Combination Trimodality Therapy Using Vismodegib for Basal Cell Carcinoma of the Face

Abstract

Background. For large basal cell carcinomas (BCCs) of the head and neck, definitive surgery often requires extensive resection and reconstruction that may result in prolonged recovery and limited cosmesis. Vismodegib, a small-molecule inhibitor of the hedgehog pathway, is approved for advanced and metastatic BCCs. We present a case of advanced BCC treated with combination of vismodegib, radiotherapy, and local excision resulting in excellent response and cosmesis. Case Presentation. A 64-year-old gentleman presented with a 5-year history of a 7 cm enlarging right cheek mass, with extensive vascularization, central ulceration, and skin, soft tissue, and buccal mucosa involvement. Biopsy revealed BCC, nodular type. Up-front surgical option involved a large resection and reconstruction. After multidisciplinary discussion, we recommended and he opted for combined modality of vismodegib, radiotherapy, and local excision. The patient tolerated vismodegib well and his right cheek lesion decreased significantly in size. He was then treated with radiotherapy followed by local excision that revealed only focal residual BCC. Currently, he is without evidence of disease and has excellent cosmesis. Conclusions. We report a case of locally advanced BCC treated with trimodality therapy with vismodegib, radiotherapy, and local excision, resulting in excellent outcome and facial cosmesis, without requiring extensive resection or reconstructive surgery.

Tamoxifen Resistance: Emerging Molecular Targets

“…Studies have revealed that blocking SMO with vismodegib can effectively reduce cellular proliferation [ 130 , 229 ] and inhibit the tumor growth of TAM-resistant xenografts in mice [ 130 ]. Vismodegib is a well-tolerated drug that offers an excellent outcome in canonical HH signaling-dependent cancers, e.g., basal cell carcinoma [ 228 , 230 ]. The limitation of SMO antagonists relates to the activation of the GLI factors independently of SMO in certain cancers [ 231 ].…”

Pathologic complete response with radiation and vismodegib in a patient with advanced basal cell carcinoma: A case report

“…To date, there is no evidence to suggest systemic chemotherapy improves local control outcomes when combined with RT for advanced BCC. In 2012, vismodegib became the first systemic therapy approved for BCC ( 5 ), followed by sonidegib approval in 2015, and evidence continues to be generated as combination with RT is explored in advanced, unresectable cases ( 10 , 11 ). In our patient with multifocal BCC, all lesions exhibited some response to vismodegib, with complete and durable responses noted in those larger lesions treated with combination therapy and a durable complete clinical response in the right lateral ankle lesion with vismodegib alone, a remarkable finding.…”

Neglected skin cancer in the elderly: a case of basosquamous cell carcinoma of the right shoulder

“…These trials suggest that this drug may provide a viable option for the treatment of previously untreatable BCC without risk of a potentially disfiguring surgery. Recent studies suggest a combination therapy with radiation and vismodegib could be even more effective for the treatment of advanced disease [ 10 ]. However, in our case, consideration should be given to all potential treatment options, accounting for the overall health of patient and after a detailed discussion of risks and benefits of each treatment approach.…”