Current landscape for treatment of advanced basal cell carcinoma

Abstract

Basal cell carcinomas (BCCs) account for around 80% of non-melanoma skin cancer. Australia has the highest incidence of BCC globally and the rates continue to increase in both Australia and New Zealand. BCC causes significant morbidity, placing an enormous burden on the healthcare system. Treatment of patients with advanced BCC can be particularly challenging. A panel of UK experts recently defined advanced disease as BCC that in which current treatment modalities are considered potentially contraindicated by clinical or patient-driven factors. Research has found that mutations in the hedgehog signalling pathway underpin the pathogenesis of the vast majority of sporadic BCC, as well as Gorlin syndrome. The first-in-class oral small molecule hedgehog pathway inhibitor -vismodegib-is now approved in a number of countries for use in locally-advanced and metastatic BCC and has resulted in improved outcomes in the majority of patients treated. With a number of similar agents in the pipeline, research is now focusing on identifying mechanisms that may contribute to resistance to this agent in some lesions.

Retrospective Real-Life Data, Efficacy and Safety of Vismodegib Treatment in Patients with Advanced and Multiple Basal Cell Carcinoma: 3-Year Experience from a Spanish Center

“…Non-surgical or topical options such as imiquimod, photodynamic therapy or 5-fluorouracil are used in small or superficial lesions but are ineffective in the treatment of advanced tumors. They could be suitable for elderly patients with multiple comorbidities, with the disadvantages of a higher recurrence rates and the absence of histological confirmation of curation [15]. Radiation therapy may be recommended in BCC in patients who are not surgical candidates due to tumor (extent and location) or patient features (comorbidities).…”

A Novel Alternate Dosing of Vismodegib for Treatment of Patients With Advanced Basal Cell Carcinomas

“…Discussion | Vismodegib is an oral inhibitor of the Hedgehog signaling pathway. 6 Increasing research in BCC pathogenesis has led to the discovery that stimulating mutations in the Hedgehog pathway account for most sporadic and basal cell nevus syndrome-associated BCCs. 7 Adverse effects have limited treatment duration and tolerability.…”