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

Amini, Arya; Freeman, Morganna; Melstrom, Laleh G.; Margolin, Kim; Parekh, Vishwas; Abdulla, Farah; Modi, Badri

doi:10.3892/mco.2021.2208

Cited by 7 publications

(6 citation statements)

References 12 publications

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“…These responses were achieved with modest levels of toxicity. Our approach is supported by a number of recent individual case reports showing that concurrent vismodegib or sonidegib with concurrent radiotherapy is feasible with high complete response rates and manageable toxicity [21][22][23][24]. In addition, vismodegib has recently been employed to downstage patients with laBCC prior to planned surgical resection [25].…”

Section: Discussionmentioning

confidence: 83%

Hedgehog Inhibitor Induction with Addition of Concurrent Superficial Radiotherapy in Patients with Locally Advanced Basal Cell Carcinoma: A Case Series

2021

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Background. Locally advanced basal cell cancer is a rare and challenging clinical problem. Historically, these patients were treated with aggressive surgery or radiotherapy. Most sporadic basal cell carcinomas have somatic mutations in the hedgehog pathway. Oral hedgehog inhibitors induce rapid and often complete clinical responses in locally advanced basal cell tumors. Unfortunately, these responses are usually transient. We hypothesized that treatment failure represents persistence of drug resistant cells that could be eradicated by addition of localized radiotherapy. Materials and Methods. We performed a retrospective review of our patients with locally advanced basal cell cancer treated with sonidegib or vismodegib induction therapy who were treated with added superficial radiotherapy at the time of maximal response. Results. Twelve patients met inclusion criteria. All patients achieved a complete response following hedgehog inhibitor therapy with addition of radiotherapy. Progression-free survival at 40 months was 89%, with a median follow-up of 40 months. Relapses occurred in only 2 of 12 patients (16.6%). Nine patients experienced grade I-II toxicity from hedgehog inhibitor induction therapy (taste changes [3], weight loss [3], muscle cramps [3]). Eight patients experienced mild radiotherapy-induced skin toxicity during concurrent therapy. No patients had to discontinue treatment. Conclusion. Induction therapy with hedgehog inhibitors followed by addition of concurrent radiation therapy resulted in an extremely high clinical response rate with relatively minor and reversible toxicity. This gave a high rate of progression-free survival and a low disease-specific progression rate. Further prospective evaluation of this treatment approach is needed to confirm the apparent clinical activity. The Oncologist ;9999:• • Implications for Practice: Locally advanced basal cell cancers are challenging to treat. Previously, aggressive surgical resection or radiotherapy represented the best treatment options. Most basal cell cancers have somatic mutations in the hedgehog pathway. Oral inhibitors of this pathway produce rapid, but transient clinical responses. This study reports 12 patients treated with hedgehog inhibitor induction therapy to near-maximal response. Addition of concurrent involved field radiotherapy resulted in a very high complete response rate with minimal toxicity. There was prolonged progressionfree survival in 90% of patients. This study identified a novel treatment approach for patients with advanced basal cell carcinoma.

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Section: Discussionmentioning

confidence: 83%

Hedgehog Inhibitor Induction with Addition of Concurrent Superficial Radiotherapy in Patients with Locally Advanced Basal Cell Carcinoma: A Case Series

2021

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“…These include fatigue, loss of appetite, alopecia, diarrhea, muscle spasms, impaired taste, and weight loss. Due to these side effects, many patients are unable to tolerate the treatment, and Jacobsen et al found that more than a quarter of their patients (28.2%) discontinued therapy [ 1 , 12 , 15 ]. Our patient developed alopecia, but was willing to continue therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Basal cell carcinoma (BCC) is the most common cutaneous malignancy in the USA and worldwide [ 1 ]. In the USA, more than 2.8 million cases are diagnosed each year.…”

Section: Introduction/backgroundmentioning

confidence: 99%

Management of Locally Advanced Basal Cell Carcinoma with Sonic Hedgehog Pathway Targeted Therapy: A Case Report and Discussion

Ferrin,

Edmond,

Jones

et al. 2024

Case Rep Dermatol

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Introduction: Basal cell carcinoma (BCC) is the most common skin malignancy in the world. While most lesions are treated using surgical methods, others may present as locally advanced or metastatic disease and are not amenable to surgical therapy alone. Treatment with sonic hedgehog pathway inhibitors (vismodegib, sonidegib) is designed to inhibit key signaling proteins and gene pathways involved with BCC to reduce the uncontrolled proliferation of basal cells in complicated disease and can be invaluable in treating patients with advanced disease. Case Presentation: We describe the course of a 68-year-old man who presented with a 7.2 × 6 cm exophytic and ulcerated locally invasive BCC of his upper back. The patient was started on daily vismodegib treatment with the goal of eventual surgical resection. After 11 weeks of therapy, he had significant improvement in both wound size and appearance. After 18 weeks of therapy, he had achieved a near complete clinical response of the central aspect of lesion with three remaining small peripheral lesions. These lesions were biopsied, and two were found to be negative for malignancy, while a small inferior nodule was positive for squamous cell carcinoma (SCC). Vismodegib therapy was discontinued after a total of 26 weeks of therapy. Excision of the SCC was performed, and the patient remains disease free at 2 years. Conclusion: This case report shows the efficacy of hedgehog pathway inhibitor therapy in the treatment of a locally advanced BCC with complete pathologic response, not requiring surgical intervention.

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“…HHIs have also been utilized in combination with radiotherapy for aBCC. 12 – 14 Concurrent vismodegib and multi-site radiotherapy led to a partial response in a case of multifocal BCC. 12 In addition, HHIs have been used as an induction treatment prior to radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

“… 12 – 14 Concurrent vismodegib and multi-site radiotherapy led to a partial response in a case of multifocal BCC. 12 In addition, HHIs have been used as an induction treatment prior to radiotherapy. A case series of 12 aBCC patients utilized this approach and found that 88.8% of patients were progression-free 40 months after initial HHI treatment.…”

Section: Discussionmentioning

confidence: 99%

Combined cemiplimab and radiotherapy for advanced basal cell carcinoma: A case report

Sarfaraz

Hayes

Hunt

2023

SAGE Open Medical Case Reports

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Advanced basal cell carcinoma may be treated with systemic therapies such as hedgehog pathway inhibitors or programmed cell death protein 1 inhibitors, namely cemiplimab. We report a case of a 70-year-old man with a nodulo-infiltrative advanced basal cell carcinoma over the right posterior neck and scapula. The patient had a partial response to the hedgehog pathway inhibitor, vismodegib. The tumour progressed, and the patient was switched from vismodegib to radiotherapy combined with cemiplimab, which led to a significant reduction in pain, bleeding, and tumour size. A combined treatment approach with radiotherapy and cemiplimab may be beneficial for advanced basal cell carcinoma cases that progress after treatment with hedgehog pathway inhibitors.

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

Cited by 7 publications

References 12 publications

Hedgehog Inhibitor Induction with Addition of Concurrent Superficial Radiotherapy in Patients with Locally Advanced Basal Cell Carcinoma: A Case Series

Hedgehog Inhibitor Induction with Addition of Concurrent Superficial Radiotherapy in Patients with Locally Advanced Basal Cell Carcinoma: A Case Series

Management of Locally Advanced Basal Cell Carcinoma with Sonic Hedgehog Pathway Targeted Therapy: A Case Report and Discussion

Combined cemiplimab and radiotherapy for advanced basal cell carcinoma: A case report

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