gdc-0449 and Skin-Neoplasms

Basal cell carcinoma (BCC) of the skin is the most common form of skin cancer in the United States. In life-threatening, advanced BCC, sonic hedgehog inhibitors (SSHis) remain a pre-eminent treatment option for locally advanced BCC and metastatic BCC.. In this updated systematic review and meta-analysis, we aimed to better characterize the efficacy and safety of SSHis by including final updates from pivotal clinical trials and additional new recent studies.. An electronic database search was performed for articles including clinical trials, prospective case series, and retrospective medical record reviews on human subjects. Overall response rates (ORRs) and complete response rates (CRRs) were the primary outcomes. For safety assessment, the prevalence of the following adverse effects was analyzed: muscle spasms, dysgeusia, alopecia, weight loss, fatigue, nausea, myalgias, vomiting, skin squamous cell carcinoma, increased creatine kinase, diarrhea, decreased appetite, and amenorrhea. Analyses were performed using R statistical software. Data were pooled using linear models with fixed effects meta-analysis for primary analyses, along with 95% confidence intervals (CIs) and p-values. Intermolecular differences were calculated using Fisher's exact test.. A total of 22 studies (N = 2384 patients) were included in the meta-analysis: 19 studies assessing both efficacy and safety, 2 studies assessing safety only, and 1 study assessing efficacy only. Overall, the pooled ORR for all patients was 64.9% (95% CI 48.2-81.6%), implicating there is at least a partial response (z = 7.60, p < 0.0001) in most patients receiving SSHis. The ORR for vismodegib was 68.5% and 50.1% for sonidegib. The most common adverse effects for vismodegib and sonidegib were muscle spasms (70.5% and 61.0%, respectively), dysgeusia (58.4% and 48.6%, respectively), and alopecia (59.9% and 51.1%, respectively). Patients were likely to experience weight loss (35.1%, p < 0.0001) from vismodegib. Alternatively, patients taking sonidegib experienced more nausea, diarrhea, increased creatine kinase levels, and decreased appetite compared with those receiving vismodegib.. SSHis are an effective treatment for advanced BCC disease. Given the high discontinuation rates, management of patient expectations is warranted for compliance and achieving long-term efficacy. It is essential to stay updated with the latest discoveries on the efficacy and safety of SSHis.

Topics: Alopecia; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Creatine Kinase; Diarrhea; Drug-Related Side Effects and Adverse Reactions; Dysgeusia; Female; Hedgehog Proteins; Humans; Nausea; Retrospective Studies; Skin Neoplasms; Spasm; Weight Loss

As one of the most common malignancies, basal cell carcinoma (BCC) has evolved as a global burden with incidence annually rising, especially in the older population. Even though the condition is mostly localized, the nature of the disease is destructive and can evolve as either locally advanced BCC (laBCC) or even more rarely as metastatic BCC (mBCC). There are well-established conventional treatment options for these cases, including surgeries and radiotherapy. However, not all cases are eligible for conventional treatments. Recently, biologic treatment has gained a lot of attention and research. This has led to the development of targeted treatment involving the hedgehog pathway inhibitor (HPI), a key pathogenesis in laBCC and mBCC. There are currently two approved HPIs, vismodegib and sonidegib to treat inoperable laBCC and mBCC. This review seeks to explore the pathophysiology of hedgehog pathway behind the development of BCC, and the current update of the efficacy as well as pharmacokinetics properties of HPIs that led to the ideal treatment for laBCC or mBCC, either as monotherapy or in combination with other conventional therapies.

Topics: Anilides; Antineoplastic Agents; Biphenyl Compounds; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Pyridines; Skin Neoplasms

Eyelid basal cell carcinoma (BCC) is usually cured by surgery. However, for a minority of patients, extensive disease progression and recurrence contraindicate surgery or radiotherapy because of severe ocular morbidity. The hedgehog signaling pathway inhibitor vismodegib is becoming the key treatment for this specific form.. The aim of this review was to define the role of surgery after vismodegib treatment.. A literature search of the PubMed, Cochrane Library, ScienceDirect, and Embase databases was conducted for all articles published up to March 2021 to identify studies that examined treatment of BCC of the eyelid by vismodegib.. Level 1 evidence was found for the use of vismodegib as neoadjuvant therapy in locally advanced eyelid BCC contraindicated to surgery and/or radiotherapy with a rather good tolerance of treatment. Level 3 evidence was found for the role of surgical excision of residual clinically suspicious lesions as for the indication of eyelid reconstruction after mapping or during residual tumoral resection if frozen sections or Mohs surgery were performed.. Vismodegib is a well-tolerated treatment for advanced periorbital BCC. The hedgehog signaling pathway inhibitor vismodegib is a potential treatment option in patients with these challenging tumors.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Pyridines; Skin Neoplasms

Basal cell carcinoma (BCC) is one of the most common neoplasms in the population. A good prognosis and mainly non-aggressive development have made it underdiagnosed and excluded from the statistics. Due to the availability of efficient surgical therapy, BCC is sometimes overlooked in the search for novel therapies. Most clinicians are unaware of its complicated pathogenesis or the availability of effective targeted therapy based on Hedgehog inhibitors (HHI) used in advanced or metastatic cases. Nevertheless, the concomitance and esthetic burden of this neoplasm are severe. As with other cancers, its pathogenesis is multifactorial and complicated with a network of dependencies. Although the tumour microenvironment (TME), genetic aberrations, and risk factors seem crucial in all skin cancers, in BCC they all have become accessible as therapeutic or prevention targets. The results of this review indicate that a central role in the development of BCC is played by the Hedgehog (Hh) signalling pathway. Two signalling molecules have been identified as the main culprits, namely Patched homologue 1 (PTCH1) and, less often, Smoothened homologue (SMO). Considering effective immunotherapy for other neoplastic growths being introduced, implementing immunotherapy in advanced BCC is pivotal and beneficial. Up to now, the US Food and Drug Administration (FDA) has approved two inhibitors of SMO for the treatment of advanced BCC. Sonidegib and vismodegib are registered based on their efficacy in clinical trials. However, despite this success, limitations might occur during the therapy, as some patients show resistance to these molecules. This review aims to summarize novel options of targeted therapies in BCC and debate the mechanisms and clinical implications of tumor resistance.

Topics: Antineoplastic Agents; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Patched-1 Receptor; Signal Transduction; Skin Neoplasms; Smoothened Receptor; Tumor Microenvironment; United States

Trichoepithelioma is a rare benign adnexal neoplasm that can occur in various forms including solitary, multiple, familial or nonfamilial. Multiple facial trichoepithelioma can be associated with significant psychosocial burden. Conventional treatment modalities such as surgical excision and ablative laser have variable results and can be associated with unacceptable complications and tumour regrowth. Pharmacological interventions such as topical and systemic agents are potentially effective but clinical data are limited and treatments are poorly standardised. We review the available evidence to determine the role of pharmacological therapies in the management of multiple trichoepithelioma. Demographic and clinical data were retrospectively collected from the available English literature. Majority of cases treated with pharmacological therapies (93.75%) had a positive treatment outcome, achieving partial lesion response. Adverse effects associated with pharmacological therapies were generally well tolerated and did not interrupt treatment. There are limitations as to how our results can be interpreted owing to the paucity of good quality evidence, spectrum of disease severity, and diversity of study designs utilised in the included articles. Nonetheless, the results of our study indicate that while most pharmacological interventions for multiple trichoepithelioma produce a partial response, they can be employed as effective suppressive therapies, either alone or in conjunction with conventional treatments. The current evidence for pharmacological therapies remains largely anecdotal justifying the need for further clinical studies in this area.

Topics: Adalimumab; Administration, Topical; Anilides; Antineoplastic Agents; Aspirin; Humans; Imiquimod; Lasers, Gas; Neoplasms, Adnexal and Skin Appendage; Pyridines; Sirolimus; Skin Neoplasms; Tretinoin

Basal cell carcinoma (BCC) is the most common malignancy in fair-skinned populations. Most cases are successfully treated with surgery, but in advanced BCC—including locally advanced BCC and metastatic BCC—surgery is likely to result in substantial morbidity or unlikely to be effective. In those patients, the systemic Hedgehog inhibitors (HHIs) sonidegib and vismodegib are the only approved pharmacologic treatment option. Although a number of clinical studies highlight the similarities and differences between the two HHIs, no head-to-head clinical comparison is available. Results from the pivotal BOLT and ERIVANCE clinical studies for sonidegib and vismodegib, respectively, demonstrate similar efficacy measured by objective response rate, complete response rate, and histologic tumor subtype. Safety results for both studies are comparable with similar common adverse events reported for muscle spasms, alopecia, and dysgeusia. A notable difference between sonidegib and vismodegib is their respective pharmacokinetic profiles with sonidegib reaching peak concentration in plasma within 2–4 hours of dosing and steady state in plasma achieved by week 17 of treatment, while vismodegib reaches peak plasma concentration approximately 2 days after a single dose and steady state within 21 days of repeated dosing. This review compares efficacy, safety, and pharmacokinetics of sonidegib and vismodegib based on published literature to date. J Drugs Dermatol. 2021;20(2):156-165. doi:10.36849/JDD.5657\ \ THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL TEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.

Topics: Alopecia; Anilides; Biphenyl Compounds; Carcinoma, Basal Cell; Clinical Trials, Phase II as Topic; Dysgeusia; Hedgehog Proteins; Humans; Multicenter Studies as Topic; Progression-Free Survival; Pyridines; Randomized Controlled Trials as Topic; Signal Transduction; Skin Neoplasms; Spasm

Topics: Anilides; Animals; Antineoplastic Agents; Biphenyl Compounds; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Pyridines; Randomized Controlled Trials as Topic; Skin Neoplasms; Smoothened Receptor

Sonidegib and vismodegib are hedgehog pathway inhibitors (HhIs) approved for the treatment of advanced basal cell carcinoma (BCC). Until recently, vismodegib was the only targeted treatment available for patients with locally advanced BCC (laBCC) in cases where surgery and radiotherapy are inappropriate. Sonidegib has recently been approved and now presents an alternative treatment option. The clinical differences between the two HhIs in patients with laBCC are unclear, as no head-to-head randomized controlled trials are or will be initiated. Moreover, there were important differences in the designs of their pivotal studies, BOLT (sonidegib) and ERIVANCE (vismodegib), and these differences complicate evidence-based analysis of their relative efficacy and safety profiles. In this paper, a group of clinical experts in the management of laBCC summarizes the clinical and pharmacological profiles of sonidegib and vismodegib based on published data and their own clinical experience. One key difference between the two pivotal studies was the criteria used to assess BCC severity. ERIVANCE (a single-arm phase II trial) used the conventional Response Evaluation Criteria in Solid Tumors (RECIST), while the more recent double-blind randomized BOLT trial used the stringent modified RECIST. A preplanned analysis adjusted the outcomes from BOLT with RECIST-like criteria, and this enabled the experts to discuss relative efficacy outcomes for the two treatments. Centrally reviewed objective response rate (ORR) for vismodegib was 47.6% (95% CI: 35.5-60.6) at 21-month follow-up using RECIST. After adjusting with RECIST-like criteria, the ORR for sonidegib according to central review at 18-month follow-up was 60.6% (95% CI: 47.8-72.4). Both treatments were associated with similar patterns of adverse events. Sonidegib and vismodegib share the same efficacy and tolerability profiles, but their pharmacokinetic profiles show several differences, such as volume of distribution and half-life. Further studies are needed to understand how these differences may impact clinical practice.

Topics: Anilides; Antineoplastic Agents; Biphenyl Compounds; Carcinoma, Basal Cell; Expert Testimony; Hedgehog Proteins; Humans; Pyridines; Skin Neoplasms

Basal cell carcinoma is the most common skin tumour, with the majority of the cases occurring on the head and neck district, where cosmetic and functional results are crucial. It can be locally destructive if not diagnosed early and treated appropriately. Surgery is the treatment of choice for most lesions, but aggressive, recurrent, or unresectable tumours can be challenging to manage. Advanced basal cell carcinoma includes high recurrence risk subtypes, in which standard therapies demonstrate lack of efficacy. This led to a need for investigating more deeply the pathogenesis of the disease and to the discovery of the implication of the hedgehog pathway. The development of systemic inhibitors of this pathway provides new treatment options for patients with advanced disease, resulting in survival improvement. Food and Drug Administration, before, and European Medicines Agency later approved 2 Hedgehog pathway inhibitors for the treatment of advanced basal cell carcinomas, vismodegib and sonidegib. Here, we present a review of the current English language literature trying to analyze differences in the 2 drugs as a head-to-head comparison between them has not already been documented in a randomized controlled clinical trial. Although vismodegib and sonidegib showed similar efficacy and safety profiles, in an indirect comparison scenario, sonidegib has shown slightly better outcomes in locally advanced basal cell carcinoma than vismodegib. They present different molecular structures, as they bind different residues on their targets and develop resistance for different mutations. In a future scenario, clinical trials comparing the 2 drugs are needed, as well as expanding data on discontinuation of therapy and/or consequential administration of them, with the aim to improve our clinical practise.

Topics: Anilides; Antineoplastic Agents; Biphenyl Compounds; Carcinoma, Basal Cell; Drug Resistance, Neoplasm; Hedgehog Proteins; Humans; Neoplasm Recurrence, Local; Pyridines; Signal Transduction; Skin Neoplasms

Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer (NMSC). Although surgery is the first-line therapy for BCC, some cases can progress to an advanced or, rarely, a metastatic state and targeted therapy are required. The main pathway involved in BCC tumorigenesis is the Hedgehog (Hh) signaling pathway and its inhibition is among the few treatment options available for patients with advanced BCCs. Recent advances in targeting this pathway have led to the development of two small-molecule oral Hh inhibitors, vismodegib and sonidegib.. The aim of this article is to provide a complete overview on the use of HPI for the treatment of advanced BCCs describing the efficacy, the benefits, and risks related to these small molecules.. To date, the class of Hh inhibitors has revolutionized the management of patients with advanced BCCs, even though they are usually related to a toxicity profile that may represent the major cause of treatment discontinuation; an accurate study of the Hh signaling pathway and the development of other small molecules could be useful to enlarge the armamentarium of treatment in order to assure patients a personalized approach to the choice of treatment.

Topics: Anilides; Antineoplastic Agents; Biphenyl Compounds; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Pyridines; Signal Transduction; Skin Neoplasms

Cutaneous basal cell carcinoma (BCC) is the most common type of human tumor, and its incidence rate is increasing worldwide. Up until a few years ago, therapeutic options have been limited for patients with advanced BCC (including metastatic and locally-advanced BCC). Over the last few years, promising systemic therapies have been investigated for the treatment of advanced BCC. In particular, the Hedgehog signaling inhibition has shown remarkable results for this population. Hedgehog inhibitors, represented by vismodegib and sonidegib, have been approved by the Food and Drug Administration and the European Medicines Agency for the treatment of both locally advanced and metastatic BCC, with, generally, a good safety profile. Notwithstanding the late onset of BCC in the global population, associated with life expectancy increase, only a few clinical trials have evaluated the efficacy and safety profile of Hedgehog inhibitors in this complex and neglected population. Herein, we review the major mechanisms implicated in the pathogenesis of BCC focusing on the Hedgehog signaling pathway and its therapeutic role in the elderly population. Finally, we report two case reports of BCC elderly patients in order to demonstrate both efficacy and safety of the Hedgehog inhibitors.

Topics: Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Female; Hedgehog Proteins; Humans; Neoplasm Metastasis; Neoplasm Proteins; Pyridines; Signal Transduction; Skin Neoplasms

Although surgical intervention remains the standard of care for nonmelanoma skin cancer, other treatment modalities have been studied and used. Nonsurgical treatment methods include cryotherapy, topical medications, photodynamic therapy, radiation therapy, Hedgehog pathway inhibitors, programmed cell death protein 1 inhibitors, and active nonintervention. Despite the favorable efficacy of surgical treatment methods, many factors, including but not limited to patient age, preference, and severity of disease, must be taken into consideration when choosing the most appropriate, patient-centered treatment approach.

Topics: Administration, Cutaneous; Anilides; Antineoplastic Agents; Antineoplastic Agents, Immunological; Biphenyl Compounds; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cryosurgery; Cyclooxygenase Inhibitors; Diclofenac; Diterpenes; Fluorouracil; Humans; Imiquimod; Photochemotherapy; Programmed Cell Death 1 Receptor; Pyridines; Radiotherapy; Skin Neoplasms; Watchful Waiting

As the most common human cancer worldwide and continuing to increase in incidence, basal cell carcinoma is associated with significant morbidity and cost. Continued advances in research have refined both our insight and approach to this seemingly ubiquitous disease. This 2-part continuing medical education series provides a comprehensive and contemporary review of basal cell carcinoma. The second article in this series will present both the current standard of care and newly developed approaches to diagnosis, treatment, and prevention of this disease.

Topics: Aged; Anilides; Biopsy, Needle; Carcinoma, Basal Cell; Dermoscopy; Early Detection of Cancer; Education, Medical, Continuing; Female; Humans; Immunohistochemistry; Male; Middle Aged; Mohs Surgery; Photochemotherapy; Prognosis; Pyridines; Randomized Controlled Trials as Topic; Risk Assessment; Skin Neoplasms; Tomography, Optical Coherence; Tomography, X-Ray Computed; Treatment Outcome

Locally advanced and metastatic nonmelanoma skin cancer (NMSC) not amenable to surgical resection requires a different approach to therapy.. To review the efficacy and adverse effects of emerging treatment options for locally advanced and metastatic NMSC.. A comprehensive search on PubMed was conducted to identify relevant literature investigating the role of program cell death 1 (PD-1) inhibitor, cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) inhibitor, epidermal growth factor receptor (EGFR) inhibitor, and Hedgehog pathway inhibitors in the treatment of NMSC.. PD-1 inhibitor and CTLA-4 inhibitor have shown promising efficacy with tolerable side-effect profiles in the treatment of NMSC, although the number of cases reported is limited. Currently, 3 larger-scale clinical trials are investigating PD-1 inhibitor therapy for NMSC. Similarly, EGFR inhibitor demonstrated marginal success in unresectable cutaneous squamous cell carcinomas. Hedgehog pathway inhibitors were approved by the US FDA for treatment of locally advanced and metastatic basal cell carcinomas and have shown favorable efficacy. Common adverse effects included muscle spasm, alopecia, and dysgeusia.. Systemic therapies including PD-1 inhibitors and CTLA-4 inhibitors have demonstrated early promising results for difficult-to-treat NMSC. Future studies are necessary to optimize treatment outcome.

Topics: Anilides; Antibodies, Monoclonal, Humanized; Antineoplastic Agents, Immunological; Biphenyl Compounds; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cetuximab; CTLA-4 Antigen; ErbB Receptors; Hedgehog Proteins; Humans; Ipilimumab; Nivolumab; Programmed Cell Death 1 Receptor; Pyridines; Skin Neoplasms

Basal cell cancer is the most common cutaneous malignancy. It rarely presents with locally advanced or metastatic disease. Rare presentations such as intraorbital invasion remain a difficult clinical problem with significant potential morbidity. There is no review of sonic hedgehog pathway inhibitors (HPIs) for intraorbital basal cell cancer, and evidence regarding optimal management is limited.. To evaluate the evidence for the management of intraorbital basal cell cancer with HPIs.. A search to identify evidence for treatment intraorbital basal cell cancers with HPIs to date was performed in PubMed database and OVID using the phrases "basal cell cancer/carcinoma/BCC," "intraorbital," "orbital," "ocular," "periocular," "vismodegib," "GDC-0449," "sonidegib," and "LDE224," in various combinations with Boolean operators "AND" and "OR.". Rigorous clinical trials have previously reported the use of vismodegib and sonidegib in locally advanced and metastatic basal cell carcinoma (BCC). However, specific descriptions of treatment of intraorbital tumors are rarely presented in detail adequate for analysis. Twenty-two cases of intraorbital BCC treated with vismodegib have been described in the literature, and no cases using sonidegib were identified. These vary in quality, but highlight important questions regarding optimal treatment duration, follow-up, and adjunctive therapies. Reports describing locally advanced BCC in various facial and periocular locations, but without specific mention of intraorbital invasion, were excluded.. Vismodegib is an attractive eye and vision-sparing option in patients with locally advanced intraorbital basal cell cancer whose other options often include exenteration, radiation, or other radical surgery.

Topics: Administration, Oral; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Lacrimal Apparatus; Male; Middle Aged; Neoplasm Recurrence, Local; Orbital Neoplasms; Pyridines; Salvage Therapy; Skin Neoplasms

Basal cell carcinoma (BCC) is the most common type of skin cancer, with rising incidence rates primarily attributed to an aging population and ultraviolet radiation exposure. While the majority of BCCs are localized and respond to standard therapies, a very small minority of these tumors become locally destructive or metastasize. These advanced BCCs may not be amenable to localized treatment with surgery and/or radiation therapy. Most BCCs result from mutations in key receptors in the Hedgehog (HH) signaling pathway. As a result, identification of drugs that inhibit the receptor Smoothened (SMO) in the HH pathway has resulted in novel therapeutic approaches to treating patients with advanced BCC. These HH-pathway inhibiting medications have shown efficacy in clinical trials, and two medications, vismodegib and sonidegib, have received FDA approval. However, several limitations of these drugs have been identified, including treatment-limiting adverse events, drug resistance, and the formation of additional malignancies. This paper aims to summarize the clinical trials leading to the approval of SMO inhibitors, as well as reviewing potential mechanisms driving tumor resistance and the formation of cutaneous squamous cell carcinomas. Strategies to overcome some of these challenges, including the development of drugs that inhibit other downstream targets in the HH pathway, are the subject of ongoing clinical trials.

Topics: Anilides; Antineoplastic Agents; Biphenyl Compounds; Carcinoma, Basal Cell; Clinical Trials as Topic; Drug Resistance, Neoplasm; Hedgehog Proteins; Humans; Mutation; Neoadjuvant Therapy; Pyridines; Signal Transduction; Skin Neoplasms; Smoothened Receptor; Treatment Outcome

Sonic hedgehog inhibitors (SHHis) provide an additional treatment option for basal cell carcinomas (BCCs), especially for metastatic or locally advanced BCC. However, studies have been heterogeneous and lacked direct comparisons between molecules.. To determine the efficacy and safety of the class of molecules SHHi for treating BCC and to compare them individually.. We performed a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant systematic review of studies followed by a meta-analysis.. Eighteen articles were included in our meta-analysis; 16 articles were combined for efficacy and 16 for safety. In locally advanced BCC, overall response rates (ORRs) were similar for vismodegib and sonidegib (69% vs 57%, respectively) but not complete response rates (31% vs 3%, respectively). In metastatic disease, the ORR of vismodegib was 2.7-fold higher than the ORR of sonidegib (39% vs 15%, respectively). For side effects affecting a majority of patients, prevalences for muscle spasms (67.1%), dysgeusia (54.1%), and alopecia (57.7%) were in similar proportions for sonidegib and vismodegib. Patients receiving sonidegib experienced more upper gastrointestinal distress than patients receiving vismodegib.. SHHis induce a partial response to locally advanced BCC disease. Side effects are common, similar across molecules, associated with high discontinuation rates, and warrant discussion beforehand.

Topics: Alopecia; Anilides; Antineoplastic Agents; Biphenyl Compounds; Carcinoma, Basal Cell; Clinical Trials as Topic; Dysgeusia; Gastrointestinal Diseases; Hedgehog Proteins; Humans; Muscular Diseases; Neoplasm Proteins; Prospective Studies; Pyridines; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Asthenia; Carcinoma, Basal Cell; Clinical Trials, Phase III as Topic; Disease Progression; Humans; Neoplasm Metastasis; Pyridines; Skin Neoplasms; Weight Loss

Until recently, advanced BCC were only accessible to a highly morbid surgery not necessarily proving to be carcinologic, and leaving terrible dysmorphic sequelae hard to accept by the patient. Another possibility, the only one in case of metastatic BCC, was chemotherapy which efficacy has never been proven in a clinical trial. Radiotherapy is most often not accessible because of previous radiotherapy or because of the localization or the extension of the lesion. The discovery of the importance of the sonic hedgehog pathway in the physiopathology of BCC has opened a new strategy with the development of targeted anti SMO drugs inactivating the pathway. Two molecules have become available following Phase I and II studies: vismodegib (Erivedge®) the first in class indicated for locally advanced and metastatic BCC and sonidegib (Odomzo®) indicated only for locally advanced BCC. The pharmacokinetic profiles of sonidegib and vismodegib showed several differences. No head to head comparative studies are available between these two drugs. Their pivotal phase II studies had similar study designs and endpoints. The objective response rate (ORR) by central review for vismodegib was 47.6% (95% CI 35.5-60.6) at 21 months follow-up. The ORR for sonidegib according to central review at 18 months follow-up is 56.1% (95% CI 43.3-68.3). Although both treatments share a similar adverse event profile with possible numerically differences in incidence, most patients will discontinue hedgehog inhibitors treatment in the long term because of side effects. Some resistant cases to these drugs have been described but are rather rare. In case of resistance or bad tolerability to the drug future hopes rely on immunotherapy currently under investigation. © 2018. Published by Elsevier Masson SAS. All rights reserved. Cet article fait partie du numéro supplément Prise en charge des carcinomes basocellulaires difficiles à traiter réalisé avec le soutien institutionnel de Sun Pharma.

Topics: Alopecia; Anilides; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Basal Cell Nevus Syndrome; Biphenyl Compounds; Carcinoma, Basal Cell; Cisplatin; Clinical Trials as Topic; Drug Resistance, Neoplasm; Dysgeusia; Fluorouracil; Hedgehog Proteins; Humans; Molecular Targeted Therapy; Multicenter Studies as Topic; Muscle Cramp; Mutation; Neoplasm Proteins; Patched-1 Receptor; Patched-2 Receptor; Pyridines; Signal Transduction; Skin Neoplasms; Smoothened Receptor

Basal cell carcinoma (BCC) is the most prevalent malignant tumor in humans and the local destruction of tissue that can result from excision has a significant impact on well-being. Treating BCC is costly for health care systems given the high incidence of this tumor, especially in older patients. Standard treatment involves either resection with histologic assessment of margins or Mohs micrographic surgery. Surgery is sometimes contraindicated, however, due to the presence of significant comorbidity or high cosmetic expectations. For such patients, nonsurgical treatments have become available. These alternatives can offer good local control of disease, preserve function, and achieve excellent cosmetic results.

Topics: Administration, Cutaneous; Aminoquinolines; Anilides; Antineoplastic Agents; Biphenyl Compounds; Carcinoma, Basal Cell; Clinical Trials as Topic; Fluorouracil; Humans; Imiquimod; Interferons; Meta-Analysis as Topic; Molecular Targeted Therapy; Neoplasm Invasiveness; Photochemotherapy; Pyridines; Randomized Controlled Trials as Topic; Risk Assessment; Skin Neoplasms

Basosquamous carcinoma is a rare cutaneous neoplasm that has caused considerable controversy as to its classification, pathogenesis, and management.. To review and summarize current literature on the definition, pathogenesis, incidence, and management of basosquamous carcinoma.. Through December 2015, an electronic search of the Pubmed database was performed using combinations of basosquamous carcinoma and metatypical basal cell carcinoma as search terms.. A selection of 39 publications including case reports and series, retrospective studies, and systematic reviews of the literature were included. Descriptions of the definition of basosquamous carcinoma, clinical behavior, histopathological characteristics, current treatment therapies, and future advances are summarized.. This systematic review provides a comprehensive overview of the current understanding of basosquamous carcinoma. Further study is required to elucidate the mechanisms driving the formation of this aggressive tumor.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basosquamous; Combined Modality Therapy; Humans; Immunohistochemistry; Mohs Surgery; Pyridines; Skin Neoplasms

Basal cell carcinomas are the most common form of skin cancer. Some develop into advanced cases not suitable for standard therapy. Vismodegib is the first-in-class oral hedgehog pathway inhibitor (which is dysregulated in 90% of basal cell carcinomas), and has demonstrated efficacy for advanced disease in clinical trials. An UK expert panel met to discuss management strategies for adverse events associated with vismodegib (most commonly taste disturbances, muscle cramps and alopecia). Managing patient expectations and implementing treatment breaks were considered important strategies. Quinine was useful to alleviate muscle cramps. For taste disturbances, food swaps alongside dietician referral were suggested. The experts concluded that these common adverse events can be successfully managed to allow optimum treatment duration of vismodegib.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Clinical Trials as Topic; Disease Management; Drug-Related Side Effects and Adverse Reactions; Humans; Pyridines; Skin Neoplasms

Advanced basal cell carcinoma (aBCC) encompasses locally advanced BCC (laBCC) and metastatic BCC (mBCC), two variants of BCC with a limited prevalence worldwide. Treatment of aBCC is still very challenging for the lack of randomized controlled trials/guidelines and the scarcity of available therapeutic options. Based on current data, surgical procedures and radiotherapy are considered the treatments of choice for aBCC although often associated with substantial morbidity and/or deformity. Alternatively, systemic chemotherapy and electrochemotherapy can be used but standardized treatment schedules and randomized clinical trials are not available for both treatments. In recent years, novel tumor-specific and pathogenesis-based molecules have been developed for the treatment of aBCC. A number of clinical trials have recently demonstrated the efficacy and tolerability of vismodegib, the first novel systemic, anti-Smo target cancer therapy for aBCC. Additional molecules currently investigated in phase I-III clinical trials include other Smo antagonists and itraconazole. The contribution of a multidisciplinary team composed of dermatologists, surgeons, oncologists, pathologists, radiologists and radiotherapists is required to deal with the spectrum of issues that emerge from managing patients affected by aBCC.

Topics: Anilides; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Basal Cell; Clinical Trials as Topic; Humans; Interdisciplinary Communication; Itraconazole; Neoplasm Staging; Pyridines; Radiotherapy, Adjuvant; Skin Neoplasms; Treatment Outcome

Non-melanoma skin cancers are the most common malignancy in humans, with a basal/squamous cell carcinoma incidence ratio of 4:1 in immunocompetent patients. Basal cell carcinoma rarely metastasizes but commonly causes significant local tissue destruction and disfigurement, whereas squamous cell carcinoma is associated with a substantial risk of recurrence and metastasis; the prognosis in metastatic patients is poor. Surgical approaches give a cure rate greater than 90% if appropriately applied, on the basis of the characteristics of the primary tumors and of the patients, but in selected cases, medical treatment (5-fluorouracil, imiquimod, diclofenac and, more recently, ingenol mebutate) is preferable to invasive procedures and provides a good chance of cure, with generally excellent cosmetic outcomes. In case of advanced and metastatic non-melanoma skin cancer, newly developed molecularly targeted therapy represents a reasonably promising alternative to classical cytostatics. In particular, the monoclonal antibody cetuximab, directed against the epidermal growth factor receptor, is effective and well-tolerated in squamous cell carcinoma patients. Moreover, the recent identification of mutations in the Hedgehog signaling pathway in basal cell carcinoma lead to the development of the smoothened Hedgehog pathway inhibitor vismodegib, that was recently approved for the treatment of locally advanced or metastatic basal cell carcinoma. In this review we provide an overview of the molecular pathways involved in NMSC pathogenesis, focusing on the mechanisms of action, indications, efficacy, side effects and contraindications of new medical treatments that specifically tackle molecular targets of these pathways.

Topics: Anilides; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cetuximab; Clinical Trials as Topic; Humans; Molecular Targeted Therapy; Neoplasm Metastasis; Prognosis; Pyridines; Signal Transduction; Skin Neoplasms

Nonmelanoma skin cancer (NMSC) is the most common cancer in patients and includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Treatments useful for SCC and BCC include surgical, topical, and in advanced cases systemic chemo-radiation. This review of the literature aims to describe previous and current treatment options for oral therapy in locally advanced and metastatic NMSC otherwise unamenable to standard treatment. Oral Smoothened (Smo) inhibitors Vismodegib, Sonidegib, and Taladegib have shown to be effective in several trials. Oral tyrosine kinase inhibitors Erlotinib and Gefitinib, which target epidermal growth factor receptor (EGFR), have early supporting data and are currently undergoing large multicenter trials. Other less studied oral therapies which have shown at least partial efficacy include 5-Fluorouracil, capecitabine, and picropodophyllin. In vitro studies have elucidated new targets for dual combination oral therapy targeting both EGFR and insulin-like growth factor 1 receptor (IGF-1R). It is important to stratify treatment options based on patient risk of advanced disease, failure of conservative treatment, and ill-tolerated intravenous chemotherapy adverse events. Oral therapy in NMSC is useful in high risk patients with recurrent and aggressive disease who may not tolerate other systemic therapies.

Topics: Administration, Oral; Anilides; Antineoplastic Agents; Biphenyl Compounds; Capecitabine; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; ErbB Receptors; Erlotinib Hydrochloride; Fluorouracil; Gefitinib; Hedgehog Proteins; Molecular Targeted Therapy; Phthalazines; Podophyllotoxin; Pyridines; Quinazolines; Receptor, IGF Type 1; Retinoids; Skin Neoplasms; Tumor Burden

The advent of more sophisticated studies published has clarified the understating of the root cause of various skin cancers or basal cell carcinomas (BCCs). The remarkable role is played by the comprehensive work done on unraveling the mechanism controlling the function of hedgehog (Hh) pathway. The defective Hh pathway has been found as the major cause for BCCs as activated Hh signaling within primary cilia plays a key role in the pathogenesis of BCCs. The BCC accounts for up to 40% of all cancers in the US, with growing incidences in other countries as well. Thus, it is considered to be utmost important by the researchers all over the world developing drugs for the treatment of skin cancers targeting Hh pathway. Fewer drugs like vismodegib, itraconazole and sonidegib have shown promising results inhibiting the awry function of Hh pathway resulting in treatment of different forms of skin cancers. These drugs have shown positive results but failed to prove their potential as expected. Vismodegib and sonidegib are better but fail in case of resistant tumors. This review article describes the mechanism of actions of these Hh pathway inhibitors and provides the rationale for their effectiveness/non-effectiveness for the treatment of metastatic or locally advanced BCC.

