Low-Dose Vismodegib as Maintenance Therapy After Locally Advanced Basal Cell Carcinoma Complete Remission: High Efficacy with Minimal Toxicity

Scalvenzi, Massimiliano; Cappello, Milena; Costa, Cláudia; Fabbrocini, Gabriella; Luciano, Mariaantonietta; Villani, Alessia

doi:10.1007/s13555-020-00371-1

Cited by 11 publications

(12 citation statements)

References 8 publications

(13 reference statements)

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“…All patients who took the maintenance therapy did not experience clinical recurrence at 1-year follow-up, whereas 26% of patients not on the maintenance dose relapsed. 90 Consequently, these results indicate that BCC recurrence is frequent after SHH inhibitor therapy and highlights the importance of close surveillance after CR is attained. Nevertheless, most patients still respond to treatment with SHH inhibitors after relapsing, and intermittent maintenance doses may be an effective means to reduce risk of recurrence.…”

Section: Recurrencementioning

confidence: 86%

“…89 An observational retrospective study also assessed the efficacy of SHH inhibitor maintenance therapy for advanced BCC patients who achieved a CR. 90 In the study, 27 (64%) patients received a maintenance dose of 150 mg vismodegib once per week for 1 year, while 15 (36%) patients decided not to take a maintenance dose following CR of their BCC. All patients who took the maintenance therapy did not experience clinical recurrence at 1-year follow-up, whereas 26% of patients not on the maintenance dose relapsed.…”

Section: Recurrencementioning

confidence: 99%

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Systemic Targeted Treatments for Basal Cell Carcinoma

Svoboda

Johnson

Phillips

2022

Cutis

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The sonic hedgehog (SHH) inhibitors vismodegib and sonidegib currently are the only 2 oral medications approved by the US Food and Drug Administration for the first-line treatment of locally advanced basal cell carcinoma (BCC). Vismodegib also is approved for metastatic BCC.• Cemiplimab, a programmed cell death protein 1 inhibitor, is now an approved treatment for patients with advanced BCC refractory or intolerant to SHH inhibitor therapy.• Adverse effects of SHH inhibitors, most commonly muscle spasms, often lead to treatment discontinuation, but intermittent dosing regimens can be used to increase tolerability and adherence.• Combining SHH inhibitors with radiotherapy or antifungal therapy as well as maintenance dosing strategies may help reduce the risk of recurrence.• Neoadjuvant administration of a SHH inhibitor may enable surgical excision of previously inoperable cases through tumor shrinkage.

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Section: Recurrencementioning

confidence: 86%

Section: Recurrencementioning

confidence: 99%

Systemic Targeted Treatments for Basal Cell Carcinoma

Svoboda

Johnson

Phillips

2022

Cutis

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“…In a single-center retrospective observational study, 42 patients with aBCC who had CR after vismodegib treatment were divided into two groups: 64% of patients received a once-weekly maintenance dose of 150 mg vismodegib for one year after CR, while 36% of patients did not receive a maintenance dose due to more severe AEs [ 47 ]. In patients who continued low-dose vismodegib treatment, no BCC recurrence occurred during the 1-year follow-up.…”

Section: Targeted Treatment With Hhis—how To Balance Efficacy and Tox...mentioning

confidence: 99%

Long-Term Management of Advanced Basal Cell Carcinoma: Current Challenges and Future Perspectives

Heppt

Gebhardt

Hassel

et al. 2022

Cancers

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The first-line therapy for locally advanced basal cell carcinoma (laBCC) is Hedgehog pathway inhibitors (HHIs), as they achieve good efficacy and duration of response. However, toxicity in the course of long-term treatment may lead to a decrease in the quality of life, and consequently to interruption or even discontinuation of therapy. As HHI therapy is a balancing act between effectiveness, adverse events, quality of life, and adherence, numerous successful treatment strategies have evolved, such as dose reduction and dose interruptions with on-off treatment schedules or interruptions with re-challenge after progression. As a small percentage of patients show primary or acquired resistance to HHIs, the inhibition of programmed cell death protein 1 (PD-1) has been approved as a second-line therapy, which may also be accompanied by immune-related toxicities and non-response. Thus, optimization of current treatment schedules, novel agents, and combination strategies are urgently needed for laBCC. Here, we narratively model the treatment sequence for patients with laBCC and summarize the current state of approved treatment regimens and therapeutic strategies to optimize the long-term management of laBCC.

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“…In patients with Gorling syndrome, the ORR was 80% in MBCC and 81.7% in LBCC [ 8 ]. Long-term use of vismodegib at a low dose of 150 mg once a week has shown to reduce the risk of recurrence after complete regression of BCC compared to the 26.6% regression in patients who did not take the drug [ 10 ].…”

Section: Reviewmentioning

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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Low-Dose Vismodegib as Maintenance Therapy After Locally Advanced Basal Cell Carcinoma Complete Remission: High Efficacy with Minimal Toxicity

Cited by 11 publications

References 8 publications

Systemic Targeted Treatments for Basal Cell Carcinoma

Systemic Targeted Treatments for Basal Cell Carcinoma

Long-Term Management of Advanced Basal Cell Carcinoma: Current Challenges and Future Perspectives

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

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