug might have a license to treat a particular stage or type of skin cancer. 

Once a drug has a license, several independent organisations approve the new cancer drugs before doctors can prescribe them on the NHS.

In England the National Institute for Health and Care Excellence (NICE) decides which drugs and treatments are available on the NHS.

In Wales, the All Wales Medicines Strategy Group (AWMSG) advises NHS Wales. They generally follow NICE decisions but can also issue their own guidance,

The Scottish Medicines Consortium (SMC) advises NHS Scotland. Its decisions are separate from decisions made by NICE.

The Department of Health advises about health and social care in Northern Ireland. They usually follow NICE decisions.

Having targeted and immunotherapy drug treatment

You have:

• imiquimod as a cream on your skin
• cemiplimab through a tube into your bloodstream
• vismodegib as a tablet that you swallow

Imiquimod cream on the skin

You put the cream on yourself at home.

To treat BCC, you usually put imiquimod cream on to the affected area once a day. You do this 5 days a week for 6 weeks. You usually leave the cream on the skin for about 8 hours. You shouldn't shower or bathe during this time. 

Into the bloodstream

You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You may need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

By mouth (orally)

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

Side effects

Everyone is different and the side effects vary from person to person. The side effects you have depend on:

• which drug you have
• whether you have it alone or with other drugs
• the amount of drug you have (the dose)
• your general health

A side effect may get better or worse during your course of treatment. Or more side effects may develop as the treatment goes on. For more information about the side effects of your treatment, go to the individual drug pages.

We don't have a page about cemiplimab or vismodegib at the moment.

You can read some general information about the side effects of checkpoint inhibitors in our immunotherapy section. 

You can read some general information about the side effects of cancer growth blockers in our targeted cancer drug section.