Topics: Anilides; Antineoplastic Combined Chemotherapy Protocols; Biphenyl Compounds; Carcinoma, Basal Cell; Drug Resistance, Neoplasm; Hedgehog Proteins; Humans; Itraconazole; Pyridines; Signal Transduction; Skin Neoplasms

We summarize the concept of a locally advanced basal cell carcinoma (laBCC) and present the current consensus definition. We also review the key pieces of primary research undertaken in the past year and how these affect the use of smoothened inhibitors in a clinical setting.. Medium term follow-up (30 months) of patients treated with vismodegib shows an improvement in response rates for patients with laBCC. The safety profile of vismodegib demonstrated in the original ERIVANCE study has been replicated in a larger patient cohort in a repeat study. Sonidegib is a new smoothened inhibitor currently under investigation for treatment of laBCC, which demonstrates a comparable safety profile to vismodegib. The side-effects of smoothened inhibitors appear related to both dose and duration of treatment. The durability of response to vismodegib is uncertain, but has been observed to last for over a year following discontinuation of treatment.. The understanding of the efficacy and safety of vismodegib has improved since its introduction in 2012. A broadening evidence base supports its use as a valid treatment for laBCC. However, questions remain as to how to integrate its use into existing pathways for treating laBCC and its long-term efficacy.

Topics: Anilides; Antineoplastic Agents; Biphenyl Compounds; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Pyridines; Receptors, G-Protein-Coupled; Skin Neoplasms; Smoothened Receptor

This commentary summarizes studies showing risk of basal cell carcinoma (BCC) development in relationship to environmental, occupational and therapeutic exposure to ionizing radiation (IR). BCC, the most common type of human cancer, is driven by the aberrant activation of hedgehog (Hh) signaling. Ptch, a tumor suppressor gene of Hh signaling pathway, and Smoothened play a key role in the development of radiation-induced BCCs in animal models. Epidemiological studies provide evidence that humans exposed to radiation as observed among the long-term, large scale cohorts of atomic bomb survivors, bone marrow transplant recipients, patients with tinea capitis and radiologic workers enhances risk of BCCs. Overall, this risk is higher in Caucasians than other races. People who were exposed early in life develop more BCCs. The enhanced IR correlation with BCC and not other common cutaneous malignancies is intriguing. The mechanism underlying these observations remains undefined. Understanding interactions between radiation-induced signaling pathways and those which drive BCC development may be important in unraveling the mechanism associated with this enhanced risk. Recent studies showed that Vismodegib, a Smoothened inhibitor, is effective in treating radiation-induced BCCs in humans, suggesting that common strategies are required for the intervention of BCCs development irrespective of their etiology.

Topics: Anilides; Animals; Carcinoma, Basal Cell; Chernobyl Nuclear Accident; Hedgehog Proteins; Humans; Neoplasms, Radiation-Induced; Nuclear Weapons; Pyridines; Radiation Exposure; Radiation, Ionizing; Signal Transduction; Skin Neoplasms; Survivors

As the population ages and incidence of basal cell carcinoma continues to increase, we will be faced more frequently with difficult treatment decisions for basal cell carcinoma in the elderly. Different treatment options, including surgical excision, electrodessication and curettage, cryosurgery, imiquimod, photodynamic therapy, 5-fluorouracil, radiation therapy, vismodegib, combination therapy, and observation, may be considered on the basis of tumor characteristics. Given the wide range of therapeutic options, treatments can be tailored to achieve patients' goals of care within their anticipated life expectancy.

Topics: Aminoquinolines; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Combined Modality Therapy; Cryosurgery; Dermatologic Surgical Procedures; Fluorouracil; Humans; Imiquimod; Photochemotherapy; Pyridines; Radiotherapy; Skin Neoplasms

Hedgehog pathway inhibitors (HPIs) were made available by US Food and Drug Administration approval in 2012 for vismodegib and 2015 for sonidegib. Both target the Smoothened molecule and are indicated for locally advanced basal cell carcinoma (laBCC) and metastatic basal cell carcinoma (mBCC).. To evaluate clinical experience with HPIs, including efficacy and adverse effects.. We conducted a systematic review in concordance with the PRISMA guidelines of PubMed, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and EMBASE, using search terms "vismodegib," "sonidegib," "Erivedge," "Odomza," "basal cell carcinoma," and "BCC.". We included clinical trials, retrospective medical record reviews, and prospective case series that used HPIs for the treatment of laBCC or mBCC in human subjects. Individual case reports and limited, retrospective case series were excluded from our review.. Data were extracted independently by 2 reviewers on a predesigned, standardized form.. The following data were recorded: number of patients with laBCC or mBCC, dose and frequency of drug administration, median duration of treatment, clearance and recurrence rates, and adverse effects.. Eleven vismodegib articles (published between 2009 and 2015) met criteria for inclusion, and 8 articles were able to be pooled for analysis. The 8 pooled articles included 744 total patients with 704 patients clinically evaluable. Sonidegib did not yield enough publications for a formal analysis. Objective response to vismodegib for laBCC had a weighted average of 64.7% (95% CI, 63.7%-65.6%); complete response averaged 31.1% (95% CI, 30.4%-31.8%). Objective response for mBCC was 33.6% (95% CI, 33.1%-34.2%); complete response averaged 3.9% (95% CI, 3.3%-4.4%). Median duration of therapy was 35.8 weeks (95% CI, 35.1-36.5 weeks).. In a systematic review of HPIs for laBCC and mBCC, vismodegib, but not sonidegib, had enough studies to warrant a pooled analysis. Vismodegib was identified to have a significant, consistent effect on the median duration of therapy of laBCC and mBCC. While mBCC responses are superior to any traditional approach, the response rate for laBCC might be considered in the context of other standard treatment options including surgery and radiation therapy.

Topics: Anilides; Antineoplastic Agents; Biphenyl Compounds; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Pyridines; Skin Neoplasms; Smoothened Receptor

A wide range of treatments is now available for nonmelanoma skin cancer, including 5-fluorouracil, ingenol mebutate, imiquimod, diclofenac, photodynamic therapy, methotrexate, cetuximab, vismodegib, and radiotherapy. All are associated with high clinical and histologic response rates. However, some tumors do not respond due to resistance, which may be primary or acquired. Study of the resistance processes is a broad area of research that aims to increase our understanding of the nature of each tumor and the biologic features that make it resistant, as well as to facilitate the design of new therapies directed against these tumors. In this second article, having covered the topical treatments of nonmelanoma skin cancer, we review resistance to other nonsurgical treatments, such as monoclonal antibodies against basal and squamous cell carcinomas, intralesional chemotherapy, photodynamic therapy, and radiotherapy.

Topics: Anilides; Antigen-Presenting Cells; Antimetabolites, Antineoplastic; Antineoplastic Agents; Carcinoma; Cetuximab; Clinical Trials as Topic; Combined Modality Therapy; Drug Resistance, Neoplasm; ErbB Receptors; Humans; Injections, Intralesional; Keratoacanthoma; Meta-Analysis as Topic; Methotrexate; Neoplasm Proteins; Neoplastic Stem Cells; Patched-1 Receptor; Photochemotherapy; Photosensitizing Agents; Pyridines; Radiation Tolerance; Skin Neoplasms

Vismodegib is a novel hedgehog pathway inhibitor approved to treat advanced and metastatic basal cell carcinoma (BCC) in the United States. Several studies have demonstrated efficacy for treatment of new and existing BCC in both basal cell nevus syndrome (BCNS) and non-BCNS patients. However, severe and numerous adverse events are associated with vismodegib use. Therefore, we have also examined all of the currently published clinical trials and tabulated the available adverse events for review. The most frequently reported adverse events include muscle spasms (53.4%), dysgeusia/ageusia (49.3%), alopecia (38.8%), fatigue (32.0%), nausea (28.4%), weight loss (24.2%), and decreased appetite (16.5%).. We report a case of a previously healthy 72-year-old male with a history of innumerable BCCs who developed severe nausea, jaundice, and cholestasis with significantly elevated BUN, creatinine, and liver enzymes one month after starting vismodegib. The patient began using over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to treat severe, vismodegib-induced myalgia. No other new medications were started. Our patient had no history of liver disease.. Herein, we describe a potential serious adverse effect associated with vismodegib use. Whether the illness is directly attributable to the medication or the result of drug-drug interactions between vismodegib and NSAIDs, practitioners should be aware of the possibility of hepatic injury in patients on vismodegib. Furthermore, patients need to be informed of the potential risks of vismodegib and should be monitored closely to ensure that life-threatening complications of treatment are avoided.

Topics: Aged; Anilides; Anti-Inflammatory Agents, Non-Steroidal; Antineoplastic Agents; Aspirin; Carcinoma, Basal Cell; Chemical and Drug Induced Liver Injury; Cholestasis; Drug Interactions; Dysgeusia; Humans; Male; Myalgia; Naproxen; Pyridines; Skin Neoplasms

Despite that basal cell carcinoma (BCC) is curative in the vast majority of cases, some patients are at high risk of recurrence and, in a few patients, lesions can progress to a point unsuitable for local therapy and prognosis is quite poor. The aim of the present work is to review clinical and pathologic characteristics as well as classical and new treatment options for high-risk, metastatic and locally advanced BCC. Surgery and radiotherapy remain the selected treatments for the majority of high-risk lesions. However, some patients are located on a blurry clinical boundary between high-risk and locally advanced BCC. Treatment of these patients is challenging and need an individualized and highly specialized approach. The treatment of locally advanced BCC, in which surgery or radiotherapy is unfeasible, inappropriate or contraindicated, and metastatic BCC has changed with new Hedgehog pathway inhibitors of which vismodegib is the first drug approved by FDA and EMA.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Dermatologic Surgical Procedures; Humans; Mohs Surgery; Pyridines; Radiotherapy; Skin Neoplasms

Basal cell carcinoma (BCC) is the most common skin cancer worldwide. Most occur on the head and neck, where cosmetic and functional outcomes are critical. BCC can be locally destructive if not diagnosed early and treated appropriately. Surgery is the treatment of choice for the majority of high-risk lesions. Aggressive, recurrent or unresectable tumors can be difficult to manage. Until recently, no approved systemic therapy was available for locally advanced or metastatic BCC inappropriate for surgery or radiotherapy. Vismodegib provides a systemic treatment option. However, a consensus definition of advanced BCC is lacking. A multidisciplinary panel with expertise in oncology, dermatology, dermatologic surgery and radiation oncology proposes a consensus definition based on published evidence and clinical experience.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Combined Modality Therapy; Consensus Development Conferences as Topic; Disease Management; Humans; Neoplasm Staging; Pyridines; Risk Factors; Skin Neoplasms

Basal cell carcinoma (BCC) is the most common cancer. Most cases of BCCs are treated with only optimal surgical resection. However, unresectable, locally advanced or metastatic tumors might have potential to progress. In this patient group, there is no standardized treatment approach. Vismodegib is a new selective inhibitor of the hedgehog (Hh) pathway. This manuscript is aimed to review the efficacy of the Hh pathway inhibitor vismodegib in BCC patients with locally advanced or metastatic disease.. Vismodegib showed positive results in clinical studies. A computerized search of the PubMed and American Society of Clinical Oncology Meeting abstracts was performed, by searching for the following keywords: 'vismodegib', 'pathway', 'inhibitor', and 'targeted therapies for BCC'. The last search was done on 1 September 2014. Most of the vismodegib data depend on phase I and II trials.. Preclinical and clinical studies have shown that Hh pathway activation occurs in BCC. In BCC patients the role of chemotherapy is not completely known. Although conventional chemotherapies like cisplatins increase the response rate in BCC, improvement in overall survival and progression free survival were not demonstrated. Results of both phase I and phase II studies have shown that vismodegib is a potential new treatment strategy for patients with locally advanced and metastatic BCC. As in previously published phase I trials, in the ERIVANCE BCC study the primary endpoint, objective response rate, significantly increased by 43% and 30% in patients with locally advanced and metastatic BCC, respectively. Because of the promising results in phase I and II trials, vismodegib was approved by the Food and Drug Administration (FDA) in the treatment of patients with BCC who are not suitable for surgery or radiotherapy or with relapsed locally advanced disease following surgery or metastatic disease.. Recent trials have shown that vismodegib has produced promising activity in patients with locally advanced and metastatic BCC. The ongoing studies with vismodegib in other solid tumors and BCC will shed light on more certain treatment pathways.

Topics: Anilides; Animals; Antineoplastic Agents; Carcinoma, Basal Cell; Disease-Free Survival; Hedgehog Proteins; Humans; Pyridines; Skin Neoplasms

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.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Neoplasm Recurrence, Local; Pyridines; Signal Transduction; Skin Neoplasms

Basal cell carcinoma (BCC), the most common type of skin cancer, is occasionally aggressive with deep invasion, destruction of adjacent structures, recurrence and, on very rare occasions, regional and distant metastases. Mutations that occur in BCC in hedgehog (Hh) pathway genes primarily involve the genes encoding patched homolog (PTCH) and smoothened homolog (SMO). Several animal models have demonstrated the functional relevance of genetic alterations in the Hh pathway during tumorigenesis. Recently, targeted therapy has become available both commercially and in the context of human clinical trials. Interestingly, Hh pathway inhibitors not only suppress BCC progression but also promote acquired immune responses. Since immune responses are crucial for long-term tumor control, new clinical trials, such as those involving a combination of Hh inhibitors with immune modifiers, are needed to supplement standard methods of tumor control.

Topics: Adaptive Immunity; Anilides; Animals; Antineoplastic Agents; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Molecular Targeted Therapy; Patched Receptors; Patched-1 Receptor; Pyridines; Receptors, Cell Surface; Receptors, G-Protein-Coupled; Signal Transduction; Skin Neoplasms; Smoothened Receptor

Basal cell carcinoma (BCC) is a frequent skin cancer which can cause substantial morbidity due to its location on the face, its frequency of relapse and its capacity to invade local tissues. The primary treatment of BCC usually involves surgery or radiotherapy. In patients who have exhausted surgical and radiotherapy options or with metastatic BCC, guidelines recommend the use of the Hedgehog pathway inhibitor vismodegib. This molecule is indicated for the treatment of adults with metastatic BCC, or with locally advanced BCC which has recurred following surgery or who are not eligible to surgery or radiation. This paper aims to provide suggestions on the optimal management of BCC patients treated with vismodegib in clinical practice, according to the large experience gained by a group of Italian dermatologists and oncologists. In particular, the focus of this paper will be on the monitoring of patients and the management of adverse events.

Topics: Anilides; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms; Treatment Outcome

During the past several years, targeted therapies have significantly improved outcomes in advanced basal cell carcinoma, psoriasis, and metastatic melanoma. This article reviews how advances in our understanding of the molecular pathogenesis of these diseases led to the development of targeted therapies and how these therapies are improving outcomes. Research is ongoing to address continuing challenges of drug resistance, adverse effects, and how best to use the new medications.

Topics: Adult; Anilides; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Azetidines; Brain Neoplasms; Carcinoma, Basal Cell; Dermatologic Agents; Dermatology; Etanercept; Female; Humans; Imidazoles; Indoles; Interleukin-17; Male; Melanoma; Middle Aged; Molecular Targeted Therapy; Oximes; Piperidines; Proto-Oncogene Proteins B-raf; Psoriasis; Pyridines; Pyridones; Pyrimidinones; Skin Neoplasms; Sulfonamides; Tumor Necrosis Factor-alpha; Ustekinumab; Vemurafenib

Epithelial skin cancers (ESCs), namely basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), are considered common skin malignancies, with rising incidence rates over the past few decades. A subgroup of patients with ESC present with advanced and 'difficult'-to-treat tumours, including locally advanced and metastatic tumours. Currently, there is no widely accepted staging system for locally advanced ESCs, while metastatic BCCs and SCCs share a staging system. Therefore, selecting an appropriate therapeutic regimen for these patients may be difficult.. The purpose of this review is to highlight the pharmacologic treatment options for advanced ESCs. These include 'conventional' chemotherapeutic regimens such as 5-fluorouracil, cisplatin, vincristine, bleomycin and doxorubicin and newer, more 'targeted' therapies.. Vismodegib, a Hedgehog (Hh) inhibitor, was recently approved for the treatment of advanced BCC showing a good efficacy rate and a relatively well-tolerated safety profile in clinical studies. In addition, a number of hedgehog inhibitors are now in Phase I and II trials of advanced BCC demonstrating encouraging results. Phase II studies with epithelial growth factor receptor inhibitors, such as cetuximab, gefitinib, panitimumab and erlotinib have been conducted in patients with advanced SCCs, used either as monotherapy or in combination with chemotherapy. However, there is still much knowledge to be gained about the treatment efficacies, optimal treatment durations, mechanisms of drug tolerance, adverse events and the ways in which these therapies influence patient outcomes and quality of life.

Topics: Anilides; Antibodies, Monoclonal; Antineoplastic Agents; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Clinical Trials as Topic; Drug Resistance, Neoplasm; ErbB Receptors; Erlotinib Hydrochloride; Gefitinib; Humans; Molecular Targeted Therapy; Pyridines; Quality of Life; Quinazolines; Skin Neoplasms; Treatment Outcome

Basal cell carcinomas (BCCs) are the most frequent human cancer. Over 90% of all BCCs have a mutation in PTCH1 or smoothened, two conducting proteins of the Hedgehog pathway. They rarely progress deeply and metastasize; however, if they do, these advanced basal cell carcinoma become amenable to treatment by inhibiting the Hedgehog and the P13K-mTOR pathways. Such innovative drugs include vismodegib, cyclopamine, itraconazole, everolimus and a few other agents that are in early clinical development.

Topics: Anilides; Carcinoma, Basal Cell; Drug Resistance, Neoplasm; Everolimus; Hedgehog Proteins; Humans; Itraconazole; Molecular Targeted Therapy; Neoplasm Staging; Phosphatidylinositol 3-Kinases; Pyridines; Receptors, G-Protein-Coupled; Signal Transduction; Skin Neoplasms; Smoothened Receptor; TOR Serine-Threonine Kinases; Veratrum Alkaloids

To review vismodegib, the first Food and Drug Administration (FDA)-approved Hedgehog (Hh) signaling pathway inhibitor, in the treatment of advanced basal cell carcinoma (BCC).. MEDLINE and PubMed were searched using the terms vismodegib, GDC-0449, RG3616, and basal cell carcinoma for relevant clinical trials through September 2013. The FDA Web site, the National Clinical Trials registry, and abstracts from the American Society of Clinical Oncology (ASCO) were also evaluated to identify unpublished data and future clinical trials.. All identified clinical and preclinical studies published in the English language were assessed, including selected references from the bibliographies of articles.. Activation of the Hh signaling pathway is well documented in BCC. Vismodegib is a small-molecule inhibitor of Hh signaling that acts by antagonizing the protein Smoothened (SMO), thereby preventing downstream transcriptional activation of genes involved in cell proliferation and survival. Vismodegib was approved by the FDA in January 2012 for the treatment of recurrent, locally advanced BCC (laBCC), or metastatic BCC (mBCC) for which surgery or radiation cannot be utilized. A pivotal phase 2 trial evaluating 104 patients demonstrated that treatment with vismodegib, 150 mg orally once daily, resulted in a 30% and 43% objective response rate in patients with mBCC and laBCC, respectively. The most common adverse effects from vismodegib were mild to moderate and included muscle spasms, dysgeusia, decreased weight, fatigue, alopecia, and diarrhea. However, clinical studies noted a high incidence of discontinuation of therapy by patients for reasons other than disease progression.. The approval of vismodegib represents the only targeted, prospectively studied treatment option for patients with advanced BCC. Further research assessing the utility of vismodegib in the treatment of other malignancies and the development of resistance patterns will more clearly define the role of Hedgehog inhibition in the broader scheme of oncological disorders.

Topics: Anilides; Animals; Antineoplastic Agents; Carcinoma, Basal Cell; Drug Interactions; Hedgehog Proteins; Humans; Pyridines; Signal Transduction; Skin Neoplasms

In January 2012, vismodegib (Erivedge, manufactured by Genentech) became the first selective inhibitor of the Hedgehog signaling pathway to be approved by the US Food and Drug Administration for the treatment of locally advanced and metastatic basal cell carcinoma. The drug selectively binds to Smoothened, a 7-helix transmembrane receptor, thereby inhibiting activation of transcription factors of the glioma-associated oncogene family and suppressing tumor proliferation and growth. Studies published to date have assessed the efficacy of vismodegib according to clinical and radiologic outcomes but little information is available on the molecular mechanisms underpinning the proven clinical efficacy of the drug. This review will cover recent data on the Hedgehog signaling pathway and data from clinical trials with vismodegib in the treatment of basal cell carcinoma, and will consider its use in other types of tumor.

Topics: Anilides; Carcinoma, Basal Cell; Clinical Trials as Topic; Hedgehog Proteins; Humans; Pyridines; Signal Transduction; Skin Neoplasms

The Hedgehog pathway has been identified as a key element in the development of many forms of cancer. Smoothened (Smo) inhibitors are known to beneficially interfere with the Hedgehog pathway and are currently under investigation as anticancer drugs for many tumor entities. Reviewed here are the most recent developments in clinical research on Smo inhibitors for the treatment of advanced basal cell carcinoma (BCC).. When reviewing the literature of the past 12 months, it is striking to see the rapid evolution of the field. Compounds that have been presented as powerful new drug candidates 12 months ago have now been discontinued, whereas new ones have emerged. Reports on 13 drug candidates have been identified: one marketed, vismodegib, eight currently under development (phase I-II) and four for which clinical investigation for BCC is currently not being pursued.. Smo inhibitors are a promising drug class for the treatment of BCC. To date, most candidates are in early stage development and are expected to enter the market in approximately 5-8 years, if successful.

Topics: Anilides; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Pyridines; Receptors, G-Protein-Coupled; Signal Transduction; Skin Neoplasms; Smoothened Receptor; Survival Analysis; Treatment Outcome

The hedgehog (Hh) signaling pathway has been identified as important to normal embryonic development in living organisms and it is implicated in processes including cell proliferation, differentiation and tissue patterning. Aberrant Hh pathway has been involved in the pathogenesis and chemotherapy resistance of different solid and hematologic malignancies. Basal cell carcinoma (BCC) and medulloblastoma are two well-recognized cancers with mutations in components of the Hh pathway. Vismodegib has recently approved as the first inhibitor of one of the components of the Hh pathway (smoothened). This review attempts to provide current data on the molecular pathways involved in the development of BCC and the therapeutic options available for the treatment of locally advanced and metastatic BCC, and the new targeted therapies in development.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Drug Resistance, Neoplasm; ErbB Receptors; Hedgehog Proteins; Humans; Molecular Targeted Therapy; Neoplasm Proteins; Neoplasms, Radiation-Induced; Neoplastic Stem Cells; Neoplastic Syndromes, Hereditary; Pyridines; Receptors, G-Protein-Coupled; Signal Transduction; Skin Neoplasms; Smoothened Receptor; Sunlight

Topics: Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Combined Modality Therapy; Compassionate Use Trials; Face; Follow-Up Studies; Humans; Male; Neoplasm Invasiveness; Neoplasm Staging; Pyridines; Radiotherapy, Adjuvant; Risk Assessment; Skin Neoplasms; Terminally Ill; Treatment Outcome

Vismodegib is the first Hedgehog (Hh) pathway inhibitor approved in the US for the treatment of adults with metastatic or locally advanced basal cell carcinoma (BCC). It was approved by the US FDA on 30 January 2012, and by the European Commission on 12 July 2013, for the treatment of adult patients with symptomatic metastatic BCC, or locally advanced BCC inappropriate for surgery or radiotherapy. Vismodegib selectively inhibits the Hh signaling pathway, binding to and inhibiting a critical signal-transducing component of the pathway, Smoothened (SMO). Vismodegib was discovered by Genentech, Inc., under a collaboration agreement with Curis, Inc.. This article reviews the development of vismodegib from its discovery, preclinical pharmacology and validation to the clinical pharmacokinetics and validation in Phase I and II clinical investigations. We also provide a survey of other Hh pathway inhibitors in clinical development.. The authors' experience in target-based drug discovery suggests that vismodegib's path to the clinic deserves some reflection to identify key steps that have contributed to its success. Targeting the Hh pathway with vismodegib blocks the abberant signaling caused by mutational inactivation of the negative regulator PTCH1 or mutational activation of SMO. Vismodegib gives physicians a treatment option for patients with locally advanced or metastatic BCC for whom surgery or radiation is not recommended.

Topics: Adult; Anilides; Animals; Antineoplastic Agents; Carcinoma, Basal Cell; Drug Design; Drug Discovery; History, 21st Century; Humans; Pyridines; Signal Transduction; Skin Neoplasms

To report a novel mechanism suggestive of early ovarian failure secondary to the anti-tumor hedgehog-pathway inhibitor vismodegib.. Case report and literature review.. Academic and private dermatology and fertility practices.. A 34-year-old nulliparous woman with locally advanced basal cell carcinomas who became amenorrheic while receiving oral therapy with vismodegib.. Physical examination and endocrine evaluation.. Elevated follicle-stimulating hormone (FSH) and low estrogen in the setting of a normal anti-Müllerian hormone.. FSH was elevated; estrogen was low. Preantral follicles were detected and anti-Müllerian hormone activity was normal. Menses resumed 5 weeks after cessation of therapy.. Vismodegib, a first-in-class inhibitor of the hedgehog signaling pathway is indicated for advanced basal cell carcinoma and is associated with amenorrhea. The mechanism is unknown; it has some features of ovarian failure but preserves ovarian potential through blockading of FSH-receptor-dependent signal transduction. This effect appears to be rapidly reversible upon cessation of therapy. Vismodegib and related compounds may have potential for a role in intervention for gynecologic and endocrine disorders and in therapy for other issues involving FSH-dependent function.

Topics: Adult; Amenorrhea; Anilides; Anti-Mullerian Hormone; Antineoplastic Agents; Biomarkers; Carcinoma, Basal Cell; Estrogens; Female; Follicle Stimulating Hormone, Human; Humans; Menstruation; Primary Ovarian Insufficiency; Pyridines; Receptors, FSH; Recovery of Function; Skin Neoplasms; Time Factors; Treatment Outcome

Vismodegib is a first-in-class, hedgehog-signal inhibitor that is FDA-approved for use with advanced basal cell carcinomas (BCCs) that cannot be removed by either surgical resection or treated with radiation. Release of the drug was fast-tracked because of need for this type of drug, and its overall efficacy in clinical trial by producing either regression or even resolution of advanced BCCs. Compared to placebo, patients using vismodegib have arrested BCC progression, reduced size of BCC, and decreased recurrence of BCC. Unfortunately, vismodegib has notable adverse effects (especially those of alopecia, gastrointestinal, muscle spasms, and dysguesia) that make dermatologists reluctant to prescribe the drug and patients unwilling to undergo therapy. In this article, we tackle this dilemma by comparing the toxicity profile of vismodegib to the adverse effect profiles of other dermatologic chemotherapeutics, immunomodulators, retinoids, and biologics. Considering that many of these drugs carry their own risks and those drugs used to treat advanced melanoma have similar toxicity profiles to that of vismodegib, we hope dermatologists and patients alike will be more willing to try vismodegib as a treatment option for advanced BCCs in the future.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Disease Progression; Humans; Neoplasm Recurrence, Local; Pyridines; Skin Neoplasms

Topics: Aminoquinolines; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Combined Modality Therapy; Cryosurgery; Disease Management; Humans; Imiquimod; Immunotherapy; Molecular Targeted Therapy; Neoplasm Proteins; Pyridines; Receptors, G-Protein-Coupled; Skin Neoplasms; Smoothened Receptor

With an incidence of 70 to over 800 new cases per 100 000 persons per year, basal cell carcinoma (BCC) is a very common disease, accounting for about 80% of all cases of non-melanoma skin cancer. It very rarely metastasizes. A variety of treatments are available for the different subtypes and stages of BCC.. This review is based on pertinent literature retrieved by a selective search in the Medline database, as well as the American Cancer Society guidelines on BCC and the German guidelines on BCC and skin cancer prevention.. The gold standard of treatment is surgical excision with histological control of excision margins, which has a 5-year recurrence rate of less than 3% on the face. For superficial BCC, approved medications such as imiquimod (total remission rate, 82-90%) and topical 5-fluorouracil (80%) are available, as is photodynamic therapy (71-87%). Other ablative methods (laser, cryosurgery) are applicable in some cases. Radiotherapy is an alternative treatment for invasive, inoperable BCC, with 5-year tumor control rates of 89-96%. Recently, drugs that inhibit an intracellular signaling pathway have become available for the treatment of locally advanced or metastatic BCC. Phase I and II clinical trials revealed that vismodegib was associated with objective response rates of 30-55% and tumor control rates of 80-90%. This drug was approved on the basis of a non-randomized trial with no control arm. It has side effects ranging from muscle cramps (71%) and hair loss (65%) to taste disturbances (55%) and birth defects.. The established, standard treatments are generally highly effective. Vismodegib is a newly approved treatment option for locally advanced BCC that is not amenable to either surgery or radiotherapy.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Chemoradiotherapy; Combined Modality Therapy; Dermatologic Surgical Procedures; Humans; Photochemotherapy; Pyridines; Skin Neoplasms

Basal cell carcinomas (BCCs) are very common epithelial cancers that depend on the Hedgehog pathway for tumor growth. Traditional therapies such as surgical excision are effective for most patients with sporadic BCC; however, better treatment options are needed for cosmetically sensitive or advanced and metastatic BCC. The first approved Hedgehog antagonist targeting the membrane receptor Smoothened, vismodegib, shows remarkable effectiveness on both syndromic and nonsyndromic BCCs. However, drug-resistant tumors frequently develop, illustrating the need for the development of next-generation Hedgehog antagonists targeting pathway components downstream from Smoothened. In this article, we will summarize available BCC treatment options and discuss the development of next-generation antagonists.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Drug Discovery; Drug Resistance, Neoplasm; Hedgehog Proteins; Humans; Pyridines; Receptors, G-Protein-Coupled; Skin Neoplasms; Smoothened Receptor; Technology, Pharmaceutical; Treatment Outcome

Basal cell carcinoma (BCC) is the most common human malignancy. Treatment options for the minority of patients presenting with locally advanced inoperable or metastatic BCC are very limited. The hedgehog (Hh) pathway plays a crucial role in the pathogenesis of BCC. Recent advances in targeting this pathway have led to the development of a first-in-class, small-molecule oral Hh inhibitor, vismodegib (Erivedge®, Genentech).. In this article, we review vismodegib with regard to its mechanism of action, clinical efficacy, safety and tolerability, and we consider the causes of emerging resistance to the drug.. Vismodegib is a welcome addition to the treatment paradigm for BCC. Approval was based on Phase II evidence, the patient number was relatively small, there was no control group or a comparator group and survival data have not been presented so longer term follow-up and larger exposure to the drug is required to fully appreciate its clinical utility into the future. With ongoing use of the drug in the nontrial population and further studies investigating its use in both early- and later-stage disease, we will get a better understanding of the drug and determine its place in the armamentarium against BCC.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Drug Approval; Drug Resistance, Neoplasm; Hedgehog Proteins; Humans; Neoplasm Metastasis; Pyridines; Skin Neoplasms

Precision medicine and precision therapeutics is currently in its infancy with tremendous potential to improve patient care by better identifying individuals at risk for skin cancer and predict tumor responses to treatment. This review focuses on the Hedgehog signaling pathway, its critical role in the pathogenesis of basal cell carcinoma, and the emergence of targeted treatments for advanced basal cell carcinoma. Opportunities to utilize precision medicine are outlined, such as molecular profiling to predict basal cell carcinoma response to targeted therapy and to inform therapeutic decisions.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Drug Resistance, Neoplasm; Hedgehog Proteins; Humans; Mutation; Pyridines; Receptors, G-Protein-Coupled; Skin Neoplasms; Smoothened Receptor

Actinic keratosis (AK) is a common premalignant skin lesion that is frequently treated by cryosurgery. Basal cell carcinoma is the most common malignancy of man, and early-stage lesions are usually cured via surgery. Advanced basal cell carcinoma may require more extensive surgery resulting in deformity, and many advanced lesions cannot be treated surgically. Several recent developments have improved therapeutic options for both conditions. Cryosurgery is still a mainstay of treatment for AK, but the introduction of effective topical agents, imiquimod cream and ingenol mebutate, has provided alternatives to cryosurgery. For advanced basal cell carcinoma, the small-molecule inhibitor vismodegib has proven to be an effective therapy for lesions that are not amenable to surgery and has demonstrated ability to achieve dramatic improvement in advanced, potentially disfiguring cancer.

Topics: Aminoquinolines; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Cryosurgery; Diterpenes; Humans; Imiquimod; Keratosis, Actinic; Mutation; Patched Receptors; Pyridines; Receptors, Cell Surface; Skin Neoplasms; Treatment Outcome

Basal cell carcinoma (BCC) is the most common cancer in the U.K. and its incidence is increasing. Vismodegib, a hedgehog pathway inhibitor, has recently been licensed by the U.S. Food and Drug Administration for treatment of advanced BCC. Phase 2 trials have demonstrated efficacy in cases of locally advanced and metastatic BCC, as well as cases of hereditary basal cell naevus (Gorlin) syndrome. Side-effects are frequent and considerable and include myalgia, taste disturbance, alopecia, weight loss and fatigue. Further research is needed to investigate means of circumventing these side-effects, and longitudinal data are required to assess the long-term benefits of, and the nature of resistance to, this novel class of agents. Alternative hedgehog inhibitors are currently in clinical development. We review the current data pertaining to this novel treatment modality and discuss its likely future role in the management of BCC.

Topics: Anilides; Antineoplastic Agents; Benzamides; Biphenyl Compounds; Carcinoma, Basal Cell; Clinical Trials as Topic; Hedgehog Proteins; Humans; Pyridines; Quinazolines; Skin Neoplasms

The discovery of mutations that activate hedgehog (Hh) signaling in basal cell carcinoma (BCC) and other cancers has spurred the development of small molecule inhibitors that target the Hh pathway. High-throughput screens have identified a number of drug candidates that antagonize smoothened (SMO), an essential protein in the Hh signaling pathway. Clinical studies of the oral SMO inhibitor vismodegib (GDC-0449) in patients with inoperable or metastatic BCC have led to its recent approval by the US Food and Drug Administration. This review aims to give the clinician an overview of vismodegib and other Hh pathway inhibitors in the treatment of patients with advanced BCC and basal cell nevus syndrome. Issues of drug mechanism, efficacy, safety, tolerability, and tumor resistance are addressed.

