Reply to Woltsche N. et al. Managing adverse effects by dose reduction during routine treatment of locally advanced basal cell carcinoma with the hedgehog inhibitor vismodegib: a single‐centre experience

Abstract

Linked article: This article is commented on by N. Woltsche et al., pp. e144–e145 in this issue. To view this article visit https://doi.org/10.1111/jdv.15367.

Real-Life Effectiveness of Vismodegib in Patients with Metastatic and Advanced Basal Cell Carcinoma: Characterization of Adverse Events and Assessment of Health-Related Quality of Life using the Dermatology Life Quality Index (DLQI) Test

“…In recent years, different dose reduction strategies during routine treatment have been proposed as a means to reduce AE severity and achieve the optimum duration of vismodegib treatment. Transitioning from a continuous to an intermittent regimen could be a way to avoid dropouts [9,10]. NMSC also has an appreciable impact on patient QOL, especially for the locally advanced and the metastasizing forms of BCC, due to the symptomatology involved and the potential for physical disfigurement, which usually compromises the psychological state of the patient [11].…”

Sonidegib: Safety and Efficacy in Treatment of Advanced Basal Cell Carcinoma

“…Side effects from SMO inhibitors are very common and can be significant. Adverse events frequently represent a limiting factor in continuous treatment, and dose adjustments or different schemes to avoid discontinuation and increase patients compliance are often required [45,46]. In the initial BOLT study, [22].…”

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

“…In recent years, vismodegib, a HHI, has been used in the treatment of patients with laBCCs who are ineligible for surgery or radiotherapy and shown promising results [2]. Nevertheless, patients usually report several AEs while receiving vismodegib therapy, and dose adjustments are sometimes required during the therapy to decrease the possibility of the patient discontinuing the treatment and to increase the patient's adherence to therapy [7,8]. Our retrospective analysis focused on the use of a novel therapeutic scheme based on the prolonged use of low-dose vismodegib after CR of the laBCC; this strategy proved to be effective in eliminating skin tumor recurrence and in reducing the severity of common AEs.…”

“…Interestingly, we observed that patients with dose adjustment did not present any recurrence, while recurrences were reported in four of the 15 patients who stopped the drug treatment following achievement of CR. To our knowledge, there is no report in the literature of studies describing the continuous use of low-dose vismodegib as maintenance therapy after CR of laBCCs, although different dose adjustment schemes during treatment to manage AEs have been described [8].…”

“…Although this novel drug has been shown to be a safe and effective drug, usually increasing patients' health-related quality of life [5], some adverse events (AEs) during treatment, such as muscle spasms, dysgeusia, and alopecia, have been described [6]. In order to increase patients' compliance and adherence to treatment, many different schemes of dose reduction during treatment have been proposed [7,8]. However, to date, the effect of a prolonged use of low-dose vismodegib, also after complete remission (CR) of the laBCC has been achieved, has not been described.…”