Challenges and new horizons in the management of advanced basal cell carcinoma: a UK perspective

Abstract

Basal cell carcinoma (BCC) is a common malignancy with a good prognosis in the majority of cases. However, some BCC patients develop a more advanced disease that poses significant management challenges. Such cases include locally advanced, recurrent or metastatic BCC, or tumours that occur in anatomical sites where surgical treatment would result in significant deformity. Until recently, treatment options for these patients have been limited, but increased understanding of the molecular basis of BCC has enabled potential therapies, such as hedgehog signalling pathway inhibitors, to be developed. A clear definition of advanced BCC as a distinct disease entity and formal management guidelines have not previously been published, presumably because of the rarity, heterogeneity and lack of treatment options available for the disease. Here we provide a UK perspective from a multidisciplinary group of experts involved in the treatment of complex cases of BCC, addressing the key challenges associated with the perceived definition and management of the disease. With new treatments on the horizon, we further propose a definition for advanced BCC that may be used as a guide for healthcare professionals involved in disease diagnosis and management.

Long‐term efficacy and safety of sonidegib in patients with locally advanced and metastatic basal cell carcinoma: 30‐month analysis of the randomized phase 2 BOLT study

“…Patients with locally advanced basal cell carcinoma (laBCC) or metastatic BCC (mBCC) have historically had limited treatment options 1. Surgery, the primary course of treatment for most BCCs, and radiotherapy are often not viable options in advanced BCC 1, 2, 3.…”

“…Surgery, the primary course of treatment for most BCCs, and radiotherapy are often not viable options in advanced BCC 1, 2, 3. In recent years, hedgehog (Hh) pathway inhibitors (HPIs) were developed to block aberrant Hh signalling that is found in most sporadic BCCs; HPIs have demonstrated efficacy in patients with laBCC and those with mBCC 4, 5, 6, 7, 8, 9, 10, 11, 12, 13…”

Sonidegib for the treatment of advanced basal cell carcinoma

“…As locally advanced BCC is rare and rather heterogeneous, there is no officially recognized definition of the term. Other terms used in the literature include "severe", "advanced" and "aggressive" BCC 5 . Advanced BCC sometimes comprises laBCC and mBCC.…”

Photodynamic therapy for recurrent basal cell carcinoma after radiotherapy

“…Традиционно считается, что ФДТ может быть эффективна только при лечении опухолей небольшого размера, но в клиниче-ской практике нередко встречаются не только первичные, но и рецидивные местно-распространенные новообразования, при которых выбор эффективного метода лечения, в частности ФДТ, является предметом дискуссий в отечественной и зарубежной ли-тературе [9][10][11][12][13].…”

“…В результате фотохимической реакции происходит генерация синглетного кислорода внутри клеток и образование свободных радикалов, повреждающих мембраны и органеллы клеток, наиболее интенсивно накопивших ФС, вызывая их ги-бель по механизму некроза и апоптоза [7,8]. Селективность на-копления ФС обеспечивает избирательность повреждения опу-холи и минимальное поражение здоровых тканей при проведе-нии лазерного облучения [7].Традиционно считается, что ФДТ может быть эффективна только при лечении опухолей небольшого размера, но в клиниче-ской практике нередко встречаются не только первичные, но и рецидивные местно-распространенные новообразования, при которых выбор эффективного метода лечения, в частности ФДТ, является предметом дискуссий в отечественной и зарубежной ли-тературе [9][10][11][12][13].В отделе фотодинамической диагностики и терапии МРНЦ им. А.Ф.…”