Topics: Anilides; Animals; Antineoplastic Agents; Basal Cell Nevus Syndrome; Carcinoma, Basal Cell; Drug Approval; Drug Design; Hedgehog Proteins; Humans; Molecular Targeted Therapy; Mutation; Pyridines; Signal Transduction; Skin Neoplasms

Basal cell carcinoma (BCC) is the most frequent cancer with increasing incidence over the last decades. Standard of care is surgical excision, upon which complete tumour clearance is achieved in most cases. However, a small subgroup of patients will have remnants of disease post-excision and require further treatment options. Over 90% of all BCCs carry a mutation in PTCH 1 or SMO, two conducting proteins of the Hedgehog pathway (Hh). Therefore, inhibition of the Hh pathway is a promising option for systemic first-line therapy. Vismodegib was the first developed of these small molecules, which was approved by the FDA in January 2012.. The authors review current treatment modalities for BCC and discuss current developments in pharmacological therapy. The current literature including meta-analyses, the Cochrane database and registered as well as completed randomized controlled trials.. Hh inhibitors are a new promising treatment option for patients with advanced or metastatic BCC. Phase I and II clinical trials with the Hh inhibitor, vismodegib, showed a significant reduction in tumour size and appearance of new tumours with relatively good tolerability. Nevertheless, further investigation on new molecules and the effectiveness of an intermittent dosing regimen is necessary.

Topics: Anilides; Animals; Carcinoma, Basal Cell; Drug Resistance, Neoplasm; Hedgehog Proteins; Humans; Pyridines; Skin Neoplasms

Over the past two decades, advances in the fields of cancer genetics and molecular biology have elucidated molecular pathways that cause numerous cutaneous malignancies. This in turn has spurred the rational design of molecularly targeted therapies. In this review, we discuss the molecular pathways critical to the development of nonmelanoma skin cancers and the novel pharmacologic agents that target them. Included is a review of vismodegib for basal cell carcinoma, cetuximab for squamous cell carcinomas, imatinib for dermatofibrosarcoma protuberans, and sirolimus for Kaposi's sarcoma.

Topics: Anilides; Antibiotics, Antineoplastic; Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Benzamides; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cetuximab; Dermatofibrosarcoma; Humans; Imatinib Mesylate; Piperazines; Pyridines; Pyrimidines; Sarcoma, Kaposi; Sirolimus; Skin Neoplasms

The pharmacology, clinical efficacy, adverse effects, cost, and place in therapy of vismodegib are reviewed.. Vismodegib, the first oral treatment for basal cell carcinoma (BCC), was recently approved for the treatment of patients with locally advanced or metastatic BCC whose cancer is refractory to standard treatments or who are not candidates for surgery or radiation. Vismodegib is a small molecule that potently inhibits signal transduction in the hedgehog signaling pathway, demonstrates nonlinear pharmacokinetics, and has a half-life of 13 days. Agents that increase gastrointestinal pH may reduce the solubility and bioavailability of vismodegib. It is effective in both locally advanced and metastatic BCCs, with response rates ranging from 30% to 60% in two clinical trials. Vismodegib is available as a 150-mg capsule, and the approved dosage is 150 mg orally once daily. The most common adverse effects of vismodegib include mild-to-moderate hair loss, muscle cramps, taste disturbance, and weight loss. The estimated cost of one month of treatment with vismodegib is $7500.. Vismodegib was recently approved for the treatment of locally advanced or metastatic BCC that is refractory to standard treatments or if patients are not candidates for surgery or radiation. Vismodegib may have little effect on the treatment of BCC, given its high cost, the high cure rates achieved with standard therapies, and its unacceptable toxicity profile in patients with a non-life-threatening disease. However, vismodegib's novel mechanism of action, oral dosage form, preliminary efficacy, and tolerability compared with cytotoxic chemotherapy may make it an attractive candidate for the treatment of other cancers.

Topics: Administration, Oral; Anilides; Antineoplastic Agents; Humans; Neoplasms, Basal Cell; Pyridines; Salvage Therapy; Skin Neoplasms

Topics: Anilides; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Molecular Targeted Therapy; Pyridines; Signal Transduction; Skin Neoplasms

Topics: Anilides; Antibodies, Monoclonal; Antineoplastic Agents; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Pyridines; Skin; Skin Neoplasms

The development of vismodegib and its recent approval by the United States Food and Drug Administration for use in patients with locally advanced or metastatic basal cell carcinoma (BCC) carries with it a renewed sense of optimism. Once BCC has progressed to an advanced, or so-called inoperable stage, there has been a paucity of effective therapies, making the new small molecule inhibitors targeting the hedgehog pathway particularly hopeful prospects. In order to better understand the utility of these new treatments, it is important to assess the existing economic, physical, and psychological burden of advanced BCC. This review aims to recognize the impact of inoperable and metastatic BCC, as well as to better characterize the various types of advanced BCC. The use of vismodegib as a prophylactic treatment in patients with basal cell nevus syndrome is also addressed, including possible adverse events, tumor resistance, and new onset malignancies.

Topics: Anilides; Basal Cell Nevus Syndrome; Biomarkers, Tumor; Carcinoma, Basal Cell; Cost of Illness; Diagnosis, Differential; Hedgehog Proteins; Humans; Pyridines; Skin Neoplasms

Historically, basal cell carcinomas (BCCs) that are neither surgically resectable nor candidates for radiation therapy have had few treatment options. The hedgehog pathway inhibitor, vismodegib, represents a new opportunity for the treatment of such patients. Vismodegib has approval from the United States Food and Drug Administration for treatment of metastatic BCC, locally advanced BCC recurring after surgery, and BCC that is not treatable via surgery or radiation. We present the case of a patient with a BCC infiltrating the spinal column that was neither possible to fully remove surgically nor a candidate for primary treatment with radiation. Treatment with vismodegib followed by adjuvant radiation therapy resulted in complete disease clearance. Vismodegib represents a promising treatment option for patients with surgically non-resectable BCCs that are not candidates for radiation therapy. Mechanism of action, benefits, and adverse events of vismodegib are reviewed, along with a brief discussion on newer options in the hedgehog inhibitor class.

Topics: Aged; Anilides; Biopsy; Carcinoma, Basal Cell; Drug Approval; Hedgehog Proteins; Humans; Male; Neoplasm Invasiveness; Postoperative Care; Pyridines; Skin Neoplasms; Spinal Neoplasms; Tomography, X-Ray Computed; United States; United States Food and Drug Administration

Basal cell carcinomas (BCCs) are the most common cancer in the United States, and the overwhelming majority of BCCs are the result of hedgehog pathway activation. While locally advanced and metastatic BCC are rare, currently available treatments remain limited and are often unsuccessful. Vismodegib inhibits a key regulatory protein in the hedgehog pathway and was approved by the United States Food and Drug Administration in 2012. This orally-administered medication offers a novel approach for treating locally advanced and metastatic BCC. The following review will address vismodegib's mechanism of action, published clinical trial data, and the questions that still remain unanswered about this new medication.

Topics: Anilides; Carcinoma, Basal Cell; Drug Approval; Hedgehog Proteins; Humans; Neoplasm Metastasis; Pyridines; Signal Transduction; Skin Neoplasms; United States; United States Food and Drug Administration

Vismodegib is the first Hedgehog pathway inhibitor to be approved in the US, where it is indicated for the treatment of adults with metastatic basal cell carcinoma (BCC), or with locally advanced BCC that has recurred following surgery or who are not candidates for surgery, and who are not candidates for radiation. Vismodegib selectively and potently inhibits the Hedgehog signalling pathway by binding to Smoothened, thereby inhibiting the activation of Hedgehog target genes. Oral vismodegib was effective in the treatment of patients with locally advanced (n = 63) or metastatic (n = 33) BCC, according to the results of an ongoing, noncomparative, multinational, pivotal, phase II trial (ERIVANCE BCC). In this trial (using a clinical cutoff date of 26 November 2010), the independent review facility overall response rate was 42.9% in patients with locally advanced BCC and 30.3% in patients with metastatic BCC. In both patients with locally advanced BCC and those with metastatic BCC, the median duration of response was 7.6 months and median progression-free survival was 9.5 months. Oral vismodegib had an acceptable tolerability profile in patients with advanced BCC.

Topics: Anilides; Animals; Carcinoma, Basal Cell; Clinical Trials, Phase I as Topic; Clinical Trials, Phase II as Topic; Disease-Free Survival; Drug Evaluation, Preclinical; Hedgehog Proteins; Humans; Pyridines; Skin Neoplasms

Vismodegib is a novel, small-molecule inhibitor of smoothened, a key component of the hedgehog signaling pathway. Increased hedgehog pathway signaling is critical in the development of hereditary and spontaneous basal cell carcinomas of the skin, and has been implicated in the development of a number of other tumors. In preclinical models, vismodegib demonstrated potent antitumor activity in hedgehog-dependent tumors, particularly basal cell carcinomas. Clinically, phase I and II studies showed dramatic anticancer activity in patients with advanced basal cell carcinomas. In January 2012, vismodegib was approved by the FDA for the treatment of unresectable or metastatic basal cell carcinomas of the skin.

Topics: Anilides; Animals; Antineoplastic Agents; Carcinoma, Basal Cell; Drug Interactions; Drug Resistance, Neoplasm; Evidence-Based Medicine; Humans; Pyridines; Signal Transduction; Skin Neoplasms; Treatment Outcome

Vismodegib is an oral inhibitor of the Hedgehog pathway approved by the US Food and Drug Administration. It is the first systemic treatment for patients with locally advanced or metastatic basal cell carcinoma that is not amenable to surgery and radiation. This is the first drug to use the Hedgehog pathway to inhibit the proliferation of tumors and is also implicated in the development of other cancers such as medulloblastoma.. The goal of this review was to summarize the development, pharmacology, efficacy, and safety of vismodegib.. Relevant English-language literature was identified and then evaluated based on results from database searches of MEDLINE and EMBASE from 1975 to June 19, 2012. The terms searched included, but were not limited to, vismodegib, Erivedge, GDC-0449, basal cell carcinoma, and 2-chloro-N-[4-chloro-3-(pyridin-2-yl)phenyl]-4-(methylsulfonyl)benzamide. Additional literature was identified by assessing the reference lists of previously identified articles and through abstracts presented by the American Society of Clinical Oncology.. A total of 70 full text citations were identified although two national conference proceedings were then excluded. An additional 10 published abstracts were also identified. A Phase II, nonrandomized, multicenter, international study demonstrated a 30.3% objective response rate in metastatic basal cell carcinoma and a 42.9% objective response rate in locally advanced basal cell carcinoma. The adverse effect profile for vismodegib is similar to other identified Hedgehog pathway inhibitors; muscle cramps (71.7%), alopecia (63.8%), and dysgeusia (55.1%) were the most common adverse effects seen in trials. A Phase II, randomized, placebo-controlled trial in Gorlin syndrome patients with basal cell carcinoma concluded that vismodegib was significantly better than placebo at reducing new basal cell carcinoma lesions (P < 0.001) and at decreasing the sum of the longest diameter of existing lesions (P = 0.003).. For patients with unresectable basal cell carcinoma or where resection would be cosmetically disadvantageous, vismodegib is an effective therapy with good response rates. At this time, the data are too limited to determine overall survival. The Hedgehog pathway is a newly identified area in which mutations or dysregulation can occur, leading to the development and progression of tumors. Studies continue to look at other cancers with involvement of the Hedgehog pathway.

Topics: Anilides; Animals; Antineoplastic Agents; Carcinoma, Basal Cell; Disease Progression; Drug Approval; Hedgehog Proteins; Humans; Pyridines; Skin Neoplasms; United States; United States Food and Drug Administration

Surgical treatment remains the standard of care for nonmelanoma skin cancer and is successful for the vast majority of patients with these tumors. The treatment of patients with metastatic or unresectable nonmelanoma skin cancer, however, has until recently been based solely on traditional methods of chemotherapy and radiation. However, these methods have high rates of treatment failure, morbidity, and mortality, and alternative treatment modalities for patients with aggressive or advanced disease are needed. As in other areas of cancer therapeutics, recent research elucidating the molecular basis of cancer development, and the subsequent arrival of targeted molecular inhibitors for cancer therapy, have been met with much excitement. In this review, we seek to illuminate recent developments and future possibilities in the use of targeted molecular inhibitors for treatment of advanced squamous cell carcinoma, basal cell carcinoma, and dermatofibrosarcoma protuberans.

Topics: Anilides; Antineoplastic Agents; Benzamides; Carcinoma; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Dermatofibrosarcoma; ErbB Receptors; Head and Neck Neoplasms; Humans; Imatinib Mesylate; Molecular Targeted Therapy; Neoplasms, Squamous Cell; Piperazines; Pyridines; Pyrimidines; Skin Neoplasms; Squamous Cell Carcinoma of Head and Neck

Acquired resistance to targeted therapies threatens the value of these otherwise very promising agents. The recent description of resistance to the Hedgehog pathway inhibitor vismodegib (GDC-0449) in a medulloblastoma patient who had a dramatic initial response has spurred efforts to understand potential mechanisms of drug resistance. Elucidating these mechanisms will play a significant role in informing strategies to overcome this meaningful limitation.

Topics: Anilides; Animals; Antineoplastic Agents; Basal Cell Nevus Syndrome; Biphenyl Compounds; Carcinoma, Basal Cell; Drug Resistance, Neoplasm; Gene Expression Regulation, Neoplastic; Hedgehog Proteins; Humans; Medulloblastoma; Mice; Mice, Knockout; Mice, Nude; Molecular Targeted Therapy; Mutation, Missense; Neoplasm Proteins; Patched Receptors; Phosphoinositide-3 Kinase Inhibitors; Pyridines; Receptors, Cell Surface; Receptors, G-Protein-Coupled; Signal Transduction; Skin Neoplasms; Smoothened Receptor; Xenograft Model Antitumor Assays

The Hedgehog signaling pathway has been identified as fundamentally important to normal embryonic development in living organisms ranging from fruit flies to mammals. Postdevelopmentally, it remains active in hair and skin cells. Abnormal activation of components of the Hedgehog pathway--specifically, resulting from mutations in the Patched 1 gene--is associated with the development of basal cell carcinoma, as well as several other cancers, including medulloblastoma. Patched 1 gene mutation has also been identified as the underlying mechanism in most cases of Gorlin syndrome (also known as basal cell nevus syndrome or nevoid basal cell carcinoma syndrome). Research that resulted in the current understanding of the Hedgehog signaling pathway, in turn, led to multiple lines of investigation to discover mechanisms for halting abnormal signaling, in the hope that agents could be developed that could beneficially stop this pathway. To date, several agents have been developed-and some are in clinical trials-that hold promise for improved nonsurgical treatments for patients with Gorlin syndrome and those with locally advanced/metastatic BCCs.

Topics: Anilides; Basal Cell Nevus Syndrome; Carcinoma, Basal Cell; Cell Transformation, Neoplastic; Hedgehog Proteins; Humans; Patched Receptors; Patched-1 Receptor; Pyridines; Receptors, Cell Surface; Signal Transduction; Skin Neoplasms

A number of therapies that target components of the Hedgehog signaling pathway currently are in clinical trials. The specific molecules that seem most promising in basal cell carcinoma and a number of other cancers are those that target the Smoothened transmembrane protein. The pivotal phase II trials have been completed on the Smoothened inhibitor known as GDC-0449; five other agents (BMS-833923, LDE225, LEQ506, IPI926, and TAK-441) have also shown promise in animal studies and early clinical trials and have shown some efficacy in a variety of cancers that are affected by the Hedgehog signaling pathway.

Topics: Aminoquinolines; Anilides; Antineoplastic Agents; Basal Cell Nevus Syndrome; Benzamides; Carcinoma, Basal Cell; Deoxyribonuclease (Pyrimidine Dimer); Fluorouracil; Hedgehog Proteins; Humans; Imiquimod; Photochemotherapy; Pyridines; Quinazolines; Retinoids; Secondary Prevention; Signal Transduction; Skin Neoplasms; Viral Proteins

It has long been known that the hedgehog signaling pathway is crucial for embryonic development, in both Drosophila and vertebrate systems. During the past few years its implication in carcinogenesis has become clear and today it is acknowledged that this pathway plays a role in the malignant transformation of multiple cell types, either owing to the mutation of some of its components or to its erratic activation. New molecular targeted therapies that inhibit the pathway have shown their unquestionable efficiency in several tumours -among which basal cell carcinoma, medulloblastoma, or pancreatic adenocarcinoma. The assessment of these inhibitors in other types of tumours is currently underway with promising results, suggesting that the Sonic hedgehog signalling pathway may become one of the therapeutic targets of the future.

Topics: Anilides; Animals; Carcinoma, Basal Cell; Cerebellar Neoplasms; Embryonic Development; Embryonic Induction; Hedgehog Proteins; Humans; Lung Neoplasms; Medulloblastoma; Molecular Targeted Therapy; Mutation; Neoplasms; Neoplastic Stem Cells; Pancreatic Neoplasms; Patched Receptors; Patient Selection; Pyridines; Receptors, Cell Surface; Signal Transduction; Skin Neoplasms; Small Cell Lung Carcinoma

To evaluate the effect of locally advanced periocular basal cell carcinoma (POLA-BCC) on health-related quality of life (HRQoL) and the benefit of vismodegib treatment among participants in the Safety Events in Vismodegib (STEVIE) trial between 2011 and 2017.. The STEVIE trial was conducted in patients with BCC (all anatomic locations) who were treated with vismodegib in 28-day cycles. Patients completed the Skindex-16, a validated questionnaire for the analysis symptoms, emotions, and functioning, at baseline, on day 1 of cycle 2, on day 1 of cycle 7, and at the end-of-study visit. For the present study, data mining techniques were used to construct an ophthalmic database of the STEVIE study. Skindex-16 scores were compared among patients with POLA-BCC between baseline and follow-up and between patients with POLA-BCC and patients with locally advanced BCC on other sites of the head and face (controls).. The cohort included 169 patients with POLA-BCC and 428 patients with non-periocular head BCC. Patients with POLA-BCC had a significantly worse overall functioning score at baseline than controls (p = 0.038) and a lower score specifically in activities of daily living (p = 0.001). At the last follow-up, patients with POLA-BCC showed significant improvement in scores for functioning (100%), symptoms (100%), and emotions (75%) relative to baseline.. Secondary analysis of the results of the STEVIE trial showed that the HRQoL of patients with POLA-BCC is significantly impaired and can be greatly improved with vismodegib treatment.

Topics: Activities of Daily Living; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Quality of Life; Skin Neoplasms

The BOLT study for sonidegib, a Hedgehog pathway inhibitor (HHI) approved for patients with locally advanced basal cell carcinoma (laBCC) not amenable to curative surgery or radiotherapy, used modified Response Evaluation Criteria in Solid Tumors (mRECIST) for laBCC tumor evaluation. The ERIVANCE study for vismodegib, another HHI, used a composite RECIST endpoint of ≥30% reduction in externally visible tumor or radiographic dimension, or complete ulceration resolution. This preplanned sensitivity BOLT analysis evaluated efficacy outcomes using ERIVANCE-like criteria in patients with laBCC who received sonidegib 200 mg once daily.. This phase 2, double-blind study randomized patients 1:2 to sonidegib 200:800 mg daily, respectively. Key endpoints included objective response rate (ORR), duration of response (DOR), complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). laBCC tumors were assessed by both mRECIST and ERIVANCE-like criteria. Per mRECIST, an overall response of CR was based on negative histology; photographic assessment of CR, PR (scar/fibrosis only), SD (scar/fibrosis only), or not available (NA); and a magnetic resonance imaging response of CR or NA. An overall response of CR was primarily based on negative histology using ERIVANCE-like criteria.. Per mRECIST criteria, ORR (95% confidence interval [CI]) by central and investigator review for patients with laBCC (n = 66) was 56.1% (43.3-68.3%) and 71.2% (58.7-81.7%), respectively. CR per central review was achieved in 3 (4.5%) patients and PR, SD, and PD occurred in 34 (51.5%), 23 (34.8%), and 1 (1.5%) patient, respectively. Median (95% CI) DOR was 26.1 months (not estimable [NE]). Using ERIVANCE-like criteria, efficacy outcomes per central and investigator review were higher, with an ORR (95% CI) of 60.6% (47.8-72.4%) and 74.2% (62.0-84.2%), respectively. CR per central review was reached in 14 (21.2%) patients and PR, SD, and PD occurred in 26 (39.4%), 20 (30.3%), and 1 (1.5%) patient, respectively. DOR was unchanged with a median (95% CI) of 26.1 months (NE).. Overall, applying ERIVANCE-like criteria to patients with laBCC receiving sonidegib 200 mg daily yielded higher response rates vs mRECIST criteria.. BOLT registration: ClinicalTrials.gov ( NCT01327053 ) on March 30, 2011.

Topics: Adult; Anilides; Biphenyl Compounds; Carcinoma, Basal Cell; Confidence Intervals; Disease Progression; Double-Blind Method; Drug Administration Schedule; Humans; Pyridines; Response Evaluation Criteria in Solid Tumors; Skin Neoplasms; Treatment Outcome

Basal cell carcinoma (BCC) is a common skin cancer often curable by excision; however, for patients with BCC around the eye, excision places visual organs and function at risk. In this article, we test the hypothesis that use of the hedgehog inhibitor vismodegib will improve vision-related outcomes in patients with orbital and extensive periocular BCC (opBCC).. In this open-label, nonrandomized phase IV trial, we enrolled patients with globe- and lacrimal drainage system-threatening opBCC. To assess visual function in the context of invasive periorbital and lacrimal disease, we used a novel Visual Assessment Weighted Score (VAWS) in addition to standard ophthalmic exams. Primary endpoint was VAWS with a score of 21/50 (or greater) considered successful, signifying globe preservation. Tumor response was evaluated using RECIST v1.1. Surgical specimens were examined histologically by dermatopathologists.. In 34 patients with opBCC, mean VAWS was 44/50 at baseline, 46/50 at 3 months, and 47/50 at 12 months or postsurgery. In total, 100% of patients maintained successful VAWS outcome at study endpoint. Compared with baseline, 3% (95% confidence interval [CI], 0.1-15.3) experienced major score decline (5+ points), 14.7% (95% CI, 5 to 31.1) experienced a minor decline (2-4 points), and 79.4% experienced a stable or improved score (95% CI, 62.1-91.3). A total of 56% (19) of patients demonstrated complete tumor regression by physical examination, and 47% (16) had complete regression by MRI/CT. A total of 79.4% (27) of patients underwent surgery, of which 67% (18) had no histologic evidence of disease, 22% (6) had residual disease with clear margins, and 11% (3) had residual disease extending to margins.. Vismodegib treatment, primary or neoadjuvant, preserves globe and visual function in patients with opBCC. Clinical trail identification number.NCT02436408.. Use of the antihedgehog inhibitor vismodegib resulted in preservation of end-organ function, specifically with regard to preservation of the eye and lacrimal apparatus when treating extensive periocular basal cell carcinoma. Vismodegib as a neoadjuvant also maximized clinical benefit while minimizing toxic side effects. This is the first prospective clinical trial to demonstrate efficacy of neoadjuvant antihedgehog therapy for locally advanced periocular basal cell carcinoma, and the first such trial to demonstrate end-organ preservation.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Prospective Studies; Pyridines; Skin Neoplasms; Treatment Outcome

Before February, 2021, there was no standard treatment regimen for locally advanced basal cell carcinoma after first-line hedgehog inhibitor (HHI) therapy. Cemiplimab, a PD-1 antibody, is approved for treatment of advanced cutaneous squamous cell carcinoma and has shown clinical activity as monotherapy in first-line non-small-cell lung cancer. Here, we present the primary analysis data of cemiplimab in patients with locally advanced basal cell carcinoma after HHI therapy.. We did an open-label, multicentre, single-arm, phase 2 trial across 38 outpatient clinics, primarily at academic medical centres, in Canada, Europe, and the USA. Eligible patients (aged ≥18 years and with an Eastern Cooperative Oncology Group performance status of 0 or 1) with a histologically confirmed diagnosis of metastatic basal cell carcinoma (group 1) or locally advanced basal cell carcinoma (group 2) who had progressed on or were intolerant to previous HHI therapy were enrolled. Patients were not candidates for further HHI therapy due to progression of disease on or intolerance to previous HHI therapy or having no better than stable disease after 9 months on HHI therapy. Patients received cemiplimab 350 mg intravenously every 3 weeks for up to 93 weeks or until progression or unacceptable toxicity. The primary endpoint was objective response by independent central review. Analyses were done as per the intention-to-treat principle. The safety analysis comprised all patients who received at least one dose of cemiplimab. The primary analysis is reported only for group 2; group 1 data have not reached maturity and will be reported when the timepoint, according to the statistical analysis plan, has been reached. This study is registered with ClinicalTrials.gov, NCT03132636, and is no longer recruiting new participants.. Between Nov 16, 2017, and Jan 7, 2019, 84 patients were enrolled and treated with cemiplimab. At data cutoff on Feb 17, 2020, median duration of follow-up was 15 months (IQR 8-18). An objective response per independent central review was observed in 26 (31%; 95% CI 21-42) of 84 patients, including two partial responses that emerged at tumour assessments before the data cutoff and were confirmed by tumour assessments done subsequent to the data cutoff. The best overall response was five (6%) patients with a complete response and 21 (25%) with a partial response. Grade 3-4 treatment-emergent adverse events occurred in 40 (48%) of 84 patients; the most common were hypertension (four [5%] of 84 patients) and colitis (four [5%]). Serious treatment-emergent adverse events occurred in 29 (35%) of 84 patients. There were no treatment-related deaths.. Cemiplimab exhibited clinically meaningful antitumour activity and an acceptable safety profile in patients with locally advanced basal cell carcinoma after HHI therapy.. Regeneron Pharmaceuticals and Sanofi.

Topics: Adult; Aged; Anilides; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Basal Cell; Drug Resistance, Neoplasm; Female; Hedgehog Proteins; Humans; Immune Checkpoint Inhibitors; Male; Middle Aged; Neoplasm Recurrence, Local; Programmed Cell Death 1 Receptor; Pyridines; Skin Neoplasms

Vismodegib demonstrated 60% response rates in the ERIVANCE trial. Basal cell carcinoma has various histopathologies. Their effect on response is unclear.. The purpose of this study was to determine whether basal cell carcinoma histopathology affected vismodegib response.. This phase 2b, single-center, prospective case series study compared the efficacy of vismodegib in infiltrative, nodular, and superficial basal cell carcinomas treated for 12 or 24 weeks in 27 patients. Patients had 1 target lesion and up to 3 nontarget lesions.. Twenty-seven patients were enrolled, with 65 tumors (27 target lesions/38 nontarget lesions). At 24 weeks, most basal cell carcinomas achieved histologic clearance, with positive biopsy results in 10.5% of target lesions, 30.4% of nontarget lesions, and 21.4% overall. No statistical differences were observed between histopathologic subtypes. One hundred percent of patients experienced an adverse event, 94% grade 1 or 2. The most common adverse events were dysgeusia/loss of taste (86%), muscle spasms (82%), and alopecia (71%). Clinically progressive disease during treatment was low (1.5%). Two patients had recurrence within 1 year of treatment.. Limitations included sample size of basal cell carcinoma histopathologic subtypes, sampling punch biopsies, and short follow-up.. Basal cell histopathologic subtype did not significantly affect response to vismodegib. Each subtype was observed to completely respond at 12 weeks of therapy, 24 weeks, or both.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Alopecia; Anilides; Antineoplastic Agents; Biopsy; Carcinoma, Basal Cell; Drug Administration Schedule; Dysgeusia; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Prospective Studies; Pyridines; Skin; Skin Neoplasms; Spasm; Treatment Outcome

Topics: Adult; Aged; Aged, 80 and over; Anilides; Animals; Antineoplastic Agents; ATP-Binding Cassette Transporters; Carcinoma, Basal Cell; Cohort Studies; Disease Progression; Female; Humans; Italy; Male; Middle Aged; Pyridines; Quality of Life; Skin Neoplasms

The outcomes of vismodegib treatment in a relatively large cohort of study participants with periocular locally advanced basal cell carcinoma (POLA-BCC) may guide physicians when considering this treatment.. To report the outcomes of vismodegib treatment in patients with POLA-BCC in the Safety Events in Vismodegib (STEVIE) study.. This post hoc subgroup analysis from the STEVIE single-arm, multicenter, open-label cohort study screened all 1215 participants for ocular or periocular involvement and identified 244 participants with POLA-BCC or metastatic BCC. Data for the first STEVIE trial were collected from 167 treatment locations in 36 countries from June 30, 2011, to June 14, 2017. This post hoc analysis was performed from April 1 to August 31, 2019.. Response to treatment and adverse events.. Ocular or periocular involvement was found in 244 of 1215 STEVIE participants (20.1%), who constituted the analytic sample. The median age of the study participants was 72.0 (interquartile range [IQR], 60.0-82.0]) years, and they included 143 men (58.6%). Locally advanced BCC was diagnosed in 238 of the 244 participants (97.5%) and metastatic BCC, in 6 (2.5%). The median duration of exposure to vismodegib was 40.0 (IQR, 20.0-78.0) weeks, specifically 39.7 (IQR, 19.9-76.0) weeks for POLA-BCC and 92.4 (IQR, 53.2-163.0) weeks for metastatic BCC. Sixty-nine participants (28.3%) sustained serious adverse events (alopecia, muscle spasms, dysgeusia, weight loss, decreased appetite, asthenia, ageusia, nausea, fatigue, and diarrhea). Two hundred thirty-two study participants (95.1%) sustained more than 1 adverse effect. The overall mean (SD) number of drug-related adverse effects per study participant by first adverse event, regardless of the severity, was 5.48 (3.84). Discontinuation of vismodegib treatment owing to an adverse event was recorded in 58 participants (23.8%). During the study, 22 participants (9.0%) died, 70 (28.7%) achieved complete response, and 94 (38.5%) achieved partial response.. Vismodegib was well tolerated by the study participants with POLA-BCC. The safety of vismodegib treatment according to the STEVIE trial findings is consistent with that reported in previous studies. These data may be helpful when considering vismodegib for patients with POLA-BCC.

Topics: Aged; Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Dose-Response Relationship, Drug; Eye Neoplasms; Female; Humans; Male; Middle Aged; Neoplasm Staging; Pyridines; Skin Neoplasms; Treatment Outcome

Topics: Anilides; Antibodies, Monoclonal, Humanized; Antineoplastic Agents, Immunological; Carcinoma, Basal Cell; Disease-Free Survival; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Infusions, Intravenous; Male; Neoplasm Invasiveness; Neoplasm Staging; Prognosis; Prospective Studies; Pyridines; Risk Assessment; Skin Neoplasms; Survival Analysis; Treatment Outcome

Topics: Anilides; Biopsy; Carcinoma, Basal Cell; Female; Humans; Male; Margins of Excision; Mohs Surgery; Neoadjuvant Therapy; Proof of Concept Study; Pyridines; Skin; Skin Neoplasms; Treatment Outcome

Oral vismodegib therapy and photodynamic therapy (PDT) are non-invasive treatments for basal cell carcinoma (BCC) with overlapping utility in widespread BCCs and patients who are poor surgical candidates. There is no published study to date investigating the combination use of PDT with vismodegib to optimize individual response rates.. To evaluate the combination of red light PDT and vismodegib therapy in patients with multiple nodular BCCs. The primary objective was to determine the safety of this combination therapy. Secondary outcomes included evaluation of the overall response rate, treatment-related pain, and cosmesis.. An open label pilot study of immunocompetent patients with multiple BCCs treated with 3 months of continuous vismodegib therapy (150 mg daily) and 3 consecutive ALA PDT sessions. Outcomes were assessed following each PDT session and 30 days post-treatment.. Four patients with multiple nodular BCC (median=5) were enrolled in the trial between January and August of 2016. Three patients completed the full intervention phase trial and a total of 19 lesions were treated. One patient completed 2 months of vismodegib and 2 PDT sessions. One PDT session was sufficient for small lesions, whereas larger lesions required all 3 sessions. The fifteen evaluable lesions at the end of the 3 PDT sessions showed complete responses. At 30-day follow-up, one of the treated lesions was noted to have clinical evidence of disease. Overall response rate showed 90% complete response and 10% partial response for the study. Combination therapy was well tolerated and yielded a similar or superior side effect profile to that of individual therapies with excellent cosmesis.. Combination PDT-vismodegib is a potential safe & effective therapy for the treatment of multiple BCCs that may enhance efficacy of individual therapies.

Topics: Aged; Aminolevulinic Acid; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Combined Modality Therapy; Hamartoma Syndrome, Multiple; Humans; Immunocompromised Host; Male; Middle Aged; Photochemotherapy; Photosensitizing Agents; Pyridines; Skin Neoplasms

Topics: Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Carnitine; Double-Blind Method; Female; Humans; Male; Middle Aged; Pilot Projects; Pyridines; Skin Neoplasms; Spasm

Health-related quality of life (HRQoL) data are limited in patients with advanced basal cell carcinoma. To report HRQoL outcomes based on STEVIE (NCT01367665), a phase 2 study of vismodegib safety in patients with metastatic BCC or locally advanced BCC that is unsuitable for surgery or radiotherapy. Skindex-16 and MD Anderson Symptom Inventory (MDASI) questionnaires were completed at baseline and at three subsequent visits. Clinically meaningful improvement was defined as a ≥10-point decrease from baseline (Skindex-16) or improvement of at least 3 points from baseline (MDASI). HRQoL-evaluable patients with locally advanced BCC (n = 730) had ≥10-point improvements in Skindex-16 emotion domain scores at all time points. Changes in symptom and function scores in these patients or in any domain scores at any time point in patients with metastatic BCC (n = 10) were not clinically meaningful. Of 10 patients with symptomatic metastatic BCC at baseline, six had ≥3-point improvements in MDASI symptom severity. Skindex-16 and MDASI showed improvement in HRQoL in vismodegib-treated patients with locally advanced or metastatic BCC or BCC.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Emotions; Female; Humans; Male; Middle Aged; Pyridines; Quality of Life; Skin Neoplasms; Surveys and Questionnaires; Time Factors; Young Adult

In the primary analysis of the ERIVANCE BCC trial, vismodegib, the first US Food and Drug Administration-approved Hedgehog pathway inhibitor, showed objective response rates (ORRs) by independent review facility (IRF) of 30% and 43% in metastatic basal cell carcinoma (mBCC) and locally advanced BCC (laBCC), respectively. ORRs by investigator review were 45% (mBCC) and 60% (laBCC). Herein, we present long-term safety and final investigator-assessed efficacy results in patients with mBCC or laBCC.. One hundred four patients with measurable advanced BCC received oral vismodegib 150 mg once daily until disease progression or intolerable toxicity. The primary end point was IRF-assessed ORR. Secondary end points included ORR, duration of response (DOR), progression-free survival, overall survival (OS), and safety.. At data cutoff (39 months after completion of accrual), 8 patients were receiving the study drug (69 patients in survival follow-up). Investigator-assessed ORR was 48.5% in the mBCC group (all partial responses) and 60.3% in the laBCC group (20 patients had complete response and 18 patients had partial response). ORRs were comparable across patient subgroups, including aggressive histologic subtypes (eg, infiltrative BCC). Median DOR was 14.8 months (mBCC) and 26.2 months (laBCC). Median OS was 33.4 months in the mBCC cohort and not estimable in the laBCC cohort. Adverse events remained consistent with clinical experience. Thirty-three deaths (31.7%) were reported; none were related to vismodegib.. This long-term update of the ERIVANCE BCC trial demonstrated durability of response, efficacy across patient subgroups, and manageable long-term safety of vismodegib in patients with advanced BCC.. This study was registered prospectively with Clinicaltrials.gov , number NCT00833417 on January 30, 2009.

