Invasive Basal Cell Carcinoma of the Skin Treated Successfully with Vismodegib: A Case Report

Awad, Ramez; Andrade, Juan Camilo Barreto; Mousa, Heba; Mahmoud, Fade

doi:10.7812/tpp/17-181

Cited by 6 publications

(4 citation statements)

References 9 publications

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“…Twenty‐nine studies were included, 13–42 providing demographic and treatment information from 103 patients. Specifically, 23 studies ( n = 78) were included in a pooled statistical analysis encompassing treatment outcomes from a combination of HHIT (vismodegib only, as no reports were retrieved for sonidegib) and adjunctive therapies including excisional surgery, Mohs micrographic surgery (MMS), and/or radiation therapy (RT).…”

Section: Resultsmentioning

confidence: 99%

“…Following the removal of manuscripts meeting exclusion criteria, 29 studies were ultimately included (Figure 1). 13–42 Treatment(s) consisted of HHIT followed by adjunctive therapy in all cases. Complete response (CR) was defined as no evidence of BCC post‐HHIT and adjunctive treatment per study investigator.…”

Section: Methodsmentioning

confidence: 99%

“…In contrast, head and neck tumors were most commonly treated with MMS (n = 11, 44%), followed by RT (n = 7, 25%) and surgical excision (n = 4, 16%). RT was utilized for more than half of trunk lesions (n = 5, 55.6%), followed by MMS (n = 2, 22.2%) and surgery (n = 2, 22.2%), and modalities were evenly distributed for extremity lesions (n = 4).Duration of HHIT was variable between treatment modalitieswith the longest median duration (IQR) of 12(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) months prior to surgical excision (p = 0.009), with no significant difference between HHIT duration and best response (CR vs. non-CR) after surgery. Overall, the median duration of HHIT was 6 months (IQR: 4-10 months) in complete responders versus 14 months (IQR: 8-15 months) in patients with non-CR (Table…”

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confidence: 99%

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Outcomes of adjunctive therapies post hedgehog inhibitors in the management of locally advanced basal cell carcinoma: A systematic review and pooled analysis

Patel

Kim

Liss

et al. 2021

Dermatologic Therapy

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Management of patients with locally advanced basal cell carcinoma (laBCC) with traditional strategies has yielded suboptimal outcomes. Targeted treatments including hedgehog inhibitor therapy (HHIT) present limitations when utilized as monotherapy.Herein, we report evidence-based outcomes from available literature on multimodality treatments adjuvant to HHIT in laBCC management. Utilizing a systematic search strategy in PubMed, we identified studies published from inception to April 15, 2020, screened for definitive inclusion/exclusion criteria, and performed individual study quality assessment and pooled analysis to assess impact of adjunctive treatment-based responses post-HHIT on clinical response and recurrence outcomes. Twenty-nine studies (n = 103) were included. Primary findings include a complete response (CR) rate of 90.5%, the median follow-up of 12 months post-HHIT completion. The recurrence rate was 10.8% with 12-month median time to recurrence. Mohs micrographic surgery (MMS) had 100% CR post-HHIT, while no difference was observed between surgery and radiation therapy (RT). MMS and surgery had comparable 2-year recurrence free rates (RFR) at 87% and 86% respectively, while RT had the lower 2-year RFR at 67%. Male gender portended a more advanced stage at diagnosis and worse outcomes. In a subset analysis, periorbital laBCCs with orbital involvement had a CR rate of 81.8% versus 100% in those without orbital involvement, with similar rates of recurrence. Limited available quantitative data and possible publication bias were limitations. Pooled analysis of observational data supports use of adjunctive therapies post-HHIT to improve treatment response in patients with laBCC. Longer-term follow-up is needed to study recurrence rates after combination therapy.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

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confidence: 99%

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Outcomes of adjunctive therapies post hedgehog inhibitors in the management of locally advanced basal cell carcinoma: A systematic review and pooled analysis

Patel

Kim

Liss

et al. 2021

Dermatologic Therapy

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“…The mainstay of BCC treatments includes surgical local excision, microscopic Mohs surgery, local destructive measures by cryotherapy, topical imiquimod, 5-fluorouracil, and photodynamic therapy, with most treatments having a five-year cure rate of ≥95% [2][3][4]. For LBCC and MBCC, surgical or local treatments are not curable and systemic therapies should be considered [3].…”

Section: Introductionmentioning

confidence: 99%

Hedgehog Pathway Inhibitors: Clinical Implications and Resistance in the Treatment of Basal Cell Carcinoma

Habashy

Jafri

Osman

et al. 2021

Cureus

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Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer and is on the rise. Most BCCs are benign; however, a very small percentage are locally advanced and metastatic. The pathway that normally regulates cell growth and proliferation is directed by the hedgehog pathway (HP). In BCC, it becomes over-stimulated due to genetic abnormalities. Treatments for BCC include local treatment by cryotherapy (liquid nitrogen), topical immunosuppression, surgery, or radiotherapy. Systemic treatment may be required in locally advanced lesions, metastatic BCC, or individuals who are inoperable. The systemic treatments of BCC act to inhibit the HP and are called hedgehog pathway inhibitors. The first one being vismodegib and the second sonidegib. Although these treatments have shown promising results, they have prominent side effects in almost all patients, with few patients having to discontinue the treatment. About 50% of patients did not respond to treatment from the beginning, some had partial responses, others had recurrence after discontinuing the drugs, and few had worsening of the disease. In this paper, we will explore the most common side effects, resistance, and different methods to overcome resistance to ensure the highest rate of cure for BCC.

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Contemporary Topics in Radiation Medicine

Gao

Decker

2020

Hematology/Oncology Clinics of North America

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Invasive Basal Cell Carcinoma of the Skin Treated Successfully with Vismodegib: A Case Report

Cited by 6 publications

References 9 publications

Outcomes of adjunctive therapies post hedgehog inhibitors in the management of locally advanced basal cell carcinoma: A systematic review and pooled analysis

Outcomes of adjunctive therapies post hedgehog inhibitors in the management of locally advanced basal cell carcinoma: A systematic review and pooled analysis

Hedgehog Pathway Inhibitors: Clinical Implications and Resistance in the Treatment of Basal Cell Carcinoma

Contemporary Topics in Radiation Medicine

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