Topics: Anilides; Antineoplastic Agents; ATP-Binding Cassette Transporters; Carcinoma, Basal Cell; Disease Progression; Disease-Free Survival; Female; Hedgehog Proteins; Humans; Male; Prospective Studies; Pyridines; Signal Transduction; Skin Neoplasms

Vismodegib, a first-in-class Hedgehog-pathway inhibitor, is approved for use in adults with advanced basal-cell carcinoma. Patients with multiple basal-cell carcinomas, including those with basal-cell nevus (Gorlin) syndrome, need extended treatment. We assessed the safety and activity of two long-term intermittent vismodegib dosing regimens in patients with multiple basal-cell carcinomas.. In this randomised, regimen-controlled, double-blind, phase 2 trial, we enrolled adult patients with multiple basal-cell carcinomas, including those with basal-cell nevus syndrome, who had one or more histopathologically confirmed and at least six clinically evident basal-cell carcinomas. From a centralised randomisation schedule accessed via an interactive voice or web-based response system, patients were randomly assigned (1:1) to treatment group A (150 mg oral vismodegib per day for 12 weeks, then three rounds of 8 weeks of placebo daily followed by 12 weeks of 150 mg vismodegib daily) or treatment group B (150 mg oral vismodegib per day for 24 weeks, then three rounds of 8 weeks of placebo daily followed by 8 weeks of 150 mg vismodegib daily). Treatment assignment was stratified by diagnosis of basal-cell nevus syndrome, geographical region, and immunosuppression status. The primary endpoint was percentage reduction from baseline in the number of clinically evident basal-cell carcinomas at week 73. The primary analysis was by intention to treat. The safety population included all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT01815840, and the study is ongoing.. Between April 30, 2013, and April 9, 2014, 229 patients were randomly assigned treatment, 116 in treatment group A and 113 in treatment group B. The mean number of basal-cell carcinoma lesions at week 73 was reduced from baseline by 62·7% (95% CI 53·0-72·3) in treatment group A and 54·0% (43·6-64·4) in treatment group B. 216 (95%) of 227 patients included in the safety analysis had at least one treatment-emergent adverse event deemed to be related to study treatment (107 [94%] of 114 in treatment group A and 109 [97%] of 113 in treatment group B). The most common grade 3 or worse treatment-related adverse events were muscle spasms (four [4%] patients in treatment group A vs 12 [11%] in treatment group B), increased blood creatine phosphokinase (one [1%] vs four [4%]), and hypophosphataemia (zero vs three [3%]). Serious treatment-emergent events were noted in 22 (19%) patients in treatment group A and 19 (17%) patients in treatment group B. Four (2%) patients died from adverse events; one (pulmonary embolism in treatment group A) was possibly related to treatment.. Both intermittent dosing schedules of vismodegib seemed to show good activity in long-term regimens in patients with multiple basal-cell carcinomas. Further study is warranted.. F Hoffmann-La Roche.

Topics: Adult; Aged; Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Staging; Prognosis; Pyridines; Skin Neoplasms

To assess the tumor response to the smoothened (SMO) inhibitor, sonidegib (LDE225), in patients with an advanced basal cell carcinoma (BCC) resistant to treatment with vismodegib (GDC0449).. Nine patients with an advanced BCC that was previously resistant to treatment with vismodegib were given sonidegib in this investigational, open-label study. Tumor response was determined using the response evaluation criteria in solid tumors. SMO mutations were identified using biopsy samples from the target BCC location.. The median duration of treatment with sonidegib was 6 weeks (range, 3-58 weeks). Five patients experienced progressive disease with sonidegib. Three patients experienced stable disease and discontinued sonidegib either due to adverse events (n = 1) or due to election for surgery (n = 2). The response of one patient was not evaluable. SMO mutations with in vitro data suggesting resistance to Hh pathway inhibition were identified in 5 patients, and none of these patients experienced responses while on sonidegib.. Patients with advanced BCCs that were previously resistant to treatment with vismodegib similarly demonstrated treatment resistance with sonidegib. Patients who have developed treatment resistance to an SMO inhibitor may continue to experience tumor progression in response to other SMO inhibitors.

Topics: Adult; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Biphenyl Compounds; Carcinoma, Basal Cell; Drug Resistance, Neoplasm; Female; Humans; Male; Middle Aged; Models, Molecular; Mutation; Neoplasm Staging; Protein Conformation; Pyridines; Retreatment; Skin Neoplasms; Smoothened Receptor; Treatment Outcome

Topics: Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Chemotherapy, Adjuvant; Facial Neoplasms; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mohs Surgery; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Pyridines; Skin Neoplasms; Tumor Burden

Aberrant activation of the Hedgehog (Hh) pathway is a key driver in the pathogenesis of basal cell carcinomas (BCCs), including patients with BCC nevus syndrome (BCCNS). It is unclear whether BCCs arising in patients with BCCNS respond differently to vismodegib than in patients without BCCNS. We examined the best overall response rate (BORR) and adverse events (AEs) of vismodegib in patients with advanced BCC (aBCC) with and without BCCNS.. Patients were treated with vismodegib 150 mg/day in the ERIVANCE BCC trial (ClinicalTrials.gov number, NCT00833417) and the expanded access study (EAS; ClinicalTrials.gov number, NCT01160250). BCCNS diagnosis was based on medical history at the time of enrollment. Metastatic BCC response was evaluated using Response Evaluation Criteria In Solid Tumors, version 1.0 (RECIST v1.0) in both studies. Locally advanced BCC was evaluated by a novel composite end point in ERIVANCE BCC and by RECIST v1.0 in the EAS. Response assessments were performed every 8 weeks in ERIVANCE BCC and every 8-16 weeks in the EAS. Safety assessments (National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0) were performed monthly in both trials. Because of described differences in response assessment/schedule, patients with BCCNS were not pooled across trials. Analytic cohorts for BCCNS and sporadic aBCC were created within each trial for comparison using descriptive statistical methods.. Forty-one patients with BCCNS were included in the study: 22 from ERIVANCE BCC and 19 from the EAS. Investigator-assessed BORR in BCCNS groups ranged from 31 to 81 % in patients with locally advanced BCC (n = 33) and was 50 % in patients with metastatic BCC (n = 6). These results were comparable with the non-BCCNS groups. Incidence and severity of AEs were also comparable between the BCCNS and non-BCCNS groups. Amenorrhea was observed in both patient cohorts and was reversible in two patients who discontinued treatment.. Vismodegib demonstrated comparable efficacy and safety against aBCC in patients with and without BCCNS.

Topics: Adult; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Hedgehog Proteins; Humans; Male; Middle Aged; Pyridines; Skin Neoplasms; Young Adult

Aberrant hedgehog signalling underlies the development of basal-cell carcinomas. We previously reported the interim analysis of a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial in patients with the basal-cell nevus (Gorlin) syndrome indicating that the smoothened inhibitor vismodegib reduces basal-cell carcinoma tumour burden and prevents new basal-cell carcinoma growth in patients with basal-cell nevus syndrome. We report the final results of this 36 month trial.. In our multicentre, randomised, double-blind, placebo-controlled, phase 2 trial we enrolled patients aged 35-75 years with basal-cell nevus syndrome with at least ten surgically eligible basal-cell carcinomas at the Children's Hospital Oakland, Columbia University outpatient dermatology clinic (NY, USA) and a private practice outpatient dermatology office in Newport Beach (CA, USA). Patients were assigned to vismodegib or placebo (2:1) according to a randomisation sequence generated by computer code. The primary endpoint of the trial of 41 patients was to compare the effect of oral vismodegib (150 mg/day) versus placebo on the incidence of new surgically eligible basal-cell carcinomas after 3 months of treatment. In the subsequent, open-label phase (n=37) patients continued vismodegib at two sites for as long as month 36 (n=25) and at the third site were monitored up to month 36 (n=12). Additional endpoints for this phase were: whether continuous versus interrupted dosing differentially affected tumour burden; time to reach various levels of reduction in tumour burden; reduction in tumour size in patients who took less than 50% of the expected number of vismodegib tablets; reduction in the number of surgical excisions required per year before, during, and after treatment; and the effect of vismodegib on hedgehog target gene expression. We monitored patients at visits every 3 months for up to 36 months. The primary endpoint was analysed on a modified intention-to-treat basis. This trial is registered with ClinicalTrials.gov, number NCT00957229.. Between Sept 22, 2009, and Jan 24, 2011, 41 patients were monitored for a median of 36 months (IQR 36-36). Patients treated with vismodegib (n=26) had a mean reduced rate of new surgically eligible basal-cell carcinomas compared with patients randomly assigned to placebo (n=15; two [SD 0·12] new surgically eligible basal-cell carcinomas per patient per year vs 34 [1·32] new surgically eligible basal-cell carcinomas per patient per year, p<0·0001). In the 11 patients initially assigned to placebo, mean cross over to vismodegib reduced the development of new surgically eligible basal-cell carcinomas compared with placebo (0·4 [SD 0·2] new surgically eligible basal-cell carcinomas per patient per year vs 30·0 [7·8] new surgically eligible basal-cell carcinomas per patient per year, p<0·0001). Only three (17%) of 18 patients tolerated vismodegib continuously for the full 36 months. Fewer new surgically eligible basal-cell carcinomas developed in patients receiving vismodegib continuously than in those who interrupted dosing (mean 0·6 [0·72] new surgically eligible basal-cell carcinomas per patient per year vs 1·7 [1·8] new surgically eligible basal-cell carcinomas per patient per year, p<0·0001). Treatment-related grade 3-4 adverse events included weight loss of 20% or more (n=6) and muscle cramps (n=2). Two patients died during the course of the trial, one each from laryngeal and metastatic prostate cancer, deemed probably unrelated to drug.. Vismodegib reduces basal-cell carcinoma tumour burden in patients with basal-cell nevus syndrome. Adverse events associated with vismodegib frequently led to interruption of treatment, which is followed by basal-cell carcinoma recurrence.. Genentech investigator-initiated trial funding, Clinical and Translational Science Award from the National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Cancer Institute, Damon Runyon Cancer Research Foundation Clinical Investigator Award, Swim across America Foundation, and Michael J Rainen Family Foundation.

Topics: Adult; Aged; Anilides; Basal Cell Nevus Syndrome; Double-Blind Method; Female; Hedgehog Proteins; Humans; Male; Middle Aged; Pyridines; Skin Neoplasms

Vismodegib is approved for treatment of advanced basal cell carcinoma.. We sought to characterize vismodegib efficacy and safety in operable basal cell carcinoma.. Patients with new, operable, nodular basal cell carcinoma received vismodegib (150 mg/d) followed by excision and Mohs micrographic surgery to ensure clear margins. Cohort 1 received vismodegib for 12 weeks; cohort 2 received vismodegib for 12 weeks, then 24 weeks of observation before excision; and cohort 3 received vismodegib for 8 weeks on/4 weeks off/8 weeks on.. In all, 24 patients enrolled in cohort 1, and 25 in cohorts 2 and 3. Complete histologic clearance was achieved by 42%, 16%, and 44% of patients in cohorts 1, 2, and 3, respectively. Muscle spasms (76%), alopecia (58%), and dysgeusia (50%) were the most frequent adverse events (AEs). Five (7%) patients discontinued treatment because of an AE. AE reversibility was evaluated in cohort 2 with 24 weeks of observation after treatment discontinuation.. Nonrandomized, small cohort sizes, and short observation durations for some patients are limitations.. Primary efficacy end points were not met (predefined complete histologic clearance rate: >50% in cohorts 1 and 3; >30% in cohort 2). Safety was comparable when dosed continuously versus intermittently. Posttreatment reversibility of vismodegib-related AEs was demonstrated.

Topics: Adult; Aged; Anilides; Carcinoma, Basal Cell; Cohort Studies; Female; Humans; Male; Middle Aged; Pyridines; Skin Neoplasms; Treatment Outcome

Primary analysis from the pivotal ERIVANCE BCC study resulted in approval of vismodegib, a Hedgehog pathway inhibitor indicated for treatment of adults with metastatic or locally advanced basal cell carcinoma (BCC) that has recurred after surgery or for patients who are not candidates for surgery or radiation.. An efficacy and safety analysis was conducted 12 months after primary analysis.. This was a multinational, multicenter, nonrandomized, 2-cohort study in patients with measurable and histologically confirmed locally advanced or metastatic BCC taking oral vismodegib (150 mg/d). Primary outcome measure was objective response rate (complete and partial responses) assessed by independent review facility.. After 12 months of additional follow-up, median duration of exposure to vismodegib was 12.9 months. Objective response rate increased from 30.3% to 33.3% in patients with metastatic disease, and from 42.9% to 47.6% in patients with the locally advanced form. Median duration of response in patients with locally advanced BCC increased from 7.6 to 9.5 months. No new safety signals emerged with extended treatment duration.. Limitations include low prevalence of advanced BCC and challenges of designing a study with heterogenous manifestations.. The 12-month update of the study confirms the efficacy and safety of vismodegib in management of advanced BCC.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Male; Maximum Tolerated Dose; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Patient Safety; Pyridines; Risk Assessment; Skin Neoplasms; Survival Analysis; Time Factors; Treatment Outcome

The Hedgehog pathway inhibitor vismodegib has shown clinical benefit in patients with advanced basal cell carcinoma and is approved for treatment of patients with advanced basal cell carcinoma for whom surgery is inappropriate. STEVIE was designed to assess the safety of vismodegib in a situation similar to routine practice, with a long follow-up.. In this multicentre, open-label trial, adult patients with histologically confirmed locally advanced basal cell carcinoma or metastatic basal cell carcinoma were recruited from regional referral centres or specialist clinics. Eligible patients were aged 18 years or older with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, and adequate organ function. Patients with locally advanced basal cell carcinoma had to have been deemed ineligible for surgery. All patients received 150 mg oral vismodegib capsules once a day on a continuous basis in 28-day cycles. The primary objective was safety (incidence of adverse events until disease progression or unacceptable toxic effects), with assessments on day 1 of each treatment cycle (28 days) by principal investigator and coinvestigators at the site. Efficacy variables were assessed as secondary endpoints. The safety evaluable population included all patients who received at least one dose of study drug. Patients with histologically confirmed basal cell carcinoma who received at least one dose of study drug were included in the efficacy analysis. An interim analysis was pre-planned after 500 patients achieved 1 year of follow-up. This trial is registered with ClinicalTrials.gov, number NCT01367665. The study is still ongoing.. Between June 30, 2011, and Nov 6, 2014, we enrolled 1227 patients. At clinical cutoff (Nov 6, 2013), 499 patients (468 with locally advanced basal cell carcinoma and 31 with metastatic basal cell carcinoma) had received study drug and had the potential to be followed up for 12 months or longer. Treatment was discontinued in 400 (80%) patients; 180 (36%) had adverse events, 70 (14%) had progressive disease, and 51 (10%) requested to stop treatment. Median duration of vismodegib exposure was 36·4 weeks (IQR 17·7-62·0). Adverse events happened in 491 (98%) patients; the most common were muscle spasms (317 [64%]), alopecia (307 [62%]), dysgeusia (269 [54%]), weight loss (162 [33%]), asthenia (141 [28%]), decreased appetite (126 [25%]), ageusia (112 [22%]), diarrhoea (83 [17%]), nausea (80 [16%]), and fatigue (80 [16%]). Most adverse events were grade 1 or 2. We recorded serious adverse events in 108 (22%) of 499 patients. Of the 31 patients who died, 21 were the result of adverse events. As assessed by investigators, 302 (66·7%, 62·1-71·0) of 453 patients with locally advanced basal cell carcinoma had an overall response (153 complete responses and 149 partial responses); 11 (37·9%; 20·7-57·7) of 29 patients with metastatic basal cell carcinoma had an overall response (two complete responses, nine partial responses).. This study assessed the use of vismodegib in a setting representative of routine clinical practice for patients with advanced basal cell carcinoma. Our results show that treatment with vismodegib adds a novel therapeutic modality from which patients with advanced basal cell carcinoma can benefit substantially.. F Hoffmann-La Roche.

Topics: Aged; Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Male; Middle Aged; Neoplasm Staging; Pyridines; Skin Neoplasms

Topics: Adult; Aged; Amlodipine; Anilides; Antineoplastic Agents; Basal Cell Nevus Syndrome; Calcium Channel Blockers; Female; Humans; Male; Middle Aged; Muscle Cramp; Pyridines; Skin Neoplasms; Time Factors

Vismodegib, a first-in-class Hedgehog pathway inhibitor, was US Food and Drug Administration (FDA) approved for advanced basal cell carcinomas (BCCs) based on a single, nonrandomized, phase-II trial. Consequently, additional clinical data are critical to confirm the efficacy and safety of vismodegib.. We sought to assess efficacy and safety of vismodegib, while providing early drug access to patients with advanced BCC and limited treatment options.. This was an open-label, multicenter study in patients with advanced BCC inappropriate for radiotherapy or surgery. Patients received 150 mg vismodegib daily until disease progression or intolerable toxicity. Tumor response was assessed via Response Evaluation Criteria in Solid Tumors version 1.0.. A total of 119 patients with advanced BCC took vismodegib for a median of 5.5 months. Objective responses occurred in 46.4% of locally advanced BCC and 30.8% of patients with metastatic BCC. Response was negatively associated with prior systemic therapy in patients with locally advanced BCC (P = .002). Mean follow-up for safety was 6.5 months, with muscle spasms (70.6%), dysgeusia (70.6%), alopecia (58.0%), and diarrhea (25.2%) as the most common adverse events.. Abbreviated follow-up time because of study termination upon FDA approval was a limitation.. This study provides important clinical data supporting the efficacy and safety of vismodegib. Larger studies are underway to assess predictors of response and long-term outcomes.

Topics: Adult; Aged; Aged, 80 and over; Alopecia; Anilides; Antineoplastic Agents; Bone Neoplasms; Carcinoma, Basal Cell; Diarrhea; Disease Progression; Dysgeusia; Female; Humans; Male; Middle Aged; Pyridines; Skin Neoplasms; Spasm; Treatment Outcome; Young Adult

Keratocystic odontogenic tumors (KCOTs) of the jaw affect more than 65% of patients with basal cell nevus syndrome (BCNS). Surgery frequently causes facial disfigurement and is not always curative. Most BCNS-related and some sporadic KCOTs have malignant activation of the Hedgehog signaling pathway.. We examined the effect of vismodegib (an oral Hedgehog pathway inhibitor) on KCOT size in patients with BCNS enrolled in a clinical trial testing vismodegib for basal cell carcinoma prevention (NCT00957229), using pretreatment and posttreatment magnetic resonance imaging. Four men and 2 women had pretreatment KCOTs (mean longest diameter, 2.0 cm; range, 0.7-3.3 cm), occurring primarily in the mandible. Patients were treated with vismodegib, 150 mg/d, for a mean (SD) of 18.0 (4.8) months (range, 11-24 months). Four patients experienced a size reduction and 2 had no change. Vismodegib reduced the mean longest diameter of KCOTs in all patients by 1.0 cm (95% CI, 0.03-1.94; P = .02) or 50% from baseline. We observed no enlargement of existing KCOTs or new KCOT development.. Vismodegib shrinks some KCOTs in patients with BCNS and may offer an alternative to surgical therapy. These effects were maintained for at least 9 months after drug cessation in 1 patient. Further studies assessing long-term efficacy and optimal maintenance regimens should be performed.

Topics: Adult; Anilides; Basal Cell Nevus Syndrome; Biopsy, Needle; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Immunohistochemistry; Jaw Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Odontogenic Tumors; Patient Selection; Prognosis; Prospective Studies; Pyridines; Risk Assessment; Skin Neoplasms; Survival Analysis; Treatment Outcome

Vismodegib is an oral hedgehog-pathway inhibitor approved for advanced basal cell carcinoma (BCC). Although most BCCs are amenable to surgery, excision of large tumors in aesthetically sensitive sites may compromise function or cosmesis.. We sought to evaluate the reduction in BCC surgical defect area after 3 to 6 months of neoadjuvant vismodegib.. This was an open-label, single-arm intervention trial with a primary outcome of change in target-tumor surgical defect area pre- and post-vismodegib (150 mg/d). Secondary outcomes were change in tumor area and tolerability.. Eleven of 15 enrolled patients, aged 39 to 100 years, completed the trial. Thirteen target tumors were excised after a mean of 4±2 months of vismodegib. In all, 29% (4 of 14 patients) could not complete more than 3 months because of vismodegib-related side effects. The mean baseline target-tumor diameter was 3.2 cm, and 10 of 13 tumors occurred on the face. Overall, vismodegib reduced the surgical defect area by 27% (95% confidence interval -45.7% to -7.9%; P=.006) from baseline. Vismodegib was not effective in patients who received less than 3 months. Over a mean follow-up of 11.5 (range 4-21) months for all tumors, only 1 tumor recurred at 17 months post-Mohs micrographic surgery.. Short follow-up time and no placebo control are limitations.. Neoadjuvant vismodegib appears to reduce surgical defect area when taken for 3 months or longer for nonrecurrent BCCs in functionally sensitive locations. Further studies with larger sample sizes and long-term follow-up are warranted.

Topics: Adult; Aged; Aged, 80 and over; Alopecia; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Chemotherapy, Adjuvant; Dysgeusia; Female; Humans; Male; Middle Aged; Mohs Surgery; Muscle Cramp; Neoadjuvant Therapy; Pyridines; Skin Neoplasms; Tumor Burden

The need for effective treatment of patients with locally advanced or metastatic basal cell carcinoma (BCC), in conjunction with major advances in the elucidation of the molecular basis of this tumor has led to the advent of new targeted therapies - namely, hedgehog inhibitors. The rationale for their use in patients with advanced BCC is based on their inhibitory effect on the hedgehog pathway, which is aberrantly activated in BCCs due to mutations of its primary components, PTCH1 and SMO genes. Vismodegib (GDC-0449) is an orally bioavailable hedgehog pathway inhibitor that selectively inhibits SMO. The ERIVANCE BCC study is a Phase II, international, multicenter clinical trial evaluating the efficacy and safety of vismodegib 150 mg once daily in patients with locally advanced or metastatic BCC. Vismodegib has been approved for the treatment of adult patients with metastatic BCC, or with locally advanced BCC that has recurred following surgery or who are not candidates for surgery or radiation therapy. This article will outline the rationale, design and available results from the ERIVANCE BCC study and discuss the clinical implications of vismodegib in the management of patients with BCC. Challenges regarding vismodegib use include the recurrence of BCC after drug discontinuation, the development of acquired resistance, the dramatic efficacy in patients with Gorlin syndrome, and class-related drug toxicity. Ongoing clinical trials aim to explore the role of vismodegib in the neoadjuvant setting prior to surgery, the potential use of alternate dosing regimens in order to limit chronic adverse events, as well as the identification of patients with BCC that are more likely to respond to this targeted therapy based on genotypic and/or phenotypic characteristics.

Topics: Adult; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Disease Progression; Female; Humans; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Pyridines; Skin Neoplasms; Treatment Outcome; Young Adult

Topics: Administration, Oral; Aged; Anilides; Antineoplastic Agents; Brain; Carcinoma, Basal Cell; Facial Neoplasms; Humans; Magnetic Resonance Imaging; Male; Neoplasm Invasiveness; Pyridines; Skin Neoplasms; Treatment Outcome

Alterations in hedgehog signaling are implicated in the pathogenesis of basal-cell carcinoma. Although most basal-cell carcinomas are treated surgically, no effective therapy exists for locally advanced or metastatic basal-cell carcinoma. A phase 1 study of vismodegib (GDC-0449), a first-in-class, small-molecule inhibitor of the hedgehog pathway, showed a 58% response rate among patients with advanced basal-cell carcinoma.. In this multicenter, international, two-cohort, nonrandomized study, we enrolled patients with metastatic basal-cell carcinoma and those with locally advanced basal-cell carcinoma who had inoperable disease or for whom surgery was inappropriate (because of multiple recurrences and a low likelihood of surgical cure, or substantial anticipated disfigurement). All patients received 150 mg of oral vismodegib daily. The primary end point was the independently assessed objective response rate; the primary hypotheses were that the response rate would be greater than 20% for patients with locally advanced basal-cell carcinoma and greater than 10% for those with metastatic basal-cell carcinoma.. In 33 patients with metastatic basal-cell carcinoma, the independently assessed response rate was 30% (95% confidence interval [CI], 16 to 48; P=0.001). In 63 patients with locally advanced basal-cell carcinoma, the independently assessed response rate was 43% (95% CI, 31 to 56; P<0.001), with complete responses in 13 patients (21%). The median duration of response was 7.6 months in both cohorts. Adverse events occurring in more than 30% of patients were muscle spasms, alopecia, dysgeusia (taste disturbance), weight loss, and fatigue. Serious adverse events were reported in 25% of patients; seven deaths due to adverse events were noted.. Vismodegib is associated with tumor responses in patients with locally advanced or metastatic basal-cell carcinoma. (Funded by Genentech; Erivance BCC ClinicalTrials.gov number, NCT00833417.).

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Hedgehog Proteins; Humans; Male; Middle Aged; Neoplasm Metastasis; Pyridines; Signal Transduction; Skin Neoplasms; Treatment Outcome

Dysregulated hedgehog signaling is the pivotal molecular abnormality underlying basal-cell carcinomas. Vismodegib is a new orally administered hedgehog-pathway inhibitor that produces objective responses in locally advanced and metastatic basal-cell carcinomas.. We tested the anti-basal-cell carcinoma efficacy of vismodegib in a randomized, double-blind, placebo-controlled trial in patients with the basal-cell nevus syndrome at three clinical centers from September 2009 through January 2011. The primary end point was reduction in the incidence of new basal-cell carcinomas that were eligible for surgical resection (surgically eligible) with vismodegib versus placebo after 3 months; secondary end points included reduction in the size of existing basal-cell carcinomas.. In 41 patients followed for a mean of 8 months (range, 1 to 15) after enrollment, the per-patient rate of new surgically eligible basal-cell carcinomas was lower with vismodegib than with placebo (2 vs. 29 cases per group per year, P<0.001), as was the size (percent change from baseline in the sum of the longest diameter) of existing clinically significant basal-cell carcinomas (-65% vs. -11%, P=0.003). In some patients, all basal-cell carcinomas clinically regressed. No tumors progressed during treatment with vismodegib. Patients receiving vismodegib routinely had grade 1 or 2 adverse events of loss of taste, muscle cramps, hair loss, and weight loss. Overall, 54% of patients (14 of 26) receiving vismodegib discontinued drug treatment owing to adverse events. At 1 month, vismodegib use had reduced the hedgehog target-gene expression by basal-cell carcinoma by 90% (P<0.001) and diminished tumor-cell proliferation, but apoptosis was not affected. No residual basal-cell carcinoma was detectable in 83% of biopsy samples taken from sites of clinically regressed basal-cell carcinomas.. Vismodegib reduces the basal-cell carcinoma tumor burden and blocks growth of new basal-cell carcinomas in patients with the basal-cell nevus syndrome. The adverse events associated with treatment led to discontinuation in over half of treated patients. (Funded by Genentech and others; ClinicalTrials.gov number, NCT00957229.).

Topics: Adult; Anilides; Antineoplastic Agents; Basal Cell Nevus Syndrome; Double-Blind Method; Female; Hedgehog Proteins; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Pyridines; RNA, Messenger; Signal Transduction; Skin Neoplasms; Transcription Factors; Treatment Outcome; Tumor Cells, Cultured; Zinc Finger Protein GLI1

The use of 18-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET/CT) in subjects with advanced basal cell carcinoma (BCC) has not been fully explored due to the rarity of disease presentation. This study evaluated PET/CTs from subjects with advanced BCC participating in a phase I dose-escalation clinical trial of vismodegib. Fourteen subjects with BCC were imaged with 18-FDG PET/CT for lesion identification and response categorizing (European Organisation for Research and Treatment for Cancer [EORTC] and PET response criteria in solid tumors [PERCIST] 1.0). Several parameters including metabolic activity of target lesions, site of disease presentation and spread, treatment response, and prognostic significance of metabolic activity following therapy were evaluated. All subjects exhibited at least one hypermetabolic lesion. Most subjects had only four organ systems involved at study enrollment: skin-muscle (93%), lung (57%), lymph nodes (29%), and bone (21%). SUVmax measured across all lesions decreased (median 33%, SD ± 45%) following therapy with metabolic activity normalizing or disappearing in 42% of lesions. No significant difference was observed between EORTC and PERCIST 1.0. Subjects that demonstrated at least a 33% reduction in SUVmax from baseline had a significantly longer progression-free survival (PFS) (median 17 months, 95% confidence interval [CI] ±4 months vs. 9 months, 95% CI ±5 months, P = 0.038) and overall survival (OS) (median 24 months, 95% CI ±4 months vs. 17 months, 95% CI ±13 months, P = 0.019). BCC lesions are hypermetabolic on 18-FDG PET/CT. A decrease in SUVmax was associated with improved PFS and OS. These results further support the incorporation of 18-FDG PET/CT scans in advanced BCC management.

Topics: Adult; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Bone Neoplasms; Carcinoma, Basal Cell; Disease-Free Survival; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Multimodal Imaging; Muscle Neoplasms; Positron-Emission Tomography; Pyridines; Skin Neoplasms; Tomography, X-Ray Computed; Treatment Outcome

Mutations in hedgehog pathway genes, primarily genes encoding patched homologue 1 (PTCH1) and smoothened homologue (SMO), occur in basal-cell carcinoma. In a phase 1 clinical trial, we assessed the safety and pharmacokinetics of GDC-0449, a small-molecule inhibitor of SMO, and responses of metastatic or locally advanced basal-cell carcinoma to the drug.. We selected 33 patients with metastatic or locally advanced basal-cell carcinoma to receive oral GDC-0449 at one of three doses; 17 patients received 150 mg per day, 15 patients received 270 mg per day, and 1 patient received 540 mg per day. We assessed tumor responses with the use of Response Evaluation Criteria in Solid Tumors (RECIST), physical examination, or both. Molecular aspects of the tumors were examined.. The median duration of the study treatment was 9.8 months. Of the 33 patients, 18 had an objective response to GDC-0449, according to assessment on imaging (7 patients), physical examination (10 patients), or both (1 patient). Of the patients who had a response, 2 had a complete response and 16 had a partial response. The other 15 patients had either stable disease (11 patients) or progressive disease (4 patients). Eight grade 3 adverse events that were deemed to be possibly related to the study drug were reported in six patients, including four with fatigue, two with hyponatremia, one with muscle spasm, and one with atrial fibrillation. One grade 4 event, asymptomatic hyponatremia, was judged to be unrelated to GDC-0449. One patient withdrew from the study because of adverse events. We found evidence of hedgehog signaling in tumors that responded to the treatment.. GDC-0449, an orally active small molecule that targets the hedgehog pathway, appears to have antitumor activity in locally advanced or metastatic basal-cell carcinoma. (ClinicalTrials.gov number, NCT00607724.)

Topics: Adult; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Benzimidazoles; Carcinoma, Basal Cell; Dose-Response Relationship, Drug; Female; Gene Expression; Hedgehog Proteins; Humans; Male; Middle Aged; Mutation; Patched Receptors; Patched-1 Receptor; Polymerase Chain Reaction; Pyridines; Receptors, Cell Surface; RNA, Messenger; Sequence Analysis, DNA; Signal Transduction; Skin Neoplasms; Transcription Factors; Zinc Finger Protein GLI1

To establish a model to predict treatment outcome of periocular locally advanced basal cell carcinoma (POLA BCC) based on initial response to treatment with vismodegib (Erivedge. Subgroup analysis of data from the STEVIE study database.. Analysis of medical history, treatment protocol, and treatment outcome of POLA BCC tumours in a STEVIE study population of 244 POLA BCC patients treated with ≥1 dose of vismodegib.. A predictive model for complete response (CR) was established based on the initial treatment response. A cutoff value of 20% reduction in tumour size at 3 months of treatment identified the patients with a high probability (82.76%) to achieve CR. A second cutoff value of 67.7% reduction in tumour size at 6 months of treatment improved the prediction to a 95.42% probability of a CR outcome.. A treatment model was constructed based on the prediction of a CR outcome and the initial response to vismodegib treatment at 3 and 6 months. The study result provide significant new insights can facilitate decision-making on treatment management according to tumour response in patients with POLA BCC.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Skin Neoplasms; Treatment Outcome

Vismodegib is a first-in-class inhibitor of the hedgehog pathway for treatment of locally advanced basal cell carcinoma (laBCC) and metastatic BCC.. The purpose of this study is to report outcomes of patients with laBCC, with basal cell carcinoma nevus syndrome (Gorlin Goltz syndrome [G-G Syn]) treated with vismodegib in routine clinical practice in Slovenia in 8.3-year period.. In this retrospective cohort study, we analyzed baseline characteristics, outcomes, and treatment-related adverse events from locally advanced BCC. The patients were divided into two cohorts: 39 laBCC or multiple BCC patients and 7 patients with G-G Syn who were treated with vismodegib from November 2012 till January 2021.. During 100-month period, 46 patients were diagnosed with laBCC (26), multiple BCC (13), and G-G Syn (7), all inappropriate for surgery or radiotherapy. Baseline characteristics: median age was 72.8 years in laBCC + multiple BCC cohort and 47.4 years in G-G Syn cohort. The objective response rate was 80% in laBCC + multiple BCC and 86% in G-G Syn cohort. Disease control rate (DCR) was 95% in laBCC + multiple BCC and 100% in G-G Syn cohort. Median duration of treatment was 9.9 months (range: 1.5-43.1) in laBCC and multiple BCC cohort and 19.5 months (range: 3.6-94.1) in G-G Syn cohort. Majority of treatment-emergent adverse events (TEAEs) in laBCC or multiple BCC cohort were grade 1 or 2 (96%), only 4% of AEs were grade 3. Majority of TEAEs in G-G Syn cohort were also grade 1 or 2 (87%), 13% of AEs were grade 3. No grade 4 or 5 vismodegib-related AEs were reported.. Vismodegib has shown meaningful efficacy with DCR from 95% to 100% in patients with laBCC, multiple BCC, and G-G Syn in Slovenia. TEAEs were successfully alleviated with multidisciplinary approach and early supportive care.

Topics: Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Retrospective Studies; Skin Neoplasms; Slovenia

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Skin Neoplasms; Treatment Outcome; Withholding Treatment

The aim of this study was to describe the disease and treatment and to alert health professionals for the identification of signs and symptoms and the need for an early diagnosis in patients with xeroderma pigmentosum (XP).. An 8-year-old male patient was referred to the Joana de Gusmão Hospital (HIJG) in 2021 for evaluation and specialized care. Previously, the child was followed in his place of origin by oncologic and palliative care, where he was submitted to surgeries and chemotherapy. He was admitted to the HIJG using vismodegib, acitrein, tramadol, and solar protective measures. On physical examination, there were tumors and disseminated macular verrucous and ulcerated lesions. The imaging examination showed solid and expansive lesions on the face, and atelectasis and fibroscarring changes in the lung. The histopathological report proved the existence of melanocanthoma, carcinoma, and pyogenic granuloma. After the evaluation of the case, no surgery, chemotherapy, or radiotherapy was performed. It was decided to maintain the palliative treatment and to continue the use of tramadol for pain, and vismodegib and acitretin were used to control carcinomas and prophylactic measures.. The XP is a rare disease of autosomal recessive inheritance whose mechanism comes from failure in the DNA repair by exposure to ultraviolet rays, resulting in lesions on the skin and mucous membranes. They start as sunburns and can progress to melanosis, areas with altered pigmentation, premature aging, poikiloderma, and areas of high risk for neoplasms.

Topics: Carcinoma; Child; DNA Repair; Humans; Male; Skin Diseases; Skin Neoplasms; Tramadol; Xeroderma Pigmentosum

Basal cell carcinoma (BCC) is the most common type of skin cancer and can represent a therapeutic challenge in patients with locally advanced disease. Vismodegib is a hedgehog pathway inhibitor approved by the FDA for use in this type of tumor. We present a case series to describe our experience with the use of vismodegib.. A retrospective study that included patients treated with vismodegib at our dermatology unit was conducted. Monthly follow-up was performed, and we registered the clinical evolution and adverse reactions.. A total of six patients with locally advanced BCCs were included (50% males and 50% females), with a mean age of 78.5 years old. The treatment was administered over a mean of 5 months. A complete response was observed in four cases and partial response in two cases. No recurrence was detected, with a median follow-up duration after discontinuation of 18 months. Most patients (83%) had at least one adverse event, and two needed dose adjustment temporarily or permanently to continue. The main adverse effect was muscle spasms (66.7%). The main limitation of our study was the small sample, which was not representative of the general population.. Vismodegib is a safe and effective treatment for locally advanced BCC, and its role in unresectable BCC seems to be an important option in these challenging cases.

Topics: Aged; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Hedgehog Proteins; Humans; Male; Retrospective Studies; Skin Neoplasms

Vismodegib is approved for advanced cases of basal cell carcinomas not amenable to surgery or radiotherapy. Large studies on the use of vismodegib in clinical practice are scarce.. The main objective of the study was to analyse the evolution and therapeutic management of relapses and lack of response in patients who had received vismodegib for locally advanced and/or multiple basal cell carcinomas in a real-life multicentre setting.. This nationwide retrospective study collected data on patients treated with vismodegib in 15 specialized centres. We included patients who first received vismodegib until intolerable toxicity, maximum response, or progressive disease. Exploratory research variables referred to patient and tumour characteristics, vismodegib effectiveness and safety, relapse rate and management, and mortality. A multivariable logistic regression model was used to identify predictors of complete clinical response.. 133 patients with advanced BCC were included in the registry. The objective response rate (ORR) was 77.5% and nearly half of the patients (45.9%) achieved complete remission. Long-term information and detailed information of subsequent treatments after a regime of vismodegib was available for 115 patients. Only 34% of the patients in this group were subsequently treated with other therapies or vismodegib rechallenge. Sixty-nine percent of the patients who had shown a complete remission with vismodegib remained free of recurrence while 30.7% relapsed. Almost half of the patients who received additional therapies after the first course of vismodegib achieved complete tumour remission. Three and 2 out of 9 patients who were rechallenged with vismodegib achieved complete and partial responses, respectively, with an ORR of 55.5%.. Our study confirms efficacy of vismodegib in routine clinical practice. The risk of recurrence after achieving complete response with vismodegib was lower than previous reports. Rechallenge with vismodegib is feasible and most patients responded to re-treatment.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Neoplasm Recurrence, Local; Retrospective Studies; Skin Neoplasms

Topics: Antineoplastic Agents; Hedgehog Proteins; Humans; Signal Transduction; Skin Neoplasms; Zinc Finger Protein GLI1

Advanced basal cell carcinoma (aBCC) represents a complex and clinically heterogeneous group of lesions for which curative surgery and/or radiotherapy is unlikely. Systemic therapy with hedgehog pathway inhibitors (HHIs) changed the treatment landscape for this complex patient population.. The aims of the present study are to describe the clinical characteristics of a real-life Italian cohort diagnosed with aBCC and to investigate effectiveness and safety of HHI.. A multicenter observational study was performed by twelve Italian centers in the period January 1, 2016 - October 15, 2022. Patients aged ≥18 years and diagnosed with aBCC (locally advanced [laBCC] and metastatic BCC [mBCC]) were eligible for the study. Methods for investigating tumor response to HHI included clinical and dermatoscopic evaluation, radiological imaging, and histopathology. For HHI safety assessment, therapy-related adverse events (AEs) were reported and graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.. We enrolled 178 patients under treatment with HHI: 126 (70.8%) and 52 patients (29.2%) received sonidegib and vismodegib, respectively. Comprehensive data on HHI effectiveness and disease outcome were available for 132 (74.1%) of 178 patients: 129 patients had a diagnosis of laBCC (n = 84, sonidegib; n = 45, vismodegib) and 3 patients of mBCC (n = 2, vismodegib; n = 1, sonidegib, off-label). Objective response rate was 76.7% (95% confidence interval [CI]: 82.3-68.7) and 33.3% (95% CI: 88.2-1.7) for laBCC (complete response [CR]: 43/129; PR: 56/129) and mBCC (CR: 0/3; PR: 1/3), respectively. High-risk aBCC histopathological subtypes and occurrence of >2 therapy-related AEs were significantly associated with nonresponse to HHI therapy ([OR: 2.61; 95% CI: 1.09-6.05; p: 0.03] and [OR: 2.74; 95% CI: 1.03-7.9; p: 0.04]), respectively. Majority of our cohort (54.5%) developed at least 1 therapy-related AE, most of which were mild-moderate in severity.. Our results demonstrate the effectiveness and safety profile of HHI and confirm the reproducibility of pivotal trial results in real-life clinical setting.

Topics: Adolescent; Adult; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Reproducibility of Results; Skin Neoplasms

The anti-PD-1 antibody cemiplimab has demonstrated effectiveness in the setting of locally advanced basal cell carcinoma (BCC) and squamous cell carcinoma. We describe a case of a large, locally invasive basosquamous carcinoma, an aggressive type of BCC, invading the left sternocleidomastoid muscle with near compression of the left internal jugular vein producing a severe anaemia secondary to ulceration and chronic blood loss. The patient was initially started on vismodegib monotherapy but failed to respond. He was then started on cemiplimab in addition to vismodegib. Improvement was noted after one cycle. After 21 cycles of cemiplimab, the left shoulder ulcerated lesion was completely re-epithelialised. He remains in complete remission after 31 cycles of cemiplimab in addition to vismodegib.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Carcinoma, Basosquamous; Humans; Male; Skin Neoplasms

Topics: Anilides; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Nevoid basal-cell carcinoma syndrome (Gorlin syndrome) is characterized by numerous cutaneous basal cell carcinomas mediated by mutations in the hedgehog pathway. Vismodegib or sonidegib represent promising treatment options. We identified 10 Gorlin patients who were treated with sonidegib (

Topics: Basal Cell Nevus Syndrome; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Muscle Cramp; Prospective Studies; Skin Neoplasms; Spasm

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Vismodegib is approved for the treatment of locally advanced basal cell carcinoma (laBCC), but some cases demonstrate intrinsic resistance (IR) to the drug. We sought to assess the frequency of IR to vismodegib in laBCC and its underlying genomic mechanisms.. Response to vismodegib was evaluated in a cohort of 148 laBCC patients. Comprehensive genomic and transcriptomic profiling was performed in a subset of five intrinsically resistant BCC (IR-BCC).. We identified that IR-BCC represents 6.1% of laBCC in the studied cohort. Prior treatment with chemotherapy was associated with IR. Genetic events that were previously associated with acquired resistance (AR) in BCC or medulloblastoma were observed in three out of five IR-BCC. However, IR-BCCs were distinct by highly rearranged polyploid genomes. Functional analyses identified hyperactivation of the HIPPO-YAP and WNT pathways at RNA and protein levels in IR-BCC. In vitro assay on the BCC cell line further confirmed that YAP1 overexpression increases the cell proliferation rate.. IR to vismodegib is a rare event in laBCC. IR-BCCs frequently harbor resistance mutations in the Hh pathway, but also are characterized by hyperactivation of the HIPPO-YAP and WNT pathways.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Cerebellar Neoplasms; Hedgehog Proteins; Humans; Pyridines; Skin Neoplasms

Most patients with advanced basal cell carcinomas (BCCs) may not benefit sufficiently from standard treatment comprising surgery and radiation. Vismodegib, an oral selective hedgehog pathway inhibitor, is approved for treatment of patients with locally advanced BCC inappropriate for surgery or radiotherapy, or for patients with symptomatic metastatic BCC. In order to enhance understanding of the effectiveness, safety and utilization of vismodegib in clinical practice in Germany, a non-interventional study, JONAS, was conducted. A total of 53 patients with locally advanced BCC who initiated treatment with vismodegib between 2016 and 2018 were included in the study, which was embedded in the German ADOReg skin cancer registry. Duration of response, the primary endpoint, was 12.4 months, progression-free survival 32.2 months and overall response rate 77.4%. Most adverse events were mild to moderate. Overall, results confirmed previous findings, demonstrating favourable responses and manageable safety of vismodegib in patients with locally advanced BCC in clinical practice.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Cohort Studies; Hedgehog Proteins; Humans; Pyridines; Skin Neoplasms

Basal cell carcinoma (BCC) is the most frequent non-melanoma skin cancer. The basis of treatment is surgical resection. The treatment of locally advanced and metastatic disease is currently based on sonidegb or vismodegib, small molecule inhibitors of the hedgehog signalling pathway.. The study aimed to retrospectively analyse the efficacy and safety of treatment with vismodegib in 108 patients with locally advanced or metastatic disease treated from August 1st, 2017 to December 31st, 2020. The primary objective was to evaluate the objective response rate (ORR), overall survival (OS) and progression-free survival rates. The secondary aims of the study were the disease control rate, the incidence of adverse events (AEs) and the estimation of the factors that potentially impact the treatment outcome and patient survival.. Patients treated in national drug programme were enrolled into this retrospective cohort study. Evaluation of the treatment efficacy was performed according to CT/MRI scans and by the response evaluation criteria in solid tumours (RECIST) 1.1. The safety evaluation was performed according to the Common Terminology Criteria for Adverse Events v. 5.0 (CTCAE) classification and severity assessment.. The median duration of treatment was 14 months (range 1-94 months). The median progression-free survival reached 30.5 months (95% CI; 24.8-36.3), and the progression-free survival rate after 6, 12 and 24-months were 92%, 78% and 61%, respectively. The median overall survival was 41.5 months (95% CI; 31.6-51.3), and the overall survival rate after 1, 2 and 3 years accordingly 86%, 73% and 60%. The univariant and multivariant analysis indicated that the female gender is an independent positive prognostic factor of progression-free survival.. The response to treatment is the prognostic factor for response maintenance and better overall survival. The therapy was well tolerated with the safety profile consistent in general with known from previous studies.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Hedgehog Proteins; Humans; Pyridines; Retrospective Studies; Skin Neoplasms

Axillary giant basal cell carcinoma is extremely rare and remains challenging for physicians. The few reported cases have a relatively short-term follow-up, and none were treated with an oral hedgehog pathway inhibitor. Herein, we report the case of a 71-year-old man with a giant basal cell carcinoma in the axilla. The primary treatment instituted was surgical excision and adjuvant radiotherapy. The tumor recurred 4.5 years later, and 6-month treatment with vismodegib, a hedgehog pathway inhibitor, was effective. The disease progression re-occurred 1.5 years after discontinuing vismodegib. Palliative radiotherapy was administered, and the disease remained stable for > 1 year. Our case illustrates a rare disease with an 8-year follow-up, involving different therapeutic strategies against multiple recurrences. J Drugs Dermatol. 2022;21(5):531-533. doi:10.36849/JDD.6583.

Topics: Aged; Anilides; Antineoplastic Agents; Axilla; Carcinoma, Basal Cell; Follow-Up Studies; Hedgehog Proteins; Humans; Male; Neoplasm Recurrence, Local; Pyridines; Skin Neoplasms

Topics: Adult; Anilides; Carcinoma, Basal Cell; Dermatologists; Humans; Skin Neoplasms

Vismodegib is indicated for the treatment of advanced or metastatic basal cell carcinoma (BCC). The predictive factors of response to vismodegib have so far been poorly described.. The primary objective was to determine the profile of patients responding to vismodegib and the duration of response. Secondary objectives were to assess whether there is a correlation between the duration of treatment and the risk of relapse, and to define factors associated with relapse.. We included 61 patients with locally advanced BCC (laBCC) or multiple BCC, treated with vismodegib (150 mg per day), from July 2011 to November 2015, in the Oncodermatology Department of Nantes University Hospital in France. Tumour response was assessed using Response Evaluation Criteria in Solid Tumours version 1.1.. Thirty-nine patients had advanced BCC (64%) and 22 patients multiple BCC (36%), including 10 patients with Gorlin syndrome. No factor predicted response to vismodegib. The median progression-free survival (PFS) was 69.5 months for the total population. In multivariate analysis, multiple BCC was the only factor associated with an increased risk of relapse (HR: 13.80 [CI95%, 1.93-98.64, p < 0.01]). Treatment duration decreased the risk of relapse (HR 0.95 [CI95%, 0.90-0.99, p = 0.0467]). Among the 20 patients who experienced relapse during follow-up, 15 (75%) were re-treated with vismodegib, with a response rate of 66%.. Although we were unable to establish predictive factors for the response to vismodegib, we demonstrate for the first time that increased treatment duration correlates with a decreased risk of relapse.

Topics: Anilides; Carcinoma, Basal Cell; Hamartoma Syndrome, Multiple; Humans; Neoplasm Recurrence, Local; Pyridines; Skin Neoplasms

Vismodegib (Erivedge; Roche), a Hedgehog pathway inhibitor (HPI), is indicated for the treatment of symptomatic metastatic basal cell carcinoma (BCC) and locally advanced BCC inappropriate for surgery or radiotherapy. Due to the known risk of HPI teratogenicity, the Erivedge Pregnancy Prevention Program (PPP) was introduced at approval (2013) as part of the EU Risk Management Plan.. Structured, quantitative Web-based surveys were conducted in 2015 (Wave 1), 2016 (Wave 2), and 2017/2018 (Wave 3) among prescribing oncologists and dermato-oncologists in Austria, France, Germany, Hungary, and the United Kingdom to assess the effectiveness of the Erivedge PPP.. Overall, 95%, 87%, and 91% of respondents in Waves 3 (. Survey data suggest that the risk of teratogenicity with vismodegib has been effectively communicated to the prescribing community.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Hedgehog Proteins; Humans; Pregnancy; Pyridines; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

The study aims to evaluate the vismodegib treatment in local advanced (laBCC) and metastatic (mBCC) basal cell carcinoma. The data of 29 patients were retrospectively reviewed. The clinical and histopathological features of the patients and adverse events of vismodegib were recorded. Overall survival (OS) and progression-free survival (PFS) were evaluated with Kaplan-Meier analysis. The median follow-up period was 17 months (range: 1.6-57.3), and the median age at diagnosis 73 years (range: 39-88). The most common disease location was head and neck (86.2%), and the most common non-skin sites of disease were lymph nodes (13.8%), bone (13.8%), lung (6.9%), and brain (6.9%). Three (10.3%) patients had Gorlin's syndrome. The number of metastatic patients was 5 (17.2%). With vismodegib treatment, the complete response rate was 27.6%, partial response 55.2%, and stable response 10.3%. Treatment responses were most frequently seen within 2 months from the beginning of vismodegib. The median OS was 43.3 ± 9.0 months (25.6-61.1) for all patients. The median PFS in the laBCC was 15.7 ± 1.8 months (12.2-19.3), and 12.1 ± 4.6 months (2.9-21.2) in the mBCC. In the univariable analysis for the OS, only the treatment after the vismodegib was statistically significant, showing chemotherapy was better comparing to no treatment or surgery. The most common adverse events were fatigue-58.6%, muscle spasms-48.3%, alopecia-13.8%, and weight loss-13.8%. This real-life data study shows that vismodegib treatment in locally advanced and metastatic BCC was well tolerated and effective.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Retrospective Studies; Skin Neoplasms

Since the introduction of Vismodegib as treatment of recurrent locally advanced basal cell carcinoma (laBCC), clinicians are faced with new dilemmas: 'Can Vismodegib replace complex reconstructions?', 'What is the role of neoadjuvant use of Vismodegib?' and 'What is the best approach in case of complete clinical remission after Vismodegib in a neoadjuvant setting?'. Case report and literature review.. Vismodegib cannot replace complex reconstructions. However, in unresectable laBCC, Vismodegib can provide a bridge to surgery. Due to the possibility of persistent tumour cells, we recommend imaging-assisted surgery and an imaging-based follow-up. In case of complete clinical remission after Vismodegib in a neoadjuvant setting, we recommend that Vismodegib be continued as long as the adverse effects are tolerated and an imaging-based follow-up is advised.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Neoplasm Recurrence, Local; Pyridines; Skin Neoplasms

A 45-year-old man presented with a progressively enlarging left lower lateral eyelid lesion. The initial biopsy was inconclusive; however, a repeat biopsy 5 years later revealed infiltrative morpheaform basal cell carcinoma with sclerosis. Two years later, the patient presented with ophthalmoplegia of the left eye. Computed tomography illustrated a heterogeneous enhancing soft tissue mass in the inferolateral orbit with erosion into the globe. Despite treatment with vismodegib for 1 year, the lesion progressed to involve the entire left lower eyelid and corneal-scleral junction with adjacent maxillary sinus invasion. The patient tested positive for human immunodeficiency virus and underwent a left orbital exenteration followed by adjuvant radiotherapy. The patient remained stable with no evidence of recurrent disease or distant metastasis 2 years after exenteration. This rare case highlights a neglected basal cell carcinoma in those immunocompromised with histopathological correlation of the aggressive disease on to the globe.

Topics: Anilides; Carcinoma, Basal Cell; Humans; Immunocompromised Host; Male; Middle Aged; Pyridines; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Topics: Administration, Oral; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Computer Simulation; Datasets as Topic; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Models, Biological; Neoplasm Staging; Pyridines; Skin; Skin Neoplasms; Treatment Outcome; Tumor Burden

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Vismodegib, a hedgehog pathway inhibitor, has been used in the management of locally advanced basal cell carcinoma (BCC) not suitable for surgery or radiation therapy. We report our experience using neoadjuvant vismodegib for locally advanced periocular BCC, followed by surgical excision. Our aim was to assess the effect on the extent of surgical excision and histological response.. A retrospective case series of patients treated with neoadjuvant vismodegib, for the management of locally advanced periocular BCC prior to surgical excision, with intraoperative margin control. Patients were treated until a maximum clinical response was seen. The difference between the estimated surgical margins prior to vismodegib and the eventual margins used was compared. Fine (1 mm) vertical sections through the excised tumour were performed to assess the histological response and look for a multifocal tumour.. Eight Caucasian patients had neoadjuvant treatment with vismodegib for a median duration of 6 months. Some clinical response was seen in all cases but was only partial in 6/8 patients. Histological evaluation of the excised specimen showed residual BCC in 6/8 cases and thus 2/8 showed complete histological regression. Two cases showed squamous differentiation. Side effects occurred in 7/8 patients all which resolved on cessation of therapy. The mean follow-up was 13.4 ± 5.2 months.. Neoadjuvant treatment of periocular BCC showed a mixed clinical and histological response. Final surgical excision achieved clear margins in all patients with no recurrence at 13 months and a reduction in predicted defect size, but possible squamous differentiation in two cases.

Topics: Anilides; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Pyridines; Retrospective Studies; Skin Neoplasms; Treatment Outcome

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Cohort Studies; Humans; Longitudinal Studies; Pyridines; Skin Neoplasms; Treatment Outcome

Vismodegib has shown clinical efficacy in the management of locally advanced basal cell carcinomas (laBCC). However, non-response to vismodegib is observed in 2-13.5% of patients in clinical studies. The purpose of this study was to identify factors associated with non-response to vismodegib in patients with laBCC.. We carried out a retrospective multicenter study, including patients with laBCC treated with vismodegib, from July 2011 to May 2019. Response to treatment was assessed according to the RECIST 1.1 criteria. Patients were categorized as responders with a complete response or a partial response or non-responders with a stable disease or a progressive disease according to what has been observed during follow-up. Patient demographics, tumor profile, and treatment modalities were compared in responders and non-responders.. Eighty-three patients with laBCC were included in the study. Twenty-five (30.1%) were non-responders to vismodegib. History of treatment with radiotherapy, presence of muscle involvement and intermittent treatment with vismodegib were significantly associated with a non-response (p < 0.001, p = 0.025, p < 0.001). Bone involvement (p = 0.2) and morpheaform IaBCC subtype (p = 0.056) were more frequent in non-responders without reaching statistical significance.. In this study, non-response of laBCC to vismodegib therapy was associated with muscle involvement. Previous radiotherapy and intermittent use of vismodegib have been identified as causes favoring non-response to vismodegib. Due to the low numbers of patients included in the study, it is difficult to draw firm conclusions. Further studies are needed to confirm these data.

Topics: Adult; Aged; Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Disease Progression; Female; Humans; Male; Middle Aged; Pyridines; Retrospective Studies; Skin Neoplasms; Treatment Outcome

Basal cell carcinoma (BCC) is the most commonly diagnosed cutaneous cancer in the United States with more than 2.5 million treated annually. Genetic studies have revealed that approximately 90% of BCCs have a mutation in the hedgehog-signaling pathway. Patients with BCC usually have an excellent prognosis with surgical modalities, however, patients with locally advanced BCC may potentially experience significant cosmetic or functional impairment, with only surgical intervention. Vismodegib is a hedgehog pathway inhibitor that has been successful in treating patients with locally advanced BCC. We report a patient with BCC with a good response to vismodegib and a novel xanthomatous change in the excision specimen.

Topics: Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Male; Neoplasms, Second Primary; Pyridines; Skin Neoplasms; Xanthomatosis

Basal cell carcinomas occur in up to 39% of Caucasian men and 28% of women. Rarely it can present a management dilemma in patients with neglected locally advanced disease of large dimension or involvement of critical structures. The Hedgehog pathway is constitutively active in almost all basal cell carcinomas and patients with Naevoid Basal Cell Carcinoma Syndrome have germline mutations in the Patched tumor suppressor gene, a Hedgehog pathway component, on chromosome 9q. This case describes an elderly patient with an untreated sporadic Basal cell carcinoma whose dimensions precluded local management approaches. The Hedgehog pathway inhibitor Vismodegib had a dramatic response allowing definitive treatment to be pursued.

Topics: Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Male; Neoadjuvant Therapy; Pyridines; Skin Neoplasms

Topics: Adult; Anilides; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Basal Cell; Compassionate Use Trials; Hemangiosarcoma; Humans; Immune Checkpoint Inhibitors; Male; Molecular Targeted Therapy; Neoplasm Recurrence, Local; Nivolumab; Pyridines; Skin Neoplasms; Treatment Outcome; Xeroderma Pigmentosum

Basal cell carcinoma (BCC) can arise by the uncontrolled proliferation of cells from multiple epidermal compartments due to aberrant activation of the Hedgehog (Hh) signalling pathway. Vismodegib, a small-molecule inhibitor of this pathway, is approved for treatment of patients with locally advanced (la) BCC inappropriate for surgery or radiotherapy or patients with symptomatic metastatic (m) BCC.. The aim of this non-interventional study was to assess effectiveness with a special focus on duration of response (DOR), safety and utilization of vismodegib for treatment of laBCC in daily practice in Germany.. This non-interventional study (NIS) observed treatment of laBCC with vismodegib according to the German label in clinical practice. All available patients who had received at least one dose of vismodegib between commercial availability of vismodegib in Germany (02 August 2013) and 3 years before end of study (31 March 2016) could be included and were documented retrospectively and/or prospectively for up to 3 years. Primary effectiveness variable was DOR. Assessment of tumour response was carried out by the treating physicians. Exploratory variables included utilization of vismodegib, decision makers for therapy and method of tumour response evaluation. All statistical analyses were descriptive.. Between September 2015 and March 2019, 66 patients were observed at 26 German centres. The objective response rate (ORR) was 74.2% and the disease control rate (DCR) was 90.9%. The median DOR was 15.9 months (95% CI: 9.2; 25.7; n = 49 patients with response). The median progression-free survival (PFS) was 19.1 months and the median time to response (TTR) 2.7 months. A total of 340 adverse events were reported in 63 (95.5%) patients; no new safety signals were identified.. The NIS NIELS shows effectiveness and safety of vismodegib in patients with laBCC. It confirms the transferability of the results of the pivotal trial into routine clinical practice.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Germany; Hedgehog Proteins; Humans; Pyridines; Retrospective Studies; Skin Neoplasms

Locally-advanced periocular basal cell carcinoma (BCC) pose many therapeutic challenges due to the need to preserve functionality and cosmesis of the orbit and periocular area. Surgical excision and subsequent orbital exenteration are two recognized modalities of treatment. Vismodegib is currently an FDA-approved monotherapy for locally-advanced and metastatic BCC. We present a case of the use of vismodegib as neoadjuvant therapy prior to surgical excision of a locally-advanced periocular recurrent BCC in a 75-year-old male. The patient’s tumor successfully responded to vismodegib allowing surgical excision with clear margins. The orbit was saved in a patient who otherwise would have required complete orbital exenteration. J Drugs Dermatol. 20(5):552-554. doi:10.36849/JDD.5661.

Topics: Administration, Oral; Aged; Anilides; Carcinoma, Basal Cell; Eyelid Neoplasms; Eyelids; Humans; Magnetic Resonance Imaging; Male; Margins of Excision; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Organ Sparing Treatments; Pyridines; Skin Neoplasms; Treatment Outcome

Topics: Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Chemotherapy, Adjuvant; Cytoreduction Surgical Procedures; Female; Hedgehog Proteins; Humans; Male; Middle Aged; Pyridines; Signal Transduction; Skin; Skin Neoplasms; Treatment Outcome; Tumor Burden

Topics: Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Chemical and Drug Induced Liver Injury; Eyelid Neoplasms; Humans; Male; Pyridines; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Topics: Anilides; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Topics: Aged; Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Hair Diseases; Hedgehog Proteins; Humans; Male; Pyridines; Skin Neoplasms

Topics: Adult; Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Drug-Related Side Effects and Adverse Reactions; Exanthema; Female; Humans; Male; Pyridines; Skin; Skin Neoplasms

Topics: Aged; Anilides; Biphenyl Compounds; Carcinoma, Basal Cell; Dysgeusia; Female; Humans; Male; Middle Aged; Muscle Cramp; Nausea; Pyridines; Skin Neoplasms

Vismodegib (VMD) is a hedgehog inhibitor which indicated for basal cell skin cancer (BCC). This work focuses on investigating the influence of isopropyl alcohol additive for topical delivering and targeting of VMD-loaded binary ethosomes for BCC treatment. Different binary ethosome formulae were prepared based on Box-Behnken design using different concentrations of phospholipid (A), cholesterol (B) and isopropyl alcohol/total alcohol ratio (C). The prepared formulae were characterized for %entrapment efficiency (R

Topics: Anilides; Animals; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Rats; Skin Neoplasms; Treatment Outcome

The management of advanced basal cell carcinoma (BCC) in the periocular region remains a clinical challenge. Vismodegib (Erivedge. Fourteen practicing oculoplastic surgeons across Canada were involved in formulating and reviewing guidelines until consensus was reached. A consultancy meeting was followed by further ratification of guidelines over email. Two voting surveys were performed of the group to objectively assess agreement over each statement within the guidelines. Ratification continued until at least two-thirds of the group agreed on every guideline statement.. The guidelines summarize 21 statements in a major and minor criteria format. A multidisciplinary team review is suggested for each patient with the involvement of recommended specialists. The internal survey revealed 100% agreement over 9 statements, 91.7% agreement over 8 statements, 83.3% agreement over 4 statements, and 2 statements had 66.7% and 58.7% agreement each. All statements with less than 91.7% agreement were surveyed again, and they were kept, modified, or removed on the basis of a consensus of over 66.7%.. These guidelines serve to act as a framework for physicians considering vismodegib for the medical management of patients with advanced or metastatic periocular BCC. Future applications, including neoadjuvant uses of the drug, may become apparent through further research.

Topics: Adult; Anilides; Antineoplastic Agents; Canada; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms; Treatment Outcome

Vismodegib (Erivedge, Genentech) is a first-in-class inhibitor of the hedgehog (Hh) pathway, which is licensed for use in locally advanced basal cell carcinoma (BCC) and metastatic BCC. The National Institute for Health and Care Excellence withdrew recommendation for use of vismodegib secondary to a lack of data comparing vismodegib to standard supportive care. The purpose of this multicentre, international case series is to report outcomes of patients with locally advanced periocular BCC who have been treated with vismodegib.. The medical records of all patients treated with vismodegib were retrospectively reviewed across seven institutions in the United Kingdom, Australia, and New Zealand.. Thirteen patients were identified. Seven (54%) patients were male. All BCCs were ill-defined, with seven (58%) having orbital involvement at presentation. Median treatment time was 7 months (range 2-36 months). Eleven out of 13 patients developed side effects, the most common being fatigue in six patients (46%). Median follow-up was 24 months (range 12-48 months). Complete response was found in 5/13 patients (38%) and a partial response in 8/13 patients (62%). Six patients had further surgery after vismodegib, with three classed as globe-sparing operations. Three patients developed recurrence (23%). Three patients (23%) ultimately underwent exenteration.. This study demonstrates vismodegib to be a well-tolerated treatment which may, in some cases, facilitate globe-sparing surgery and hence avoid disfiguring operations such as exenteration. Uncertainty does remain regarding the long-term outcomes of patients treated with vismodegib.

Topics: Anilides; Antineoplastic Agents; Australia; Carcinoma, Basal Cell; Female; Hedgehog Proteins; Humans; Male; Neoplasm Recurrence, Local; New Zealand; Pyridines; Retrospective Studies; Skin Neoplasms; Treatment Outcome; United Kingdom

Vismodegib (Erivedge. This is a prospective cohort study in real-world practice. We included consecutive adult patients treated in Argentina with locally advanced or metastatic BCC not suitable for surgery or radiotherapy. Patients were followed until the end of the study, death, or loss to follow-up, whichever occurred first. Patients received 150 mg vismodegib PO daily.. We included in the analysis 63 patients who received treatment. Locally advanced BCC was present in 57 (90.4%) and metastatic disease in two (3.2%). ORR was observed in 46 patients (73%; 95% CI: 60.3-83.4), with partial response in 36 (57%; 95% CI: 44-69.5) and complete response in 10 (16%; 95% CI: 7.8-27.2). As to safety, 48 (76.2%) patients had at least one adverse event (AE). The most frequently observed AEs were muscular spasms in 25 (39.6%); dysgeusia in 23 (36.5%); alopecia in nine (14.2%); weight loss in seven (11.1%); and ageusia in (9.5%) patients. Serious AEs were observed in 11 (17%) patients with one episode of deep vein thrombosis and pulmonary embolism resulting in death.. Our study provides additional evidence of the efficacy and tolerability of vismodegib in patients with locally advanced or metastatic BCC in a real-world practice.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ageusia; Alopecia; Anilides; Antineoplastic Agents; Argentina; Carcinoma, Basal Cell; Dysgeusia; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Prospective Studies; Pulmonary Embolism; Pyridines; Response Evaluation Criteria in Solid Tumors; Severity of Illness Index; Skin; Skin Neoplasms; Spasm; Venous Thrombosis; Weight Loss; Young Adult

Topics: Anilides; Antineoplastic Agents; Antineoplastic Agents, Immunological; Biphenyl Compounds; Carcinoma, Squamous Cell; Clinical Trials as Topic; Drugs, Investigational; Humans; Molecular Targeted Therapy; Pyridines; Skin Neoplasms

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anilides; Basal Cell Nevus Syndrome; Carcinoma, Basal Cell; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Neoplasm Staging; Pyridines; Retrospective Studies; Skin Neoplasms; Young Adult

We report the case of a 71-year-old woman who developed advanced basal cell carcinoma (BCC) affecting the right eyebrow, invading the orbit. Globe displacement resulted in visual disturbances. Following multidisciplinary assessment, the tumour was deemed technically resectable for excision and right orbital exenteration. The patient however refused ablative surgical treatment; in view of her multiple comorbidities, the tumour was considered unresectable for her. Targeted therapy with vismodegib (Erivedge; Roche Pharmaceuticals) was therefore initiated in accordance with the patient's desire to avoid disfiguring surgery. After nine 28-day cycles of treatment, the tumour showed dramatic regression both clinically and radiographically. Mapping biopsies taken after 9 months confirmed the absence of any residual tumour, negating the need for ablative surgery. Grade 1 adverse events including muscle cramps, loss of taste, and reduced appetite were reported. Treatment was discontinued at 15 months owing to cumulative toxicity. The patient remains in remission 14 months after cessation of vismodegib. The use of vismodegib for advanced BCC is emerging and a number of reports exist. However, its application is mainly reserved for patients with locally advanced or metastatic disease, patients who are medically unfit for surgery, and cases where primary surgical resection would cause unacceptable disfigurement.

Topics: Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Humans; Pyridines; Skin Neoplasms; Treatment Outcome

Topics: Aged; Anilides; Betacoronavirus; Biphenyl Compounds; Carcinoma, Basal Cell; Coronavirus Infections; COVID-19; Disease Management; Female; Hedgehog Proteins; Humans; Italy; Male; Medication Adherence; Pandemics; Pneumonia, Viral; Pyridines; SARS-CoV-2; Skin Neoplasms; Telemedicine

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Hamartoma Syndrome, Multiple; Humans; Patient Reported Outcome Measures; Pyridines; Quality of Life; Skin Neoplasms

Sonic hedgehog pathway inhibitor Vismodegib is the first systemic treatment to be approved for metastatic or locally advanced basal cell carcinoma non-subsidiary of surgical treatment, and appears to be a promising treatment option for patients with nevoid basal cell carcinoma syndrome. In these patients, where repeated or prolonged treatment may be necessary, the psychological exhaustion caused by the chronicity of less severe adverse effects appears as the main limiting factor in the persistence of the drug in the long term and in the willingness of patients to take the drug again after its suspension. We report our experience with three cases where a drug holiday approach was effective in decreasing the intensity of adverse effects or improving the patient's subjective tolerance to the drug while maintaining clinical response.

Topics: Anilides; Antineoplastic Agents; Basal Cell Nevus Syndrome; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Pharmaceutical Preparations; Pyridines; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Locally advanced basal cell carcinoma (laBCC) represented an uncommon, difficult-to-treat form of skin cancer until the recent approval of the Hedgehog inhibitor vismodegib. Approximately 80% of laBCCs occur in the head and neck region, causing disfiguring skin changes that have an impact on patient quality of life (QoL). Because the lives of patients with advanced BCCs are severely disrupted, it would be expected that the QoL family members involved in caregiving would also be affected. The aim of our study was to quantify the QoL of both patients and family members during vismodegib treatment using the Dermatology Life Quality Index and the Family Dermatology Life Quality Index, respectively.

Topics: Aged; Anilides; Carcinoma, Basal Cell; Family; Female; Hedgehog Proteins; Humans; Male; Middle Aged; Patients; Psychological Distress; Pyridines; Quality of Life; Quinazolinones; Skin Neoplasms; Surveys and Questionnaires

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Basal cell carcinoma (BCC) is the most common skin cancer in humans. Pigmented basal cell carcinoma (pBCC) is a rare variant of BCC. Vismodegib, was the first drug to be approved for the treatment of locally advanced (laBCCs) or metastatic basal cell carcinoma. The aim of this study was to evaluate the efficacy of Vismodegib in patients with pBCCs. We retrospectively analyzed patients receiving Vismodegib as treatment for laBCCs presenting also various pBCCs. After 6 months of treatment, we performed excisional biopsies of pBCCs, that apparently at clinical and dermoscopic assessment did not respond to therapy. A total of nine patients were assessed. After 6 months of treatment, locally advanced target BCCs showed complete remission in four out of nine patients (44.4%), four patients (44.4%) were considered in partial remission and one patient (11%) showed no response to treatment. On the contrary, all the pBCCs showed both clinically and dermoscopically resistance to treatment. Therefore, clinically persistent pBCCs were surgically removed in three patients. Histology showed a complete elimination of the neoplastic cells together with features of previous regression. Our findings indicate that the efficacy of Vismodegib is higher than that documented by clinical or even dermatoscopic observation alone.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Retrospective Studies; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Topics: Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Humans; Pyridines; Skin Neoplasms; Treatment Outcome

Topics: Administration, Oral; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Cytoreduction Surgical Procedures; Face; Female; Humans; Palliative Care; Pyridines; Skin Neoplasms; Treatment Outcome

Topics: Adult; Aged; Alopecia; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Pyridines; Retrospective Studies; Skin Neoplasms; Smoothened Receptor

Topics: Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Pyridines; Retrospective Studies; Skin Neoplasms; Treatment Outcome; Tumor Burden

There are no large series describing cutaneous histologic changes during treatment with vismodegib in locally advanced basal cell carcinoma (BCC).. To analyze histologic changes in skin biopsy specimens from patients with locally advanced BCC treated with vismodegib.. A descriptive, retrospective study of patients with locally advanced BCC treated with vismodegib between June 2012 and December 2017 at the Instituto Valenciano de Oncología, Spain. Nineteen patients were biopsied before and during the treatment with vismodegib, and we compared histologic changes observed.. Seven patients (37%) achieved complete response, which was characterized by replacement of tumor stroma with a hyaline scar, lymphocytic inflammatory infiltrate, keratin formation, and infundibular cysts. Twelve patients (63%) achieved partial response; 5 showed no phenotypic changes, whereas 7 showed histologic changes; 5 cases showed metatypical differentiation; and 2 cases presented squamous differentiation. We observed no cases of squamous cell carcinoma arising at vismodegib treatment sites and no association between initial histologic subtype and clinical response.. Many biopsy specimens were obtained by punch biopsy and may not be representative of the full tumors. We studied histologic changes only in complete and partial responses.. Vismodegib can induce histologic changes toward metatypical or squamous differentiation of BCC in patients with partial response. Keratinizing phenomena were frequent, both in partial and complete response groups.

Topics: Adult; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Humans; Male; Middle Aged; Pyridines; Retrospective Studies; Skin Neoplasms

We report a case of a 60-year-old man who was a former cigar smoker with a slow-growing, large exophytic left shoulder mass (15 cm in diameter) and later found to have left axillary lymphadenopathy. Fine needle aspirate biopsy of the left shoulder mass revealed squamous cell carcinoma (SCC). However, pathology of the enlarged left axillary lymph node was reported as metastatic adenocarcinoma. The patient underwent surgical resection of the shoulder mass which comprised of SCC (>95%) and adenoid basal cell carcinoma (BCC) as a second component of the tumour. The BCC had identical histology as the metastatic carcinoma in the left axillary lymph node. Therefore, diagnosis was revised as cutaneous collision tumour with metastatic BCC. Six months later following adjuvant radiation therapy, the patient was diagnosed with metastatic BCC in the right lung. Stereotactic body radiation therapy (SBRT) and a selective hedgehog pathway inhibitor vismodegib were given with only limited efficacy. Clinical trial registration number NCT03132636.

Topics: Anilides; Axilla; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Hedgehog Proteins; Humans; Lung Neoplasms; Lymph Nodes; Male; Middle Aged; Pyridines; Radiosurgery; Radiotherapy, Adjuvant; Skin Neoplasms; Treatment Outcome

Basal cell carcinoma (BCC) is the most common malignancy in Caucasians, and its incidence is increasing. Most BCCs are treated surgically, nevertheless surgery is not an effective treatment for locally advanced or metastatic BCC. Alterations in hedgehog signaling pathway, a key regulator of cell growth and differentiation during development, are implicated in the pathogenesis of basal-cell carcinoma. Vismodegib is a small-molecule inhibitor of smoothened (SMO), a key component of the hedgehog (Hh) signaling pathway, administered in BCC patients, especially when surgery and radiotherapy treatments have failed. We report a series of eight elderly patients treated with vismodegib for advanced BCC and affected by concomitant multiple comorbidities. The efficacy and tolerability of vismodegib in patients with single and/or multiple comorbidities has been poorly studied. In our observation an overall high safety and tolerability has been observed over the course of treatment, with side effects of grade I and II and no changes in vital parameters, electrocardiography and echocardiogram. Vismodegib has been shown to be a safe and well tolerated treatment option for elderly patients affected by multiple comorbidities and advanced BCC.

Topics: Aged; Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Comorbidity; Female; Humans; Male; Pyridines; Retrospective Studies; Skin Neoplasms

Vismodegib is a hedgehog pathway inhibitor indicated for the treatment of locally advanced basal cell carcinoma (laBCC), with an objective response rate of 65%, including a 32% complete response (CR). However, adverse effects often lead to drug discontinuation. The objective of our study was to evaluate long-term responses, predictive factors, and management of relapse after vismodegib discontinuation.. An observational retrospective study was conducted in nine French oncodermatology units. We included patients with laBCC with CR on vismodegib who discontinued treatment between March 2012 and January 2016; we reviewed charts up to June 2016. The primary objective was to evaluate median relapse-free survival (RFS). Secondary objectives were risk factors associated with RFS, relapse, and death and treatment modalities after relapse and their efficacy.. One hundred sixteen patients with laBCC were included. The median RFS was 18.4 months (95% CI, 13.5 to 24.8 months). The RFS rate at 36 months was 35.4% (95% CI, 22.5% to 47.9%) for the total population and 40.0% (95% CI, 25.7% to 53.7%) for patients without Gorlin syndrome. LaBCC to the limbs and trunk was the only variable independently associated with a higher risk of relapse (hazard ratio, 2.77; 95% CI, 1.23 to 6.22;. Long-term response after vismodegib discontinuation is frequent. Most patients who experience a relapse still respond to vismodegib rechallenge.

Topics: Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Disease Progression; Drug Administration Schedule; Female; France; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Progression-Free Survival; Pyridines; Retreatment; Retrospective Studies; Risk Factors; Skin Neoplasms; Time Factors

Topics: Anilides; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Topics: Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Female; Humans; Male; Middle Aged; Pyridines; Skin Neoplasms; Treatment Outcome

Topics: Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Male; Mohs Surgery; Pyridines; Skin Neoplasms

Topics: Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Histiocytoma, Benign Fibrous; Humans; Male; Pyridines; Skin Neoplasms

Topics: Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Hedgehog Proteins; Humans; Male; Middle Aged; Pyridines; Retrospective Studies; Skin Neoplasms

Topics: Adult; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Imiquimod; Male; Neoplasms, Radiation-Induced; Pyridines; Skin; Skin Neoplasms

Topics: Alopecia; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Pyridines; Skin Neoplasms; Treatment Refusal

Topics: Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Biphenyl Compounds; Carcinoma, Basal Cell; Female; Follow-Up Studies; Hedgehog Proteins; Humans; Male; Middle Aged; Progression-Free Survival; Pyridines; Retrospective Studies; Signal Transduction; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Basal Cell Nevus Syndrome; Carcinogenesis; Carcinoma, Basal Cell; Cell Line, Tumor; Cilia; Drug Resistance, Neoplasm; Extracellular Signal-Regulated MAP Kinases; Hedgehog Proteins; Humans; Mutation; Pyridines; ras Proteins; Signal Transduction; Skin Neoplasms

Topics: Anilides; Animals; Carcinoma, Basal Cell; Hedgehogs; Pyridines; Skin Neoplasms

Topics: Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Drug Administration Schedule; Drug-Related Side Effects and Adverse Reactions; Female; Hedgehog Proteins; Humans; Male; Pyridines; Quality of Life; Severity of Illness Index; Skin Neoplasms

Background: Vismodegib used in the treatment of metastatic basal cell carcinoma (BCC) or locally advanced, recurrent BCC not amenable to surgery or radiation leads to various clinical changes.\ \ Objective: Aim was to elucidate the histopathology that corresponds to tumor involution observed with vismodegib therapy.\ \ Methods: Retrospective case series of patients treated with vismodegib between May 2012 and April 2017 with intra- or post-treatment biopsy.\ Results: 42 biopsy specimens and 4 Mohs frozen sections were analyzed. Necrosis, fibrosis, and increased plasma cells were common features.\ \ Limitations: Single center study.\ \ Conclusion: The histologic findings of BCCs treated with vismodegib correlate with clinical response.\ J Drugs Dermatol. 2019;18(2):136-138.

Topics: Anilides; Carcinoma, Basal Cell; Humans; Pyridines; Retrospective Studies; Skin Neoplasms; Treatment Outcome

Topics: Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basosquamous; Female; Humans; Pyridines; Skin Neoplasms

Vismodegib (Erivedge®, Genentech) is a first-in-class inhibitor of the hedgehog signaling pathway for the treatment of basal cell carcinoma (BCC). The treatment currently consists of the oral administration of Erivedge® capsules. Although it has shown therapeutic efficacy in clinical trials, there are many side effects related to its systemic distribution. In this work, we have incorporated vismodegib to ultradeformable liposomes in order to obtain a nano-drug delivery system via topical route, which could be useful to reduce systemic distribution -and consequently side effects- while achieving a viable epidermis-specific target where neoplastic events of BCC develop. Vismodegib was loaded into liposomes composed of soy phosphatidylcholine and sodium cholate, and the obtained formulation was characterized by different techniques, both experimental and computational. Several analyses were performed,with a special focus on the interaction of the drug with the liposomal membrane. Additionally, the penetration of Vismodegib delivered by ultradeformable liposomes was assessed on human skin explants. This is one of the first works that propose the topical route for Vismodegib and the first, to our knowledge, in stabilizing this active into a nano-drug delivery system specifically designed for penetrating the stratum corneum impermeable barrier.

Topics: Administration, Topical; Adult; Anilides; Antineoplastic Agents; Female; Humans; Liposomes; Nanostructures; Pyridines; Skin; Skin Absorption; Skin Neoplasms

No effective therapy exists for locally advanced or metastatic basal cell carcinoma (BCC). Vismodegib is a small molecule that is an inhibitor of the hedgehog pathway. An oral treatment to inactivate Smoothened would be a new therapeutic approach to treat advanced BCC. We studied two patients with advanced BCC and analysed variables, including age and sex of the patient, tumour location and size, time of evolution and nature of the tumour (primary or recurrent), type of treatment, route of administration, treatment duration, and treatment response. The most important side effects were determined. The patients received oral vismodegib (150 mg) daily. The male patient experienced difficulty in swallowing, which necessitated administration of the drug using a percutaneous endoscopic gastrostomy tube. In the first few months of treatment, both patients displayed significant improvement with almost complete disappearance of the skin lesions in one case and more than 50% in the other case. The median duration of response was 7.6 months. The side effects observed were of slight relevance; alopecia, dysgeusia, asthenia, and fatigue were easily resolved with the appropriate treatments. Vismodegib appears to be well tolerated and effective in treating advanced and metastatic BCC. No serious adverse events were reported.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Drug Administration Routes; Female; Humans; Male; Pyridines; Skin Neoplasms; Treatment Outcome; Tumor Burden

Topics: Adult; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Humans; Italy; Male; Middle Aged; Pyridines; Retrospective Studies; Skin Neoplasms

Topics: Anilides; Carcinoma, Basal Cell; Drug Resistance, Neoplasm; Humans; Mutation; Neoplasm Recurrence, Local; Pyridines; Skin Neoplasms

Topics: Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Humans; Pancreatitis; Pyridines; Risk Factors; Skin Neoplasms

Topics: Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Everolimus; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Neoplasm Recurrence, Local; Nose Neoplasms; Pyridines; Skin Neoplasms

Hedghehog pathway inhibitors have been successfully used for patients with locally advanced basal cell carcinomas. However, these treatments have been associated with various adverse events that may limit patient compliance. In this study, an association of patient and disease characteristics with drug compliance in a real clinical setting was made. 18 patients were included in the study. The average patient age was 78.39 years. The time that patients remained to treatment was, on average, 8.73 months. 72.2% of patients experienced at least one adverse event. At study cut-off, 11 out of 18 patients had discontinued treatment. The most common reason for discontinuation was reported "fatigue" from the treatment due to the type of AEs experienced (37.4%) and patient's choice after complete response achievement (30.8%). Factors that were associated with treatment discontinuation was: number of previous treatments, severity of AEs and patient age.

Topics: Age Factors; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Disease Progression; Drug-Related Side Effects and Adverse Reactions; Female; Greece; Humans; Kaplan-Meier Estimate; Male; Medication Adherence; Proportional Hazards Models; Pyridines; Retrospective Studies; Risk Factors; Skin Neoplasms; Tertiary Care Centers; Time Factors; Treatment Outcome

Recently, it has been shown that reflectance confocal microscopy (RCM) could identify subclinical basal cell carcinoma (BCC) during vismodegib treatment of locally advanced BCC.. To evaluate specificity and sensitivity of clinical, dermoscopic and RCM examination for BCC in patients with multiple BCCs treated by vismodegib.. Ninety four BCCs had 710 clinical, dermoscopic and RCM examinations during 72 weeks of vismodegib treatment. Thirty-eight were biopsied at the end of the treatment. Sensitivity and specificity for these 38 lesions were calculated. BCC diagnoses of clinical, dermoscopic and RCM examination on all the 710 investigations were compared using chi-square test.. Reflectance confocal microscopy was extremely more sensitive than dermoscopy and clinical examination and slightly less specific (sensitivity of 95%, 35% and 33% and specificity of 81%, 88% and 86% for RCM, dermoscopy and clinical examination, respectively) for the identification of residual BCC in the 38 biopsied cases. Considering all the 710 observations, RCM correctly diagnosed more BCCs than dermoscopy and clinical examination.. Reflectance confocal microscopy is a non-invasive technique that can detect subclinical residual BCC during and after vismodegib treatment helping the clinician to identify incomplete tumour regression.

Topics: Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Dermoscopy; Humans; Male; Microscopy, Confocal; Middle Aged; Neoplasm, Residual; Observer Variation; Physical Examination; Predictive Value of Tests; Pyridines; Retrospective Studies; Skin Neoplasms

Topics: Adult; Anilides; Antineoplastic Agents; Basal Cell Nevus Syndrome; Chromosome Disorders; Chromosomes, Human, Pair 9; Drug Eruptions; Female; Humans; Pyridines; Skin Neoplasms; Treatment Outcome

Topics: Administration, Oral; Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Cohort Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; France; Humans; Male; Middle Aged; Prospective Studies; Pyridines; Risk Assessment; Skin Neoplasms; Spasm; Withholding Treatment

Vismodegib (also known as GDC-0449) is a novel small molecule inhibitor of the Hedgehog (Hh) signaling pathway currently approved for the treatment of metastatic or locally advanced basal cell carcinoma (BCC) in humans. Its tumorigenic potential was assessed in dedicated carcinogenicity studies in rasH2 transgenic (Tg.rasH2) mice and Sprague Dawley (SD) rats. Tumorigenicity potential of vismodegib was identified in rats only and was limited to benign hair follicle tumors, including pilomatricomas and keratoacanthomas at exposures of ≥0.1-fold and ≥0.6-fold, respectively, of the steady-state exposure (AUC

Topics: Anilides; Animals; Antineoplastic Agents; Carcinogenesis; Female; Hair Follicle; Hedgehog Proteins; Humans; Male; Mice; Pyridines; Rats; Rats, Sprague-Dawley; Signal Transduction; Skin Neoplasms

Basal cell carcinoma (BCC) is the most common form of human cancer, with a continually increasing annual incidence in the United States. When diagnosed early, the majority of BCCs are readily treated with office-based therapy, which is highly curative. In these evidence-based guidelines of care, we provide recommendations for the management of patients with BCC, as well as an in-depth review of the best available literature in support of these recommendations. We discuss biopsy techniques for a clinically suspicious lesion and offer recommendations for the histopathologic interpretation of BCC. In the absence of a formal staging system, the best available stratification based on risk for recurrence is reviewed. With regard to treatment, we provide recommendations on treatment modalities along a broad therapeutic spectrum, ranging from topical agents and superficially destructive modalities to surgical techniques and systemic therapy. Finally, we review the available literature and provide recommendations on prevention and the most appropriate follow-up for patients in whom BCC has been diagnosed.

Topics: Administration, Cutaneous; Aminoquinolines; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Dermatologic Surgical Procedures; Early Detection of Cancer; Humans; Imiquimod; Neoplasm Grading; Neoplasm Staging; Neoplasms, Second Primary; Photochemotherapy; Photosensitizing Agents; Pyridines; Radiotherapy; Skin Neoplasms; United States

Topics: Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Cell Proliferation; Fatal Outcome; Female; Humans; Male; Melanoma; Pyridines; Risk Factors; Skin Neoplasms; Time Factors; Treatment Outcome; Tumor Burden

An 82-year-old Caucasian woman with a history of basal cell carcinoma on vismodegib presented with nausea, vomiting and intermittent abdominal pain. Laboratory results were remarkable for the elevation of liver enzymes. Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiogram (PTC) did not show evidence of intrahepatic or extrahepatic obstruction of the biliary tract. During PTC external biliary catheter was placed; however, bilirubin continued to rise. Further, laboratory work-up and imaging studies ruled out other possible aetiologies for hepatotoxicity such as infections, autoimmune hepatitis and other drugs known to be hepatotoxic thus leaving vismodegib the most likely cause of hepatotoxicity.

Topics: Aged, 80 and over; Alanine Transaminase; Anilides; Aspartate Aminotransferases; Bilirubin; Carcinoma, Basal Cell; Chemical and Drug Induced Liver Injury; Cholangiography; Cholangiopancreatography, Endoscopic Retrograde; Female; Humans; Pyridines; Skin Neoplasms; Ultrasonography; Ursodeoxycholic Acid

Topics: Anilides; Antineoplastic Agents; Cannabis; Carcinoma, Basal Cell; Forehead; Humans; Male; Medical Marijuana; Middle Aged; Muscle Cramp; Neuromuscular Agents; Pyridines; Skin Neoplasms

Information is limited on the use of vismodegib for treatment of advanced basal cell carcinoma beyond the setting of clinical trials.. To investigate the treatment patterns and characteristics of patients treated with vismodegib in clinical practice.. A longitudinal, retrospective cohort study was undertaken using data from a US commercial insurance claims (Truven Health Analytics MarketScan) database. Eligible patients were ≥18 years of age, with ≥1 claim for vismodegib from January 2012 to December 2015.. A total of 321 patients were included in the analysis. Approximately 20% of the patients took 1 or more treatment breaks of ≥ 30 days each before treatment discontinuation. Median duration of vismodegib treatment before the first treatment break and discontinuation was 4.0 and 5.5 months, respectively. Older age ( > 65 years) and absence of Gorlin syndrome were associated with increased risk for treatment interruption or discontinuation. Overall, 47% and 36% of patients underwent surgery or radiotherapy within the 6 months before and after vismodegib initiation, respectively.. Real-world evidence indicates that vismodegib is being used in clinical practice as part of combination treatment strategies. J Drugs Dermatol. 2018;17(2):143-148.

Topics: Aged; Anilides; Carcinoma, Basal Cell; Cohort Studies; Databases, Factual; Female; Humans; Insurance Claim Reporting; Male; Middle Aged; Pyridines; Retrospective Studies; Skin Neoplasms; United States

Vismodegib is a small molecule inhibitor of the Hedgehog signaling pathway that has shown efficacy in the control of locally advanced or metastatic basal cell carcinoma, although proof of its effectiveness in the elimination of aggressive tumors is lacking. We report a case and provide complete histological evidence of a 69-year-old gentleman who presented with a recurrent, infiltrative, and sclerosing (morpheiform) basal cell carcinoma on his left upper lip that was entirely eradicated with a three-month course of vismodegib 150 mg daily. Complete histologic clearance of a tumor in a recurrent, infiltrative, and sclerosing basal cell carcinoma with vismodegib is uncommon.

Topics: Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Cicatrix; Combined Modality Therapy; Humans; Male; Mohs Surgery; Neoplasm Recurrence, Local; Pyridines; Skin; Skin Neoplasms

Vismodegib (Erivedge, Genentech-Roche) is the first in class of Hedgehog pathway inhibitors approved for treatment of metastatic basal cell carcinoma (BCC), or locally advanced BCC that has recurred after surgery or is not amenable to surgery or radiation. Its path to discovery has been unique and traces its origin to corn lilies, sheep, Drosophila flies, and the Hedgehog signaling pathway. J Drugs Dermatol. 2018;17(5):506-508.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; History, 20th Century; History, 21st Century; Humans; Neoplasm Metastasis; Neoplasm Recurrence, Local; Pyridines; Skin Neoplasms; United States

The smoothened (SMO) receptor is an essential component of the Sonic hedgehog (SHH) signalling, which is associated with the development of skin basal cell carcinoma (BCC). SMO inhibitors are indicated for BCC patients when surgical treatment or radiation therapy are not possible. Unfortunately, SMO inhibitors are not always well tolerated due to severe side effects, and their therapeutical success is limited by resistance mutations.. We investigated how common are resistance-causing mutations in two genomic databases which are not linked to BCC or other cancers, namely 1000 Genomes and ExAC. To examine the potential for combination therapy or other treatments, we further performed knowledge-based simulations of SHH signalling, in the presence or absence of SMO and PI3K/Akt inhibitors.. The database analysis revealed that of 18 known mutations associated with Vismodegib-resistance, three were identified in the databases. Treatment of individuals carrying such mutations is thus liable to fail a priori. Analysis of the simulations suggested that a combined inhibition of SMO and the PI3K/Akt signalling pathway may provide an effective reduction in tumour proliferation. However, the inhibition dosage of SMO and PI3K/Akt depended on the activity of phosphodiesterases (PDEs). Under high PDEs activities, SMO became the most important control node of the network. By applying PDEs inhibition, the control potential of SMO decreased and PI3K appeared as a significant factor in controlling tumour proliferation.. Our systems biology approach employs knowledge-based computer simulations to help interpret the large amount of data available in public databases, and provides application-oriented solutions for improved cancer resistance treatments.

Topics: Anilides; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Basal Cell; Computational Biology; Computer Simulation; Datasets as Topic; Drug Resistance, Neoplasm; Hedgehog Proteins; Humans; Mutation; Phosphatidylinositol 3-Kinases; Phosphodiesterase Inhibitors; Phosphoinositide-3 Kinase Inhibitors; Phosphoric Diester Hydrolases; Proto-Oncogene Proteins c-akt; Pyridines; Signal Transduction; Skin Neoplasms; Smoothened Receptor

Multiple familial trichoepitheliomas (MFT) is an autosomal dominantly inherited disease characterized by multiple skin appendage tumors. We describe a patient showing a continuous spectrum of follicular differentiated neoplasms including classical trichoepitheliomas but also infiltrative growing and finally metastasizing malignant follicular differentiated tumors. Germline mutation analysis revealed a nonsense mutation in the cylindromatosis (CYLD) gene. Gene expression analysis by real-time PCR of tumor tissue showed overexpression of glioma-associated oncogene Gli1 mRNA. Treatment with the Hedgehog pathway inhibitor vismodegib resulted in a significant regression of the highly differentiated trichoepitheliomas. Gli upregulation is indicative of an active Hedgehog signaling pathway. We hypothesize that its upregulation is indirectly caused by CYLD mutation which promotes tumor development. Vismodegib treatment could thus provide a new treatment option for patients with this debilitating disorder.

Topics: Anilides; Antineoplastic Agents; Codon, Nonsense; Deubiquitinating Enzyme CYLD; Genetic Predisposition to Disease; Heredity; Humans; Immunohistochemistry; Male; Middle Aged; Neoplastic Syndromes, Hereditary; Pedigree; Phenotype; Pyridines; Signal Transduction; Skin Neoplasms; Tomography, X-Ray Computed; Treatment Outcome; Up-Regulation; Zinc Finger Protein GLI1

Basal cell carcinoma (BCC) is the most common skin cancer. It is primarily a local disease, and it very rarely causes metastatic disease. Chemotherapeutic agents had limited success in management of metastatic disease until the introduction of vismodegib. In this case report, we describe the presentation of a metastatic BCC that was not amenable to surgical resection or local treatment options and was treated successfully with vismodegib.. A 69-year-old white man was referred to our surgical clinic for evaluation of an erosive left shoulder lesion. Biopsy in the clinic showed BCC with evidence of metastases on positron emission tomography-computed tomography scan. Tumors had invaded multiple bony structures and multiple organs, making surgical resection not an option. The decision was made to treat the patient with vismodegib. At 1-year follow-up, the patient's left shoulder lesion had improved with no evidence of metabolically active distant metastasis.. Although BCC is the most common skin cancer, it is usually a local disease and treated with local measures. Metastatic BCC is extremely rare, and in cases when surgical resection or local radiation are not viable options, chemotherapeutic agents typically offer very limited improvement. Vismodegib is an oral selective sonic hedgehog pathway inhibitor that shows benefit in patients with locally advanced or metastatic disease.

Topics: Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Male; Positron Emission Tomography Computed Tomography; Pyridines; Shoulder; Skin Neoplasms

Vismodegib is the first selective Hedgehog inhibitor approved for the treatment of locally advanced and metastatic basal cell carcinoma (BCC). In this article, we describe our experience with the use of this drug to treat advanced and/or multiple BCCs at a cancer center over 5 years.. We analyzed the following variables: patient age and sex; tumor location, size, type, and characteristics; time since onset; primary or recurrent status; duration of treatment; response to treatment (complete, partial, stabilization, or absence of response); adverse effects; and recurrences.. We treated 22 patients, of whom 20 had locally advanced BCCs and 2 had metastatic BCCs with lymph node involvement. The treatment was administered over a mean of 11.8 months. Nine patients (41%) achieved complete response and 10 (45%) partial response. The disease was stabilized in 3 (14%). Two patients relapsed after a median of 21 months. The main adverse effects were dysgeusia, alopecia, and muscle cramps, all of which were mild. None of the patients developed squamous cell carcinoma in an area treated with vismodegib, although metatypical changes were observed after treatment.. With a response rate of 96%, vismodegib is a safe and effective treatment for locally advanced BCC. Adverse effects are generally mild but they need to be taken into account owing to their high frequency.

Topics: Adult; Aged; Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Female; Humans; Male; Middle Aged; Neoplasm Staging; Pyridines; Retrospective Studies; Skin Neoplasms

Topics: Anilides; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Vismodegib, an inhibitor of the Hedgehog signaling pathway, is an approved drug for monotherapy in locally advanced or metastatic basal cell carcinoma (BCC). Data on combined modality treatment by vismodegib and radiation therapy, however, are rare. In the present study, we examined the radiation sensitizing effects of vismodegib by analyzing viability, cell cycle distribution, cell death, DNA damage repair and clonogenic survival in three-dimensional cultures of a BCC and a head and neck squamous cell carcinoma (HNSCC) cell line. We found that vismodegib decreases expression of the Hedgehog target genes glioma-associated oncogene homologue (GLI1) and the inhibitor of apoptosis protein (IAP) Survivin in a cell line- and irradiation-dependent manner, most pronounced in squamous cell carcinoma (SCC) cells. Furthermore, vismodegib significantly reduced proliferation in both cell lines, while additional irradiation only slightly further impacted on viability. Analyses of cell cycle distribution and cell death induction indicated a G1 arrest in BCC and a G2 arrest in HNSCC cells and an increased fraction of cells in SubG1 phase following combined treatment. Moreover, a significant rise in the number of phosphorylated histone-2AX/p53-binding protein 1 (γH2AX/53BP1) foci in vismodegib- and radiation-treated cells was associated with a significant radiosensitization of both cell lines. In summary, these findings indicate that inhibition of the Hedgehog signaling pathway may increase cellular radiation response in BCC and HNSCC cells.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cell Line, Tumor; Combined Modality Therapy; G1 Phase Cell Cycle Checkpoints; G2 Phase Cell Cycle Checkpoints; Gamma Rays; Gene Expression Regulation, Neoplastic; Head and Neck Neoplasms; Hedgehog Proteins; Histones; Humans; Organ Specificity; Pyridines; Radiation-Sensitizing Agents; Signal Transduction; Skin Neoplasms; Survivin; Tumor Suppressor Protein p53; Zinc Finger Protein GLI1

A female patient with xeroderma pigmentosum and multiple basal cell carcinomas was treated with a hedgehog pathway inhibitor (vismodegib), which successfully treated the majority of her basal cell carcinomas while preventing the appearance of new lesions. The sum diameter of lesions showed a 61% decrease after 16.5 months of treatment, although after 18.5 months of treatment, a persistent lesion showed progression and metatypical characteristics; adverse events included persistent alopecia muscle cramps, dysgeusia, and amenorrhea. Despite these limitations, vismodegib may have a role in the treatment of some patients with xeroderma pigmentosum.

Topics: Adult; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Hamartoma Syndrome, Multiple; Humans; Pyridines; Skin Neoplasms; Xeroderma Pigmentosum

Basal cell carcinoma (BCC) is the most frequent cancer in humans and results from constitutive activation of the Hedgehog pathway

Topics: Anilides; Animals; Carcinoma, Basal Cell; Cell Differentiation; Cell Lineage; Disease Models, Animal; Female; Hair Follicle; Hedgehog Proteins; Humans; Male; Mice; Neoplasm Recurrence, Local; Patched-1 Receptor; Pyridines; Receptors, G-Protein-Coupled; Recurrence; Secondary Prevention; Skin Neoplasms; Smoothened Receptor; Withholding Treatment; Wnt Proteins; Wnt Signaling Pathway

Despite the efficacy of Hedgehog pathway inhibitors in the treatment of basal cell carcinoma (BCC)

Topics: Anilides; Animals; Carcinoma, Basal Cell; Cell Differentiation; Cell Proliferation; Epidermal Cells; Hair Follicle; Hedgehog Proteins; Humans; Mice; Pyridines; Signal Transduction; Skin Neoplasms; Smoothened Receptor; Stem Cells; Wnt Signaling Pathway

Topics: Alopecia; Anilides; Antineoplastic Agents; Biphenyl Compounds; Carcinoma, Basal Cell; Creatine Kinase; Dysgeusia; Female; Hedgehog Proteins; Humans; Muscular Diseases; Ovarian Diseases; Pyridines; Skin Neoplasms; Weight Loss

Topics: Alopecia; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Diagnosis, Differential; Humans; Male; Middle Aged; Pyridines; Skin Neoplasms

Basal cell carcinoma (BCC) is the most common skin cancer but usually has a good prognosis. However, there is a subset of BCC cases with a less favorable prognosis. For patients with locally advanced, recurrent or metastatic BCCs who are not suitable for surgery or radiotherapy, small-molecule drug inhibitors of hedgehog pathway are a new therapeutic opportunity. Here, we present a case of infiltrative BCC with multiple recurrences. Wide excision with reconstructive plastic surgery was performed initially with adjuvant radiotherapy. Due to multiple recurrences afterward, radiotherapy, topical imiquimod and oral itraconazole were used but were not effective. Finally, the patient was treated with vismodegib which led to a complete response. Moreover, the patient's symptoms due to the locally diffused cancer resolved.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Nose Neoplasms; Pyridines; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Cell Differentiation; Humans; Pyridines; Skin Neoplasms

Vismodegib is a first-in-class agent targeting the hedgehog signaling pathway for treatment of patients with locally advanced basal cell carcinoma (BCC) and metastatic BCC. There have been concerns about the development of squamous cell carcinoma (SCC) in patients treated with this drug.. We sought to determine whether treatment with vismodegib is associated with an increase in the risk of cutaneous SCC.. In this retrospective cohort study, patients treated with vismodegib as part of phase I and II clinical studies were compared with participants from the University of California, San Francisco, Nonmelanoma Skin Cancer Cohort who received standard therapy for primary BCC. In total, 1675 patients were included in the analysis, and the development of SCC after vismodegib exposure was assessed.. The use of vismodegib was not associated with an increased risk of subsequent development of SCC (adjusted hazard ratio, 0.57; 95% confidence interval, 0.28-1.16). Covariates including age, sex, history of previous nonmelanoma skin cancer, and number of visits per year were significantly associated with the development of SCC.. A limitation of the study was that a historic control cohort was used as a comparator.. Vismodegib was not associated with an increased risk of subsequent SCC when compared with standard surgical treatment of BCC.

Topics: Age Factors; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Clinical Trials, Phase I as Topic; Clinical Trials, Phase II as Topic; Female; Humans; Male; Middle Aged; Neoplasms, Second Primary; Office Visits; Pyridines; Retrospective Studies; Risk Factors; Sex Factors; Skin Neoplasms

Nonmelanoma skin cancer is the most common cancer in humans, comprising mainly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). BCC proliferation is highly dependent on the Hedgehog signaling pathway. We aimed to investigate a panel of anticancer drugs with known activity against skin cancer for their therapeutic potential in localized, enhanced topical treatment of SCC and BCC. Cytotoxicity profiles for vismodegib, 5-fluorouracil (5-FU), methotrexate (MTX), cisplatin, bleomycin, and vorinostat were established in terms of half maximal inhibitory concentration values in a panel of immortalized keratinocytes (HaCaT), BCC (UWBCC1 and BCC77015), and SCC (A431 and SCC25) cell lines. The impact of treatment on the regulation of Hedgehog pathway target genes (GLI1 and PTCH1), measured by real-time PCR, was compared between UWBCC1 and HaCaT. Varying cell line sensitivity profiles to the examined anticancer drugs were observed. Generally, 24-h drug exposure was sufficient to reduce cell viability. We found that 5-FU, MTX, and cisplatin significantly downregulated the expression of two genes controlled by the Hedgehog pathway (≤25-, 2.9-, and 12.5-fold, respectively, for GLI1 in UWBCC1 cells at 48 h, P<0.0001). The gene regulation showed clear concentration dependence and correlated with cytotoxicity for both 5-FU and MTX. We find a potential for the use of anticancer drugs in localized and enhanced topical treatment of nonmelanoma skin cancer. Of importance in the clinical setting, 24-h drug exposure may be sufficient for significant cytotoxicity for vismodegib, 5-FU, cisplatin, and bleomycin. MTX, 5-FU, and cisplatin may offer particular promise through combined cytotoxicity and downregulation of Hedgehog pathway genes GLI1 and PTCH1.

Topics: Anilides; Antineoplastic Agents; Cell Line, Tumor; Cisplatin; Drug Screening Assays, Antitumor; Fluorouracil; Gene Expression Regulation, Neoplastic; Hedgehog Proteins; Humans; Methotrexate; Patched-1 Receptor; Pyridines; Signal Transduction; Skin Neoplasms; Zinc Finger Protein GLI1

Topics: Anilides; Carcinoma, Basal Cell; Combined Modality Therapy; Female; Humans; Magnetic Resonance Imaging; Microsurgery; Middle Aged; Nasolabial Fold; Neoadjuvant Therapy; Nose Neoplasms; Pyridines; Skin Neoplasms; Surgical Flaps

Topics: Anilides; Antineoplastic Agents; Humans; Pyridines; Skin Neoplasms

The regrowth of a tumor after complete clinical response and the development of keratinocytic neoplasms while patients are still undergoing continuous vismodegib have stressed the importance of the accurate monitoring to detect recurrences earlier and ensure the best possible outcome.. The objective of this study was to determine the role of reflectance confocal microscopy (RCM) in monitoring the response of locally advanced basal cell carcinoma (laBCC) to vismodegib and to discard secondary resistance.. Seven patients presenting with nine laBCC, were prospectively included and their response to this drug was assessed by means of clinical examination, dermoscopy, and RCM. The study was conducted at the Melanoma Unit in Hospital Clinic of Barcelona, between June 2012 and March 2013.. Histologically confirmed lesion 10 mm or larger in diameter for which surgery was contraindicated and radiation therapy was inappropriate. The median patient age was 73 years and the most common histological type was infiltrating BCC. RCM allowed the identification of residual tumor in two lesions and to confirm complete response in the other four cases. Two patients developed new lesions within the tumor bed, they were assessed by RCM showing features of actinic keratosis which were confirmed by histopathology.. The use of in vivo RCM allowed the characterization of the dynamic morphologic changes in tumor response helping to better define partial response and to differentiate it from secondary resistance. Another interesting observation was the recognition of a phenomenon characterized by the development of keratinocytic neoplasms within the tumor bed.

Topics: Aged; Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Dermoscopy; Female; Humans; Intravital Microscopy; Keratinocytes; Keratosis, Actinic; Male; Microscopy, Confocal; Middle Aged; Neoplasm Recurrence, Local; Prospective Studies; Pyridines; Skin Neoplasms; Spain

We report a case of a 66-year-old man with locally advanced and metastatic basal cell carcinoma (BCC) causing spinal cord compression, which was treated with spinal surgery and subsequent vismodegib. The patient presented with a large fungating chest wall lesion and a metastasis in T8 that was causing cord compression. He had neurosurgical decompression of the T8 lesion and fixation of the spine. Punch biopsy from the fungating chest wall lesion showed a BCC with some malignant squamous differentiation (basosquamous). Histopathological examination of the metastatic lesion in T8 at the time of surgical decompression identified features identical to the punch biopsy. The patient was referred to the oncology clinic for adjuvant treatment. In light of his metastatic disease and the large area over his chest wall that could not fully be covered by radiotherapy, he was treated with the novel oral Hedgehog signalling pathway (HHSP) inhibitor vismodegib, which led to marked improvement.

Topics: Aged; Anilides; Animals; Biopsy; Carcinoma, Basal Cell; Decompression, Surgical; Hedgehog Proteins; Humans; Magnetic Resonance Imaging; Male; Pyridines; Signal Transduction; Skin; Skin Neoplasms; Spinal Cord Compression; Spinal Cord Neoplasms; Thoracic Vertebrae; Tomography, X-Ray Computed

Topics: Anilides; Carcinoma, Basal Cell; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Male; Neoplasm Staging; Pyridines; Skin; Skin Neoplasms; Treatment Outcome

Topics: Aged; Anilides; Biopsy; Carcinoma, Merkel Cell; Cell Line, Tumor; Drug Screening Assays, Antitumor; Fatal Outcome; Gene Expression Regulation, Neoplastic; Hedgehog Proteins; Humans; Male; Oligonucleotide Array Sequence Analysis; Pyridines; Signal Transduction; Skin Neoplasms; Tomography, X-Ray Computed

Topics: Administration, Oral; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Humans; Male; Orbital Neoplasms; Pyridines; Skin Neoplasms; Treatment Outcome

Topics: Anilides; Antineoplastic Agents; Basal Cell Nevus Syndrome; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Topics: Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Drug Hypersensitivity Syndrome; Humans; Male; Pyridines; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Vismodegib is an oral inhibitor of the Hedgehog signaling pathway and has been used to treat basal cell carcinoma (BCC) in adults. This article reports clearance of a nodular BCC of the nasal tip in an 8-year-old boy with xeroderma pigmentosum (XP). BCC can pose therapeutic challenges when located in areas that are not amenable to traditional therapies such as Mohs micrographic surgery or topical agents. Vismodegib was used at a dose of 150 mg/day to treat the boy's BCC. After 4 months of therapy, we achieved complete clinical clearance. During 21 months of follow-up, the patient's nose remained clinically clear of tumor. Vismodegib was successfully used to treat a child with XP and nodular BCC. Our goal in using vismodegib was tumor regression while avoiding cosmetic and functional disfigurement. Vismodegib was effective in clinically clearing the tumor, and the patient has shown no signs of recurrence. Further studies are warranted.

Topics: Anilides; Carcinoma, Basal Cell; Child; Facial Neoplasms; Humans; Male; Nose; Pyridines; Skin Neoplasms; Xeroderma Pigmentosum

Whereas vismodegib is effective in the treatment of locally advanced/metastatic basal cell carcinoma, dysgeusia and weight loss are common side effects of such treatment. The main objective of this study was to monitor the nutritional status of vismodegib-treated patients. Secondary objective was to assess the incidence of dysgeusia and the benefit of early nutritional management.. This prospective study included all patients who started vismodegib between October 2011 and May 2013 at Nantes University Hospital. Prior to July 2012, patients treated with vismodegib had not received any specific nutritional management (Historical cohort). Body weight and presence of dysgeusia were recorded monthly. Patients treated after July 2012 (Nutrition cohort) were evaluated by a physician of the Nutrition Support Unit and received dietary counseling at vismodegib initiation. A standardized nutritional management protocol was initiated in case of significant weight loss.. Forty-five patients (21 and 24 in the Nutrition and Historical cohort, respectively) were enrolled. In the Nutrition cohort, five patients (24 %) were undernourished at vismodegib initiation, and the 6-month cumulative incidence of dysgeusia was 71 %. Eight patients (38 %) and 13 patients (54 %) had a weight loss greater than 5 % in the Nutrition and Historical cohort, respectively (p = 0.3727).. The results of this pilot study suggest the benefit of early nutritional screening. The potential benefit of nutritional support in this setting warrants further investigation.

Topics: Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Cohort Studies; Dysgeusia; Female; Humans; Male; Middle Aged; Pilot Projects; Prospective Studies; Pyridines; Skin Neoplasms; Weight Loss

Definitive radiotherapy and vismodegib, an oral inhibitor of the hedgehog pathway, are both established treatment options for locally advanced basal cell carcinomas (BCC). Both have shown good results in local tumor control; however, the effects concerning advanced tumors are often not of a lasting nature and to date no systematic data about the combination of the two modalities are available.. We retrospectively analyzed four patients who received vismodegib and radiotherapy in combination. Radiation doses varied between 50.4 Gy and 66.0 Gy. Three patients had recurrent BCC. One patient had locoregional lymph node involvement. Vismodegib was taken once a day (150 mg) during the entire time of irradiation and beyond upon instructions of the attending dermatologist.. In three cases a persistent complete response was observed, in one case the tumor remained stable for approximately 6 months until further tumor progression was documented. The combined therapy was well tolerated in all cases. No exceptional side effects pointing at a drug-radiation interaction were observed.. The combination of vismodegib and radiation seems feasible and the initial results are promising. In our cohort, there was no increase in unexpected side effects. Further research is needed to evaluate the significance of this combined therapy.

Topics: Aged; Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Chemoradiotherapy; Combined Modality Therapy; Female; Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Pyridines; Radiotherapy Dosage; Retrospective Studies; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Basal Cell Nevus Syndrome; Biopsy; Diagnosis, Differential; Female; Humans; Laparoscopy; Mesenteric Cyst; Mesentery; Middle Aged; Peritoneal Neoplasms; Pyridines; Skin Neoplasms; Tomography, X-Ray Computed

Topics: Adult; Anilides; Antineoplastic Agents; Basal Cell Nevus Syndrome; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Pyridines; Skin Neoplasms; Treatment Outcome

MicroRNAs (miRNAs) have been identified as key players in posttranscriptional gene regulation and have a significant impact on basal cell carcinoma (BCC) development. The Sonic hedgehog pathway inhibitor vismodegib has been approved for oral therapy of metastatic or advanced BCC. Here, a high-throughput miRNA sequencing analysis was carried out to identify differentially expressed miRNAs and possible novel miRNA candidates in vismodegib-treated BCC tissue. Additionally, we described our surgical experience with neoadjuvant oral vismodegib therapy.. A punch biopsy (4 mm) from a patient with an extensive cranial BCC under oral vismodegib therapy and a corresponding nonlesional epithelial skin biopsy were harvested. Total RNA was isolated, after which a sequencing cDNA library was prepared, and cluster generation was carried out, which was followed by an ultra-high-throughput miRNA sequencing analysis to indicate the read number of miRNA expression based on miRBase 21. In addition to the identification of differentially expressed miRNAs from RNA sequencing data, additional novel miRNA candidates were determined with a tool for identifying new miRNA sequences (miRDeep2).. We identified 33 up-regulated miRNAs (fold change ≥2) and 39 potentially new miRNA candidates (miRDeep scores 0-43.6). A manual sequence analysis of the miRNA candidates on the genomic locus of chromosome 1 with provisional IDs of chr1_1913 and chr1_421 was further carried out and rated as promising (chr1_1913) and borderline (chr1_421). Histopathology revealed skip lesions in clinically healthy appearing skin at the tumor margins, which were the cause of seven re-excisions by micrographic controlled surgery to achieve tumor-free margins.. miRNA sequencing revealed novel miRNA candidates that need to be further confirmed in functional Dicer knockout studies. Clinically, on the basis of our surgical experience described here, neoadjuvant vismodegib therapy in BCC appears to impede histopathologic evaluations with effects on surgical therapy. Thus, larger studies are necessary, but are not preferable at this time if other options are available.

Topics: Aged; Anilides; Antineoplastic Agents; Base Sequence; Biopsy; Carcinoma, Basal Cell; Female; Gene Expression Regulation, Neoplastic; Hedgehog Proteins; High-Throughput Nucleotide Sequencing; Humans; MicroRNAs; Molecular Sequence Data; Pyridines; Sequence Analysis, RNA; Skin; Skin Neoplasms

Topics: Aged; Anilides; Biopsy; Carcinoma, Basal Cell; Dose-Response Relationship, Drug; Humans; Male; Pyridines; Renal Insufficiency; Skin; Skin Neoplasms

Topics: Adult; Anilides; Antineoplastic Agents; Basal Cell Nevus Syndrome; Eyelid Neoplasms; Hedgehog Proteins; Humans; Magnetic Resonance Imaging; Male; Maxillary Sinus Neoplasms; Neoplasms, Multiple Primary; Pyridines; Skin Neoplasms; Tomography, X-Ray Computed

Smoothened inhibitors (SIs) are a new type of targeted therapy for advanced basal cell carcinoma (BCC), and their long-term effects, such as increased risk of subsequent malignancy, are still being explored.. To evaluate the risk of developing a non-BCC malignancy after SI exposure in patients with BCC.. A case-control study at Stanford Medical Center, an academic hospital. Participants were higher-risk patients with BCC diagnosed from January 1, 1998, to December 31, 2014. The dates of the analysis were January 1 to November 1, 2015.. The exposed participants (cases) comprised patients who had confirmed prior vismodegib treatment, and the nonexposed participants (controls) comprised patients who had never received any SI. Because vismodegib was the first approved SI, only patients exposed to this SI were included.. Hazard ratio for non-BCC malignancies after vismodegib exposure, adjusting for covariates.. The study cohort comprised 180 participants. Their mean (SD) age at BCC diagnosis was 56 (16) years, and 68.9% (n = 124) were male. Fifty-five cases were compared with 125 controls, accounting for age, sex, prior radiation therapy or cisplatin treatment, Charlson Comorbidity Index, clinical follow-up time, immunosuppression, and basal cell nevus syndrome status. Patients exposed to vismodegib had a hazard ratio of 6.37 (95% CI, 3.39-11.96; P < .001), indicating increased risk of developing a non-BCC malignancy. Most non-BCC malignancies were cutaneous squamous cell carcinomas, with a hazard ratio of 8.12 (95% CI, 3.89-16.97; P < .001), accounting for age and basal cell nevus syndrome status. There was no significant increase in other cancers.. Increased risk for cutaneous squamous cell carcinomas after vismodegib therapy highlights the importance of continued skin surveillance after initiation of this therapy.

Topics: Adult; Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Case-Control Studies; Female; Humans; Male; Middle Aged; Proportional Hazards Models; Pyridines; Risk; Skin Neoplasms

The hedgehog (Hh) signaling pathway is aberrantly activated in a majority of basal cell carcinomas (BCC). Vismodegib and sonidegib are targeted inhibitors of Smoothened (SMO). Both drugs are approved for use in locally advanced BCC (laBCC), with vismodegib also approved for metastatic BCC (mBCC).

Topics: Anilides; Antineoplastic Agents; Biphenyl Compounds; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Pyridines; Receptors, G-Protein-Coupled; Signal Transduction; Skin Neoplasms; Smoothened Receptor; Translational Research, Biomedical

Basal cell carcinoma (BCC) of the skin is the most common malignant neoplasm in humans. BCC is primarily driven by the Sonic Hedgehog (Hh) pathway. However, its phenotypic variation remains unexplained. Our genetic profiling of 293 BCCs found the highest mutation rate in cancer (65 mutations/Mb). Eighty-five percent of the BCCs harbored mutations in Hh pathway genes (PTCH1, 73% or SMO, 20% (P = 6.6 × 10(-8)) and SUFU, 8%) and in TP53 (61%). However, 85% of the BCCs also harbored additional driver mutations in other cancer-related genes. We observed recurrent mutations in MYCN (30%), PPP6C (15%), STK19 (10%), LATS1 (8%), ERBB2 (4%), PIK3CA (2%), and NRAS, KRAS or HRAS (2%), and loss-of-function and deleterious missense mutations were present in PTPN14 (23%), RB1 (8%) and FBXW7 (5%). Consistent with the mutational profiles, N-Myc and Hippo-YAP pathway target genes were upregulated. Functional analysis of the mutations in MYCN, PTPN14 and LATS1 suggested their potential relevance in BCC tumorigenesis.

Topics: Anilides; Antineoplastic Agents; Carcinogenesis; Carcinoma, Basal Cell; Disease Progression; DNA Mutational Analysis; Exome; Genetic Association Studies; Genetic Predisposition to Disease; HEK293 Cells; Humans; Mutation; Pyridines; Signal Transduction; Skin Neoplasms; Transcriptome

Topics: Adult; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Middle Aged; Pyridines; Skin Neoplasms

Topics: Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Facial Neoplasms; Humans; Male; Pyridines; Skin Neoplasms

Vismodegib is an effective treatment for advanced basal cell carcinoma (BCC), but primary resistance to vismodegib remains to be elucidated. Alternative approaches are warranted to help selecting patients most likely to be responsive to treatment. The identification of immunohistochemical markers may support this perspective, as well as better understanding of resistance mechanisms. To determine the level of expression of CD56, PDGF-R, CD117, MMP9, TIMP3, and CXCR4 in advanced BCC, and explore whether expression levels are associated with non-response to vismodegib. A cross-sectional study was conducted. Immunohistochemical markers were selected based on their roles in tumour proliferation and/or migration in skin tumours. Tissue samples included pretreatment advanced BCC samples from patients treated with vismodegib, with an available response after six months of treatment. Regression optimised models were used to build hypotheses regarding a possible association between expression levels and non-response to vismodegib, which was then tested by logistic regression. Twenty-three patients were included. The percentage of samples expressing markers ranged from 43.5% (CD117) to 91.3% (CXCR4). CD56 expression was significantly associated with an increased risk of non-response to vismodegib (OR = 5.5; CI 95%: 3.4-29.8; p = 0.0488); a similar association was suggested for CXCR4 (p = 0.066), but not identified for other markers. These results provide a better understanding of the expression of immunohistochemical markers in advanced BCC. Further detailed analysis of CD56 expression may provide insights into guiding further investigation of the correlation between this marker and non-response to vismodegib.

Topics: Adult; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Biomarkers, Tumor; Carcinoma, Basal Cell; CD56 Antigen; Cross-Sectional Studies; Drug Resistance, Neoplasm; Female; Humans; Immunohistochemistry; Male; Matrix Metalloproteinase 9; Middle Aged; Proto-Oncogene Proteins c-kit; Pyridines; Receptor, Platelet-Derived Growth Factor alpha; Receptors, CXCR4; Skin Neoplasms; Tissue Inhibitor of Metalloproteinase-3; Treatment Failure

Topics: Aged; Anilides; Animals; Arthritis, Rheumatoid; Basal Cell Nevus Syndrome; Biopsy, Needle; Female; Follow-Up Studies; Humans; Immunohistochemistry; Molecular Targeted Therapy; Patched-1 Receptor; Pyridines; Risk Assessment; Severity of Illness Index; Skin Neoplasms; Treatment Outcome

Topics: Anilides; Carcinoma, Basal Cell; Combined Modality Therapy; Humans; Male; Middle Aged; Prognosis; Pyridines; Skin Neoplasms

Topics: Anilides; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Case-Control Studies; Humans; Pyridines; Skin Neoplasms

Topics: Anilides; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Case-Control Studies; Humans; Pyridines; Skin Neoplasms

Topics: Anilides; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Pyridines; Skin Neoplasms

Because many patients with unresectable basal cell carcinoma (BCC) are aged ≥65 years, this study explores the efficacy and safety of vismodegib in these patients with locally advanced (la) or metastatic (m) basal cell carcinoma (BCC) in the ERIVANCE BCC trial and the expanded access study (EAS).We compared patients aged ≥65 years to patients aged <65 years taking vismodegib 150 mg/day, using descriptive statistics for response and safety. Patients aged ≥65 years (laBCC/mBCC) were enrolled in ERIVANCE BCC (33/14) and EAS (27/26). Investigator-assessed best overall response rate in patients ≥65 and <65 years was 46.7%/35.7% and 72.7%/52.6% (laBCC/mBCC), respectively, in ERIVANCE BCC and 45.8%/33.3% and 46.9%/28.6%, respectively, in EAS. These differences were not clinically meaningful. Safety was similar in both groups, although those aged ≥65 years had a higher percentage of grade 3-5 adverse events than those aged <65 years. Vismodegib demonstrated similar clinical activity and adverse events regardless of age.

Topics: Age Factors; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Combined Modality Therapy; Female; Hedgehog Proteins; Humans; Male; Middle Aged; Neoplasm Staging; Pyridines; Signal Transduction; Skin Neoplasms; Treatment Outcome

Basal cell carcinoma (BCC) is the most common cancer in humans. Vismodegib, a Hedgehog pathway inhibitor, has proved its effectiveness in treating non-resectable advanced BCC.. However, its action on squamous cell carcinoma (SCC) is unknown. We present three SCC cases developed into BCC in vismodegib-treated patients.. We have described three cases of patients developing SCC during treatment by vismodegib for BCC.. Patient 1 was treated with vismodegib for five facial BCC. Due to the progression of one of the lesions at month 3 (M3), a biopsy was performed and showed SCC. Patient 2 was treated with vismodegib for a large facial BCC. A biopsy was performed at M2 on a BCC area not responding to treatment and showed SCC. Patient 3 was treated with vismodegib for a BCC on the nose. Due to vismodegib ineffectiveness, a biopsy was performed and showed SCC.. Two similar cases have been described in the literature. This could be due to the appearance of the squamous contingent of a metatypical BCC or to the squamous differentiation of stem cells through inhibition of the hedgehog pathway.. In practice, any dissociated response of a BCC to vismodegib should be biopsied.

Topics: Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Facial Neoplasms; Female; Humans; Male; Middle Aged; Neoplasms, Second Primary; Pyridines; Skin Neoplasms

Immunosuppressed patients with solid organ transplants have an increased risk for nonmelanoma skin cancer. Vismodegib has been reported to be effective for select locally advanced or metastatic basal cell carcinomas. However, there is no data documenting the use and safety of vismodegib in immunosuppressed organ transplant patients.. We describe a 78-year-old white man with a history of orthotopic heart transplant, immunosuppressed with low-dose cyclosporine, who presented to a specialty dermatology transplant clinic with multiple, recurrent, locally aggressive facial basal cell carcinomas. Through a multidisciplinary approach, the patient was started on vismodegib therapy. The pharmacokinetics of cyclosporine in the setting of vismodegib administration and weekly monitoring of cyclosporine levels ensured that therapeutic immunosuppression levels were achieved without toxic effects.. To our knowledge, this is the first report that details vismodegib use in an immunosuppressed heart transplant patient receiving cyclosporine therapy. With a growing immunosuppressed organ transplant population at high risk for basal cell carcinoma, therapeutic options for locally advanced or metastatic disease are limited. Vismodegib appears to be a safe option for patients receiving cyclosporine therapy with routine monitoring. Future research is needed to evaluate the safety profile of vismodegib with other immunosuppressive agents.

Topics: Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Cyclosporine; Drug Monitoring; Facial Neoplasms; Heart Transplantation; Humans; Immunocompromised Host; Immunosuppressive Agents; Male; Pyridines; Skin Neoplasms

Topics: Anilides; Biopsy, Needle; Carcinoma, Basal Cell; Epidermal Cyst; Face; Follow-Up Studies; Humans; Immunohistochemistry; Keratosis; Male; Middle Aged; Mohs Surgery; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Nose; Pyridines; Risk Assessment; Skin Neoplasms; Treatment Outcome

Topics: Adult; Aged; Alopecia; Anilides; Antineoplastic Agents; Biphenyl Compounds; Carcinoma, Basal Cell; Female; Hedgehog Proteins; Humans; Male; Middle Aged; Pyridines; Skin Neoplasms

Topics: Adult; Aged, 80 and over; Alopecia; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Chronic Disease; Female; Humans; Male; Middle Aged; Pyridines; Skin Neoplasms

Basal cell carcinomas (BCCs) are tumors ignored by immune surveillance. Activated Hedgehog (Hh) signaling within primary cilia is a key driver in the pathogenesis of BCCs. We examined immune alterations during treatment with systemic Hh inhibitors.. We investigated biopsies from patients with BCC before (23 patients) and after 4 weeks of treatment (5 patients) with Hh signaling inhibitor. Ber-Ep4, BCL-2, Ki-67, CD4, CD8, MHC class I, HLA-DR-class II, and SOX9 were analyzed by immunohistochemistry. Primary cilia were analyzed by double immunofluorescence of acetylated tubulin and SOX9. Differential gene expression for 84 cytokines and chemokines was analyzed in 3 patients.. After 4 weeks of treatment, we found reduction of Ki-67, SOX9, Ber-EP4, and BCL-2 expression in tumors associated with morphologic signs of squamous differentiation. In addition, the number of cilia-positive BCC cells was significantly decreased. An upregulation of MHC I expression on the cell membranes of residual tumor cells and an influx of CD4(+), HLA-DR-class II(+), and CD8(+) cells with invasion into the tumor cell nests were found. Finally, qPCR arrays showed the differential expression of genes involved in modulating immune responses.. We show that Hh pathway inhibitor-induced tumor regression is accompanied by a dynamic change of the microenvironment with a disruption of immune privilege involving an influx of cytotoxic T cells, activation of the adaptive immune functions, and a profound alteration of the local chemokine/cytokine network.

Topics: Adaptive Immunity; Aged; Aged, 80 and over; Anilides; Biopsy; Biphenyl Compounds; Carcinoma, Basal Cell; CD4-Positive T-Lymphocytes; Cilia; Cytokines; Female; Hedgehog Proteins; HLA-DR Antigens; Humans; Lymphocyte Activation; Male; Middle Aged; Pyridines; Receptors, G-Protein-Coupled; Signal Transduction; Skin Neoplasms; Smoothened Receptor; T-Lymphocytes, Cytotoxic

Vismodegib therapy achieves a breakthrough in patients with locally advanced basal cell carcinoma (BCC). Yet, long-term safety of hedgehog pathway inhibitors remains to be established, while drug resistance is becoming a new challenging issue.. We report the case of a 90-year-old male initially referred for a locally advanced BCC of the nose. He had been previously treated by topical 5-fluorouracil for an adjacent microinvasive squamous cell carcinoma (SCC), with complete clinical response. Afterwards, vismodegib was initiated to treat his BCC. At week 16, both tumor and tumor ulceration obviously progressed. Palliative rhinectomy was performed. Histological examination found a deeply invasive SCC.. Although our case must be interpreted with caution, a role of vismodegib as a promoter of cutaneous SCC should be considered, consistently with recently published evidence. Physicians should perform new biopsies whenever in doubt about new and/or progressive skin lesions in patients receiving hedgehog pathway inhibitors.

Topics: Aged, 80 and over; Anilides; Antimetabolites, Antineoplastic; Antineoplastic Agents; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Facial Neoplasms; Fluorouracil; Humans; Male; Nose Neoplasms; Pyridines; Skin Neoplasms

Although hedgehog inhibitor therapy (HHIT) is offered as isolated medical treatment for extensive basal cell carcinoma (BCC), there is little evidence on the use of HHIT before definitive surgical intervention. In order to better define the utilization of HHIT for extensive BCC, we evaluated the impact of neoadjuvant HHIT on the subsequent surgical resection and reconstruction.. An IRB-approved, retrospective chart review was performed of patients who received HHIT as initial treatment for extensive BCC. Patients who discontinued HHIT and underwent surgical resection were included. Evaluation included BCC tumor response to HHIT, operative data, pathological data, radiation requirements, and evidence of tumor recurrence.. Six patients were identified with tumors of the face/scalp (n = 4), trunk (n = 1) and upper extremity (n = 1). Hedgehog inhibitor therapy continued until tumors became unresponsive (n = 3, mean = 71 weeks) or side effects became intolerable (n = 3, mean = 31 weeks). In each case, a less extensive surgery was performed than estimated before HHIT. In 3 cases, significant bone resection was avoided. All resected specimens contained BCC. Four specimens exhibited clear margins. Postoperative radiation was performed in cases with positive margins (n = 2), and 1 patient experienced local recurrence. Length of follow-up was 5.7 to 11.8 months (mean = 8.23 months).. Although HHIT was not curative for extensive BCC, HHIT can decrease the morbidity of surgical treatment and increase the likelihood of curative resection. For patients with extensive BCC, a combined neoadjuvant use of HHIT and surgical treatment should be considered.

Topics: Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Chemotherapy, Adjuvant; Dermatologic Surgical Procedures; Follow-Up Studies; Hedgehog Proteins; Humans; Male; Middle Aged; Neoadjuvant Therapy; Pyridines; Retrospective Studies; Skin Neoplasms; Treatment Outcome

Basal cell carcinoma (BCC), the most common cancer in the U.S.A., is treated primarily with local excision. In some cases, lesion size, location or extent prevent complete resection. Locally advanced BCC responds to systemic therapy with the Hedgehog pathway inhibitor vismodegib, but withdrawal of treatment may result in disease relapse. Here we present a case of locally advanced auricular BCC treated with induction vismodegib and radiation, resulting in durable local control and an acceptable level of acute toxicity.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Combined Modality Therapy; Ear Neoplasms; Hedgehog Proteins; Humans; Male; Middle Aged; Pyridines; Skin Neoplasms

The vismodegib, inhibitor of the hedgehog signaling pathway, is a new therapeutic option in locally advanced BCC when surgery or radiotherapy are inappropriate. If the response rate is high with rapid and sustained efficacy, complete responses are rare. Furthermore, the common side effects may limit continuous and prolonged treatment and lead to discuss sequential treatments. We report two cases that illustrate the severity of LaCBC, tumors neglected by patients and their families limiting therapeutic choice especially surgery that become impossible and for which vismodegib is indicated. These observations illustrate the possible interest of radiotherapy in combination or after tumor debulking by vismodegib. Vismodegib must be known by surgeons for LaCBC, mainly as an alternative beyond surgery but also as a possible neoadjuvant treatment to surgery that have to be evaluated.

Topics: Adult; Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Humans; Male; Pyridines; Radiotherapy, Adjuvant; Skin Neoplasms

Basal cell carcinomas are the most common skin cancers. They are usually localised and carry a good prognosis. There is no standard treatment for the rare patients with metastatic basal cell carcinoma or very extensive basal cell carcinoma for whom surgery or radiotherapy is inappropriate. Vismodegib, a cytotoxic drug, is claimed to prevent tumour growth by inhibiting a pathway involved in tissue repair and embryogenesis. It has been authorised in the European Union for patients with metastatic or locally advanced and extensive basal cell carcinoma. Clinical evaluation of vismodegib is based on a non-comparative clinical trial involving 104 patients, providing only weak evidence. Twenty-one months after the start of the trial, 7 patients with metastases (21%) and 6 patients with advanced basal cell carcinoma (10%) had died. Given the lack of a placebo group, there is no way of knowing whether vismodegib had any effect, positive or negative, on survival. There were no complete responses among patients with metastases, but about one-third of them had partial responses. Among the 63 patients with locally advanced basal cell carcinoma, there were 14 complete responses and 16 partial responses. The recurrence rate in patients with complete responses was not reported. Similar results were reported in two other uncontrolled trials available in mid-2014. Vismodegib has frequent and sometimes serious adverse effects, including muscle spasms, fatigue and severe hyponatraemia. Cases of severe weight loss, alopecia, ocular disorders, other cancers (including squamous cell carcinoma) and anaemia have also been reported. More data are needed on possible hepatic and cardiovascular adverse effects. A potent teratogenic effect was seen in experimental animals. As vismodegib enters semen, contraception is mandatory for both men (condoms) and women. In practice, vismodegib has frequent and varied adverse effects, some of which are serious, while its benefits are poorly documented. Vismodegib should only be proposed to patients in whom basal cell cancer markedly undermines quality of life, and only in the context of clinical research.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Evidence-Based Medicine; Humans; Patient Safety; Pyridines; Risk Assessment; Risk Factors; Skin Neoplasms; Time Factors; Treatment Outcome

Topics: Aged, 80 and over; Anilides; Carcinoma, Basal Cell; Deglutition Disorders; Facial Neoplasms; Female; Humans; Pyridines; Skin Neoplasms

Vismodegib, a hedgehog pathway inhibitor has been recently introduced as an oral therapy for locally advanced and metastatic basal cell carcinoma. Although treatment of patients with basal cell carcinoma with vismodegib has been associated with partial or complete clinical response, it is still unclear if it is also associated with histological cure.. Two patients with 3 large and aggressive basal cell carcinomas were treated with Vismodegib for 6 months. The treatment was followed by Mohs micrographic surgery.. Two tumors disappeared clinically and one was reduced dramatically in its size following treatment with vismodegib. Mohs surgery in all three tumors revealed residual islands of BCC although margins were cleared at the end of surgery.. Neoadjuvant therapy with vismodegib for 6 months prior to Mohs surgery was effective in reducing the size of primary and recurrent aggressive basal cell carcinoma. However, residual tumor nests were found during surgery. Further larger studies are needed to evaluate the efficacy of Vismodegib as a neoadjuvant treatment prior to Mohs surgery.

Topics: Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Humans; Male; Mohs Surgery; Neoadjuvant Therapy; Pyridines; Skin Neoplasms; Treatment Outcome

In this issue of Cancer Cell, two complementary papers by Atwood and colleagues and Sharpe and colleagues show that basal cell carcinomas resistant to the Smoothened (SMO) inhibitor vismodegib frequently harbor SMO mutations that limit drug binding, with mutations at some sites also increasing basal SMO activity.

Topics: Anilides; Carcinoma, Basal Cell; Drug Resistance, Neoplasm; Humans; Pyridines; Receptors, G-Protein-Coupled; Skin Neoplasms; Smoothened Receptor

Smoothened (SMO) inhibitors are under clinical investigation for the treatment of several cancers. Vismodegib is approved for the treatment of locally advanced and metastatic basal cell carcinoma (BCC). Most BCC patients experience significant clinical benefit on vismodegib, but some develop resistance. Genomic analysis of tumor biopsies revealed that vismodegib resistance is associated with Hedgehog (Hh) pathway reactivation, predominantly through mutation of the drug target SMO and to a lesser extent through concurrent copy number changes in SUFU and GLI2. SMO mutations either directly impaired drug binding or activated SMO to varying levels. Furthermore, we found evidence for intra-tumor heterogeneity, suggesting that a combination of therapies targeting components at multiple levels of the Hh pathway is required to overcome resistance.

Topics: Anilides; Binding Sites; Carcinoma, Basal Cell; DNA Copy Number Variations; DNA Mutational Analysis; Drug Resistance, Neoplasm; Exome; Hedgehog Proteins; Humans; Kruppel-Like Transcription Factors; Models, Molecular; Mutation; Nuclear Proteins; Patched Receptors; Protein Structure, Tertiary; Pyridines; Receptors, Cell Surface; Receptors, G-Protein-Coupled; Repressor Proteins; Sequence Analysis, DNA; Skin Neoplasms; Smoothened Receptor; Zinc Finger Protein Gli2

Advanced basal cell carcinomas (BCCs) frequently acquire resistance to Smoothened (SMO) inhibitors through unknown mechanisms. Here we identify SMO mutations in 50% (22 of 44) of resistant BCCs and show that these mutations maintain Hedgehog signaling in the presence of SMO inhibitors. Alterations include four ligand binding pocket mutations defining sites of inhibitor binding and four variants conferring constitutive activity and inhibitor resistance, illuminating pivotal residues that ensure receptor autoinhibition. In the presence of a SMO inhibitor, tumor cells containing either class of SMO mutants effectively outcompete cells containing the wild-type SMO. Finally, we show that both classes of SMO variants respond to aPKC-ι/λ or GLI2 inhibitors that operate downstream of SMO, setting the stage for the clinical use of GLI antagonists.

Topics: Anilides; Binding Sites; Carcinoma, Basal Cell; DNA Mutational Analysis; Drug Resistance, Neoplasm; Exome; Hedgehog Proteins; Humans; Models, Molecular; Mutation; Protein Structure, Tertiary; Pyridines; Receptors, G-Protein-Coupled; Sequence Analysis, DNA; Signal Transduction; Skin Neoplasms; Smoothened Receptor

Vismodegib is a targeted agent recently approved for treating patients who develop recurrent or locally advanced basal cell carcinoma (BCC), and will inevitably be integrated into existing therapy for advanced BCC as it becomes increasingly used. Improved understanding of how vismodegib interacts with other treatment modalities, including radiotherapy, would help optimize multidisciplinary therapy and clinical outcomes.. We report 2 cases of recurrent, advanced BCC treated from April 1, 2012, through October 31, 2014, with concurrent radiotherapy and vismodegib. Concurrent treatment appeared to be well tolerated and efficacious, with both patients having no evidence of progressive disease at last follow-up.. We found that the combination of vismodegib and radiotherapy is feasible for patients with recurrent or locally advanced BCC and that combined use of currently available therapies for advanced BCC warrants further prospective study.

Topics: Aged; Anilides; Carcinoma, Basal Cell; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Prospective Studies; Pyridines; Skin Neoplasms

The small molecule vismodegib is a great treatment alternative to patients challenged, e.g. psychiatric disorders, suffering from severe basal cell carcinoma of the skin in which surgery or other treatment modalities is not possible because of patient's wish or condition. We present a case of a 73-year-old schizophrenic patient with a 15-year history of a neglected tumour located at the forehead and scalp, admitted to hospital in a state of inanition because of tumour expansion to the meninges and severe anaemia caused by bleeding, treated successfully with vismodegib.

Topics: Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Humans; Pyridines; Scalp; Schizophrenia; Skin Neoplasms

To review our experience treating patients with the Hedgehog pathway inhibitor, vismodegib, in patients with orbital or periocular locally advanced or metastatic basal cell carcinoma (BCC) or basal cell nevus syndrome.. Retrospective interventional case series.. We reviewed all patients with locally advanced or metastatic orbital or periocular BCC or basal cell nevus syndrome treated with the Hedgehog pathway inhibitor, vismodegib, at a comprehensive cancer center from 2009 through 2015. Reviewed data included age; sex; American Joint Commission on Cancer tumor, node, metastasis staging system designation; type and grade of drug-related side effects; response to treatment; duration of follow-up, and status at last follow-up.. The study included 10 white men and 2 white women; the median age was 64.5 years. Ten patients had locally advanced BCC; 2 had basal cell nevus syndrome. Among the patients with locally advanced BCC, 5 had T3bN0M0 disease at presentation; 1 each had T3aN0M0, T3bN1M0, T2N1M1, T4N1M1, and T4N2cM1 disease. Overall, 3 patients had a complete response, 6 had a partial response, and 3 had stable disease at last follow-up. Two patients developed progressive disease after a complete response for 38 months and stable disease for 16 months, respectively. All patients developed grade I drug-related adverse effects, most commonly muscle spasms (12 patients), weight loss (10), dysgeusia (9), alopecia (9), decreased appetite (5), and fatigue (4). Five patients developed grade II adverse effects. At last follow-up, none of the 5 patients presenting with T3bN0M0, nor the patient with T3bN1M0 disease, had required orbital exenteration.. Hedgehog pathway inhibition produces a significant clinical response in most patients with locally advanced or metastatic orbital or periocular BCC or basal cell nevus syndrome and can obviate orbital exenteration in some patients. Drug-related adverse effects are manageable in most patients.

Topics: Adult; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Basal Cell Nevus Syndrome; Carcinoma, Basal Cell; Female; Humans; Male; Middle Aged; Pyridines; Retrospective Studies; Skin Neoplasms

Patients with advanced basal cell carcinoma due to local extension or metastatic disease were previously at a therapeutic impasse. Targeted inhibition of the sonic hedgehog pathway by vismodegib represents a new therapeutic strategy. Adnexal carcinomas are rare malignant skin tumours derived from epithelial annexes. Conventional treatment of adnexal tumours is based on surgical excision. Although the radiosensitivity of adnexal carcinomas has not been established, radiotherapy could be offered alone or in combination in locally advanced or inoperable disease. Chemotherapy represents a therapeutic option in the treatment of metastatic adnexal tumours. Currently there is no effective treatment for these tumours when they become metastatic or unresectable, and treatment is palliative. Sunitinib represents a new therapeutic strategy, with efficiency described in the literature for a small number of patients. However, its efficacy is partial, and its tolerance is not always good. We report a patient with trichoblastic carcinoma, initially diagnosed as basal cell carcinoma, treated effectively with vismodegib. The remarkable response we have observed in this patient suggests an encouraging therapeutic role of vismodegib in trichoblastic carcinoma that should be evaluated in a carefully designed trial.

Topics: Adult; Anilides; Antineoplastic Agents; Carcinoma; Carcinoma, Basal Cell; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Multimodal Imaging; Neoplasm Invasiveness; Positron-Emission Tomography; Pyridines; Skin Neoplasms; Treatment Outcome

Vismodegib has been approved for treatment of locally advanced or metastatic basal cell carcinoma (BCC). Its use for postirradiation multiple BCCs has not yet been reported.. We sought to investigate the effectiveness and safety of vismodegib for the treatment of recurrent radiation-induced multiple BCCs.. Patients with recurrent multiple BCCs treated with vismodegib and a history of exposure to radiation treatment were followed up prospectively at a tertiary dermato-oncology clinic during a 19-month period.. Eight patients met the study criteria. Mean duration of vismodegib treatment was 29 weeks (range 2-52), and of follow-up, 34 weeks (range 8-64). Drug tolerability was acceptable in 7 patients, of whom 4 showed a partial response and 3 had stable disease. In 1 patient, vismodegib was discontinued soon after its initiation because of a severe drug-induced eruption.. Small sample size and short follow-up time are limitations.. Vismodegib holds promise for the treatment of the subpopulation of patients with radiation-induced multiple BCCs in whom therapeutic options have so far been limited.

Topics: Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Neoplasms, Multiple Primary; Neoplasms, Radiation-Induced; Pyridines; Scalp; Skin Neoplasms

Topics: Anilides; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; DNA, Neoplasm; Drug Resistance, Neoplasm; Exome; Female; Humans; Lymphatic Metastasis; Middle Aged; Mutation; Pyridines; Sequence Analysis, DNA; Skin Neoplasms

This case series explores the use of vismodegib to treat locally advanced basal cell carcinoma (laBCC), with a focus on tolerability, efficacy, and outcomes after treatment cessation.. Data from patients who underwent vismodegib treatment for laBCC at a single institution from 3/6/2012 through 3/15/2015 was utilized in this study. For all included cases, treatment responses as recorded at the first follow-up after treatment cessation were assessed and are reported as complete clinical response (CCR), partial clinical response (PCR), stable disease, or progressive disease. In cases of CCR, clinical disease free survival (DFS) was calculated as the time from cessation of vismodegib until last available follow-up, death, or recurrence. Data pertaining to side effects and adverse events was also recorded, and results are presented using descriptive statistics.. A total of 24 patients and 31 tumors met inclusion criteria. CCR was observed in 17 of 31 tumors (55%), and 13 of 31 tumors (42%) demonstrated PCR. Stable disease was seen in one patient (one tumor) (3%). No cases demonstrated clinical tumor progression during treatment. The mean clinical DFS at time of data cut off for all cases of CCR was 9.3 months (range 2-21 months). In cases of PCR, the mean reduction in tumor size was 52% (range, 11%-80%). Only two patients (8%) discontinued treatment secondary to side effects.. Each patient and each tumor responds uniquely to vismodegib treatment, including variable tumor responses and a wide range of side effects and tolerability. This study highlights important unique observations, and our data as a whole adds to previously published studies, leading to thought provoking questions. Overall, the FDA approval of vismodegib for advanced basal cell carcinoma has markedly improved the prognosis and care of affected patients.

Topics: Adult; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Cheek; Disease Progression; Disease-Free Survival; Facial Neoplasms; Female; Follow-Up Studies; Forehead; Humans; Male; Middle Aged; Nose; Pyridines; Scalp; Skin Neoplasms; Thorax; Treatment Outcome; Tumor Burden

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Facial Neoplasms; Heart Failure; Humans; Male; Middle Aged; Neoplasms, Second Primary; Photochemotherapy; Pyridines; Skin Neoplasms

A case report of a sharp rise in International Normalized Ratio (INR) values during a patient's concomitant use of warfarin and the antineoplastic agent vismodegib is presented.. About three weeks after he was prescribed vismodegib for skin cancer, a 78-year-old Caucasian man whose INR had been stable during nine months of warfarin use was found to have a critical INR value (9.5) during a visit to a pharmacy anticoagulation clinic. After clinic interventions including brief suspensions of warfarin therapy and an incremental 36% decrease in the weekly dose, the patient's INR returned to a high-normal value over the next few weeks, and treatment with warfarin was resumed. One week later, the man was admitted to the emergency department for altered mental status and loss of consciousness, which were thought to be unrelated to anticoagulation therapy. The patient died in the hospital shortly thereafter of unknown causes. At the time of death, laboratory values were stable, the most recent INR was 1.8, and the patient was hemodynamically stable and on a non-intensive care ward. Assessment with the Drug Interaction Probability Scale indicated a probable interaction between warfarin and vismodegib. Since its introduction in 2012, vismodegib has been implicated as a possible factor in seven reports of patient deaths.. Concurrent use of vismodegib and warfarin was deemed the probable cause of acute INR elevation in this case, suggesting the need for close monitoring of INR values in patients receiving this combination of drugs.

Topics: Aged; Anilides; Anticoagulants; Antineoplastic Agents; Dose-Response Relationship, Drug; Drug Interactions; Drug Monitoring; Humans; International Normalized Ratio; Male; Pyridines; Skin Neoplasms; Warfarin

Topics: Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Neoplasms, Second Primary; Pyridines; Skin Neoplasms

Topics: Administration, Oral; Aged; Anilides; Carcinoma, Basal Cell; Drug Hypersensitivity Syndrome; Female; Follow-Up Studies; Humans; Neoplasm Recurrence, Local; Pyridines; Risk Assessment; Skin Neoplasms

Vismodegib is a Hedgehog signaling pathway inhibitor recently approved by the US Food and Drug Administration for advanced basal cell carcinoma. We present 2 cases of clinically significant squamous cell carcinoma within the tumor bed of locally advanced basal cell carcinoma found during vismodegib treatment.. The first case is that of a patient with locally advanced basal cell carcinoma responsive to vismodegib but with an enlarging papule within the tumor bed. On biopsy, this papule was an invasive acantholytic squamous cell carcinoma. The second case is that of a patient with Gorlin syndrome with a locally advanced basal cell carcinoma that was stable while the patient was receiving therapy with vismodegib for 2.5 years but subsequently increased in size. Biopsy specimens from this tumor showed invasive squamous cell carcinoma, spindle cell subtype. In both cases, the squamous cell carcinomas were surgically resected.. These cases highlight the importance of repeated biopsy in locally advanced basal cell carcinomas in 2 clinical situations: (1) when an area within the tumor responds differentially to vismodegib, and (2) when a tumor stops being suppressed by vismodegib. Timely diagnosis of non-basal cell histologic characteristics is critical to institution of effective therapy.

Topics: Adult; Anilides; Biopsy; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Middle Aged; Neoplasm Staging; Neoplasms, Multiple Primary; Pyridines; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Basal cell carcinomas (BCCs) in patients with Gorlin syndrome have been reported to be extremely sensitive to Smoothened (SMO) inhibitors, a novel targeted therapy against the Hedgehog pathway, because of characteristic mutations in these patients. A few cases of disease refractory to oral therapy with SMO inhibitors have been reported in patients with Gorlin syndrome and nonmetastatic BCCs, but refractory disease in distantly metastatic tumors has not been documented in this high-risk group.. A man with Gorlin syndrome and innumerable cutaneous BCCs presented with biopsy-proven BCC in his lungs. After SMO inhibitor therapy, almost all of his cutaneous tumors shrank, but his lung metastases did not. These lung metastases remained refractory to treatment despite institution of a second SMO inhibitor.. We report a case of Gorlin syndrome in a patient with metastatic BCC refractory to SMO inhibitors. Furthermore, clinical responses in this patient's cutaneous tumors did not parallel the responses in the distant site. However, serial imaging after diagnosis of metastatic disease can be critical to monitor for response to therapy.

Topics: Anilides; Antineoplastic Agents; Basal Cell Nevus Syndrome; Carcinoma, Basal Cell; Drug Resistance, Neoplasm; Humans; Lung Neoplasms; Male; Middle Aged; Pyridines; Receptors, G-Protein-Coupled; Skin Neoplasms; Smoothened Receptor; Treatment Failure; Veratrum Alkaloids

Oral hedgehog inhibitors (HHIs) have shown significant efficacy in the treatment of basal cell carcinoma (BCC). The evaluation of tumor regression has been performed using clinical photography and radiographic scans. Noninvasive imaging techniques, such as reflectance confocal microscopy (RCM) and high-definition optical coherence tomography (HD-OCT), have been shown to be valuable in detecting BCC in the skin.. We monitored HHI-treated BCC using RCM and HD-OCT in vivo and correlated morphologic changes seen on imaging to changes in traditional histopathology.. Six BCCs in 5 patients receiving HHIs (vismodegib or sonidegib) were examined by RCM and HD-OCT before and during treatment. Characteristic features were compared to histopathologic findings, including immunohistochemical analysis.. Characteristic features of BCC in RCM and HD-OCT decreased or disappeared completely during HHI treatment. Half of the clinically complete responding tumors still featured tumor residue. Pseudocystic structures ("empty" tumor nests in imaging) and widespread fibrosis (coarse bright fibers) were new findings and could be confirmed by histopathology.. Our study was limited by the number of tumor samples and imaging timepoints.. Using RCM and HD-OCT, HHI-induced regression of BCC can be visualized noninvasively in the skin. The formation of pseudocysts and fibrosis were characteristic signs of BCC response to HHIs.

Topics: Administration, Oral; Aged; Anilides; Biopsy; Biopsy, Needle; Biphenyl Compounds; Carcinoma, Basal Cell; Cysts; Female; Follow-Up Studies; Germany; Hedgehog Proteins; Humans; Immunohistochemistry; Male; Microscopy, Confocal; Middle Aged; Monitoring, Physiologic; Neoplasm Invasiveness; Neoplasm Staging; Predictive Value of Tests; Prospective Studies; Pyridines; Remission Induction; Sampling Studies; Skin Neoplasms; Tomography, Optical Coherence; Treatment Outcome; Tumor Burden

Topics: Adult; Anilides; Basal Cell Nevus Syndrome; Hair Diseases; Humans; Male; Pyridines; Skin Neoplasms

Vismodegib (GDC-0449, Genentech, USA), a small molecule inhibitor of the Hedgehog signalling pathway, has potent anti-tumour activity in advanced basal cell carcinoma (BCC). We report a case of a 67-year-old Australian man with metastatic BCC including pulmonary disease with malignant effusion who showed a dramatic complete response to vismodegib but subsequently experienced a recurrence of pulmonary disease, indicative of chemoresistance to vismodegib. This case is the first to illustrate chemoresistance in a patient with metastatic BCC, and demonstrates the need for closely monitoring metastatic BCC patients even after an apparently complete response.

Topics: Aged; Anilides; Antineoplastic Agents; Bone Neoplasms; Carcinoma, Basal Cell; Drug Resistance, Neoplasm; Hedgehog Proteins; Humans; Lung Neoplasms; Lymphatic Metastasis; Male; Pyridines; Ribs; Signal Transduction; Skin Neoplasms

Topics: Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; DNA Mutational Analysis; Drug Resistance, Neoplasm; Female; Humans; Neoplasm Recurrence, Local; Pyridines; Receptors, G-Protein-Coupled; Skin Neoplasms; Smoothened Receptor

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Genetic Therapy; Hedgehog Proteins; Humans; Male; Mohs Surgery; Pyridines; Signal Transduction; Skin Neoplasms; Stem Cells; Young Adult

Topics: Adult; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Humans; Pyridines; Skin Neoplasms

Topics: Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Humans; Keratoacanthoma; Male; Middle Aged; Pyridines; Skin Neoplasms; Treatment Outcome

Generally basal cell carcinoma can be simply and curatively treated. However, large and long-standing tumours can be locally very destructive and in rare cases even metastasize. Hedgehog pathway inhibitors such as vismodegib constitute a new and promising therapy for metastatic or locally advanced basal cell carcinoma.. We describe a patient with metastasized basal cell carcinoma and basal cell nevus syndrome who, in the context of a study, was successfully treated with vismodegib. The main undesirable effects in our patient were muscle cramps, loss of taste, nausea and hair loss.. Basal cell carcinoma is potentially a locally destructive skin tumour that only very rarely metastasizes. Hedgehog pathway inhibitors such as vismodegib can be administered in a selected group of patients with basal cell carcinoma.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Female; Hedgehog Proteins; Humans; Middle Aged; Pyridines; Skin Neoplasms; Treatment Outcome

The data and regulatory considerations leading to the U.S. Food and Drug Administration (FDA) January 30, 2012 approval of Erivedge (vismodegib) capsules for the treatment of patients with recurrent, locally advanced, or metastatic basal cell carcinoma (BCC) are described. The FDA's approval decision was based primarily on the results observed in a single-arm, parallel cohort, international trial of vismodegib, administered orally at 150 mg daily until disease progression, in patients with pathologically confirmed, recurrent, locally advanced basal cell carcinoma (laBCC) or metastatic basal cell carcinoma (mBCC). An independent review committee confirmed an overall response rate (ORR) of 30.3% [95% confidence interval (CI): 15.6-48.2] in 33 patients with mBCC and an ORR of 42.9% (95% CI: 30.5-56.0) in 63 patients with laBCC; median response durations were 7.6 months and 7.6 months for patients with mBCC and laBCC, respectively. The most common adverse reactions were muscle spasms, alopecia, dysgeusia, weight loss, fatigue, nausea, diarrhea, decreased appetite, constipation, cough, arthralgias, vomiting, headache, ageusia, insomnia, and upper respiratory tract infection. Animal toxicology studies confirmed that vismodegib is a potent teratogenic agent. Approval was based on durable objective tumor responses supported by knowledge of the pathologic role of Hedgehog signaling in BCC and acceptable toxicity in a population without effective alternative therapies.

Topics: Adolescent; Adult; Aged; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Drug Approval; Female; Humans; Male; Middle Aged; Multicenter Studies as Topic; Neoplasm Recurrence, Local; Pyridines; Skin Neoplasms; United States; United States Food and Drug Administration; Young Adult

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Pyridines; Signal Transduction; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Basal Cell Nevus Syndrome; Drug Resistance, Neoplasm; Head and Neck Neoplasms; Humans; Male; Middle Aged; Neoadjuvant Therapy; Pyridines; Scalp; Skin Neoplasms; Skin Transplantation

Basal cell nevus syndrome (BCNS) has existed at least since Dynastic Egyptian times. In 1960, Gorlin and Goltz first described the classic clinical triad: multiple basal cell carcinomas (BCCs), jaw keratocysts, and bifid ribs. As an autosomal-dominant disorder, it is characterized by tumorigenesis and developmental defects.. To review the current literature on BCNS, including reports on epidemiology, pathogenesis, clinical presentation, diagnostic criteria, management, treatment, and prognosis.. A literature review of currently available articles related to BCNS.. Individuals with a mutation in the tumor suppressor gene PTCH1 are predisposed to tumorigenesis and developmental defects. Clinical features include BCCs, often with onset in adolescence, jaw keratocysts, bifid ribs, craniofacial defects, palmar-plantar pits, and ectopic intracranial calcification. Despite high cure rates for individual lesions and various treatment modalities including excision, Mohs micrographic surgery, photodynamic therapy, and topical imiquimod, management of BCCs is challenging. The development of an oral hedgehog pathway inhibitor, vismodegib, has added a new dimension to current treatment algorithms.. Adolescents and young adults with BCC should be evaluated for BCNS. Early diagnosis of BCNS is critical for possible prevention of the devastating effects of BCCs and establishment of multidisciplinary care.

Topics: Anilides; Antimetabolites, Antineoplastic; Antineoplastic Agents; Basal Cell Nevus Syndrome; Combined Modality Therapy; Fluorouracil; Genes, Tumor Suppressor; Germ-Line Mutation; Humans; Laser Therapy; Patched Receptors; Patched-1 Receptor; Photochemotherapy; Prognosis; Pyridines; Receptors, Cell Surface; Skin Neoplasms

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Male; Middle Aged; Molecular Targeted Therapy; Neoplasm Recurrence, Local; Phenotype; Pyridines; Skin Neoplasms

Basal cell carcinoma (BCC) represents 90% of malignant eyelid tumors and is locally invasive and destructive, if left untreated.. To assess the feasibility of using vismodegib for periocular and orbital BCC based on its efficacy and tolerability.. In this prospective observational case series, consecutive patients with periocular or orbital BCC who met criteria for treatment with vismodegib were recruited prospectively during an 8-month period from February through September 2012 from 2 academic hospitals. Seven patients received oral vismodegib, 150 mg daily, until maximum clinical response was achieved, the tumor progressed, or the patient could no longer tolerate adverse effects. Clinical response and adverse effects related to treatment were recorded. The primary endpoint was reduction in lesion size, measured as percentage change in the externally visible dimension.. Oral vismodegib.. All 7 patients had locally advanced, biopsy-proven, infiltrative BCC that was not amenable to surgical resection or radiation. No patients had metastatic disease at presentation. The mean patient age was 71 years (range, 43-100 years), and 4 patients (57%) had secondary orbital involvement. The mean lesion size was 3.4 cm (range, 1.0-6.0 cm), and all 7 cases (100%) represented recurrent tumors excised previously with controlled margins by frozen section or Mohs micrographic surgery. The mean treatment duration was 11 weeks (range, 4-16 weeks), and the mean duration of follow-up was 7.3 months (range, 5-10 months). Two patients (29%) demonstrated complete clinical regression, 2 (29%) demonstrated greater than 80% partial clinical regression, 2 (29%) demonstrated less than 35% partial clinical regression, and 1 (14%) progressed. Adverse reactions occurred in 6 patients (86%) and included alopecia (29%), dysgeusia (29%), muscle cramps (29%), and anorexia (14%). Two patients (29%) developed new squamous cell carcinomas (well-differentiated, keratoacanthoma type) at uninvolved sites including the eyebrow and forearm.. Vismodegib seems to be well-tolerated and effective for treating periocular and orbital BCC in about half of all cases. Patients receiving treatment should be monitored for new squamous cell carcinomas at uninvolved sites.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Eyelid Neoplasms; Female; Follow-Up Studies; Hedgehog Proteins; Humans; Male; Middle Aged; Orbital Neoplasms; Pilot Projects; Prospective Studies; Pyridines; Skin Neoplasms; Treatment Outcome

Basal cell carcinoma (BCC) is a common skin cancer and its incidence is on the rise worldwide. Clinical presentation and histologic examination are used for diagnosis and to stratify BCCs as either low- or high-risk for recurrence or development of advanced disease. A number of surgical and nonsurgical options are available for BCC. BCC is most often managed with a surgical approach, but not all tumors and patients are suitable for surgery. Vismodegib is a recently approved first-in-class hedgehog pathway inhibitor that has expanded options for patients who have locally advanced or metastatic BCC.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Drug Approval; Humans; Neoplasm Metastasis; Neoplasm Recurrence, Local; Pyridines; Risk Factors; Skin Neoplasms

Vismodegib is the first Hedgehog pathway inhibitor to be approved in the USA, where it is indicated for the treatment of adults with metastatic basal cell carcinoma (BCC), or with locally advanced BCC that has recurred following surgery or who are not candidates for surgery, and who are not candidates for radiation. In an ongoing, noncomparative, phase II trial, oral vismodegib was effective in and had an acceptable tolerability profile in the treatment of patients with locally advanced or metastatic BCC.

Topics: Adult; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Drug Approval; Hedgehog Proteins; Humans; Neoplasm Metastasis; Pyridines; Skin Neoplasms

Topics: Adult; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Contraindications; Drug Interactions; Female; Hedgehog Proteins; Humans; Male; Middle Aged; Pyridines; Skin Neoplasms; Young Adult

Topics: Anilides; Animals; Antineoplastic Agents; Hedgehog Proteins; Humans; Pyridines; Signal Transduction; Skin Neoplasms; United States; United States Food and Drug Administration

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Drug Approval; Humans; Pyridines; Skin Neoplasms; United States; United States Food and Drug Administration

Topics: Anilides; Antineoplastic Agents; Basal Cell Nevus Syndrome; Carcinoma, Basal Cell; Female; Hedgehog Proteins; Humans; Male; Pyridines; Skin Neoplasms

Topics: Administration, Oral; Anilides; Animals; Antineoplastic Agents; Carcinoma, Basal Cell; Drug Approval; Hedgehog Proteins; Humans; Pyridines; Skin Neoplasms; United States; United States Food and Drug Administration

Topics: Anilides; Antineoplastic Agents; Basal Cell Nevus Syndrome; Female; Hedgehog Proteins; Humans; Middle Aged; Neoplasm Recurrence, Local; Pyridines; Skin Neoplasms

Dependence of basal cell carcinomas and medulloblastomas on the Hedgehog pathway provides an opportunity for targeted or "personalized" therapy. The recent effectiveness and FDA approval of the first Smoothened inhibitors validates this class of agents, but has revealed drug-resistant tumor variants that bypass Smoothened inhibition. Here, we summarize the effectiveness of Hedgehog pathway inhibitors and highlight promising areas for the development of next generation drug antagonists for Hedgehog-dependent cancers.

Topics: Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Cerebellar Neoplasms; Drug Resistance, Neoplasm; Hedgehog Proteins; Humans; Medulloblastoma; Pyridines; Receptors, G-Protein-Coupled; Signal Transduction; Skin Neoplasms; Smoothened Receptor; Transcription Factors; Veratrum Alkaloids; Zinc Finger Protein GLI1

Odontogenic keratocysts of the jaw are a central feature of basal cell nevus syndrome (BCNS) and arise from the basal cell layer of the surface epithelium. Although they are benign, they tend to be aggressive, with local invasion of bony structures, extensive growth, and potential for substantial disfigurement and speech dysfunction. Complete surgical resection is the current standard of care; however, the procedures are often technically challenging and are followed by high recurrence rates.. We report the case of a 55-year-old man with a long-standing history of BCNS. Over a 25-year period, this patient had been treated for many basal cell carcinomas (BCCs). He also had multiple large odontogenic keratocysts in the mandible that had previously been treated using surgical, chemotherapeutic, and radiation treatment techniques. He had also undergone a right inguinal lymph node dissection after BCC metastasis was diagnosed within a lymph node. Owing to the recalcitrant nature of his condition and his history of BCC metastasis, the patient was started on a daily regimen of a new oral drug, GDC-0449, which inhibits the hedgehog signaling pathway, a key genetic contributor in the oncogenesis of BCCs. In addition to complete resolution of all his BCCs at 12-week follow-up, nearly complete resolution of 3 odontogenic keratocysts was documented by serial dental radiographs after 2 years of therapy.. We report the nearly complete regression of multiple BCNS-associated odontogenic keratocysts following nonsurgical treatment with GDC-0449. This novel drug, useful for the treatment of BCC, also appears to be effective for treatment of odontogenic keratocysts.

Topics: Anilides; Antineoplastic Agents; Basal Cell Nevus Syndrome; Carcinoma, Basal Cell; Humans; Jaw; Male; Middle Aged; Odontogenic Cysts; Pyridines; Radiography; Skin Neoplasms

With the incidence of nonmelanoma skin cancer on the rise, current prevention methods, such as the use of sunscreens, have yet to prove adequate to reverse this trend. There has been considerable interest in identifying compounds that will inhibit or reverse the biochemical changes required for skin cancers to develop, either by pharmacologic intervention or by dietary manipulation. By targeting different pathways identified as important in the pathogenesis of nonmelanoma skin cancers, a combination approach with multiple agents or the addition of chemopreventative agents to topical sunscreens may offer the potential for novel and synergistic therapies in treating nonmelanoma skin cancer.

Topics: Anilides; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Carotenoids; Cell Transformation, Neoplastic; Cyclooxygenase 2 Inhibitors; Diet, Fat-Restricted; DNA Repair Enzymes; Eflornithine; Flavonoids; Genistein; Humans; Keratosis, Actinic; Lycopene; Phenols; Photochemotherapy; Polyphenols; Pyridines; Retinoids; Skin Neoplasms; Sunscreening Agents; Ultraviolet Rays

Topics: Anilides; Animals; Antineoplastic Agents; Clinical Trials, Phase II as Topic; Drug Approval; Drug Industry; Hedgehog Proteins; Humans; Pyridines; Skin Neoplasms

The Hedgehog (Hh) signaling pathway is critical for cell growth and differentiation during embryogenesis and early development. While it is mostly quiescent in adults, inappropriate reactivation of the Hh pathway has been shown to be involved in the development of cancer. A number of tumor types rely on overexpression of Hh ligands to activate the pathway in a paracrine manner from the tumor to the surrounding stroma. Alternatively, Hh ligands may act on cancer stem cells in some hematopoietic cancers, such as chronic myelogenous leukemia. However, the role of the Hh pathway is best established in tumors, such as basal cell carcinoma and medulloblastoma, where the pathway is activated via mutations. Understanding the contribution of Hh signaling in these various tumor types will be critical to the development and use of agents targeting this pathway in the clinic. We review here the activity of clinical inhibitors of the Hh pathway, including GDC-0449, a small molecule inhibitor of Smoothened (SMO).

Topics: Adult; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Cerebellar Neoplasms; Child; Hedgehog Proteins; Humans; Medulloblastoma; Paracrine Communication; Pyridines; Receptors, G-Protein-Coupled; Signal Transduction; Skin Neoplasms; Smoothened Receptor

Topics: Anilides; Antineoplastic Agents; Benzimidazoles; Carcinoma, Basal Cell; Hedgehog Proteins; Humans; Neoplasms; Patched Receptors; Pyridines; Receptors, Cell Surface; Signal Transduction; Skin Neoplasms

Topics: Adult; Anilides; Animals; Antineoplastic Agents; Benzimidazoles; Brain Neoplasms; Carcinoma, Basal Cell; Drug Resistance, Neoplasm; Hedgehog Proteins; Humans; Male; Medulloblastoma; Mice; Point Mutation; Protein Binding; Pyridines; Receptors, G-Protein-Coupled; Signal Transduction; Skin Neoplasms; Smoothened Receptor