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Bengoa-González A, Mencía-Gutiérrez E, Garrido M, Salvador E, Lago-Llinás MD. Advanced Periocular Basal Cell Carcinoma with Orbital Invasion: Update on Management and Treatment Advances. J Ophthalmol 2024; 2024:4347707. [PMID: 38456099 PMCID: PMC10919982 DOI: 10.1155/2024/4347707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 02/04/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
Purpose Basal cell carcinoma (BCC) is the most frequent malignant periocular tumor. It is associated with exposure to ultraviolet radiation, and its incidence is gradually increasing. It may occasionally display more aggressive behavior and result in orbital or intracranial invasion. Mortality from periocular BBC with orbital invasion is very low, but the associated morbidity can be significant, from disfigurement to blindness. Traditionally, these cases have been treated with orbital exenteration or with radiotherapy (RT), but in recent years, hedgehog pathway inhibitors (HPIs) have emerged, are effective in more serious cases, and are used primarily or combined with surgery, changing our perspective on the management of these patients. Methods We studied 24 cases of periocular BCC with orbital invasion, some primary and others recurrent, which were treated between 2011 and 2021 in the same hospital. All patients had clinical or radiological evidence of orbital invasion. Orbital exenteration was performed on 9/24 of the patients (1 received vismodegib after surgery), and 12/24 were treated, surgically preserving the eyeball, with 3 of them receiving adjuvant vismodegib. Three of the twenty-four patients were treated exclusively with vismodegib (Erivedge®, Genentech). Results One patient died due to poor tumor evolution, but the rest evolved favorably and they have had no recurrences. Vismodegib was generally well tolerated, except for in one patient who discontinued treatment due to the side effects. Conclusions In advanced BBC with orbital invasion, mutilating surgical treatments such as exenteration or potentially vision-threatening treatments such as RT remain as options. In recent years, however, very promising new medical therapies have emerged, such as HPI, which can be used effectively instead of surgery or in combination with it, preserving the eye and vision, which implies a new approach to treatment.
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Affiliation(s)
| | | | - María Garrido
- Pathology Department, 12 de Octubre Hospital, Complutense University, Madrid, Spain
| | - Elena Salvador
- Radiology Department, 12 de Octubre Hospital, Complutense University, Madrid, Spain
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Villani A, Fabbrocini G, Micali G, Fornaro L, Potestio L, Scalvenzi M. The Efficacy of Sonidegib in Treating Locally Advanced Basal Cell Carcinoma Involving the Periocular Area. Dermatol Ther (Heidelb) 2023; 13:2121-2126. [PMID: 37477769 PMCID: PMC10442300 DOI: 10.1007/s13555-023-00985-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Basal cell carcinoma (BCC) is the most common skin malignancy in Caucasians. Globally, about 20% of BCCs involve the periocular region. The treatment of periocular BCC may be very challenging because of its proximity to the intracranial structures. Thus, early diagnosis and early treatment is mandatory. Recently, the introduction of Hedgehog pathway inhibitor therapy revolutionized the management of unresectable BCCs. The aim of our study was to evaluate the outcome of sonidegib treatment in patients affected by periocular locally advanced (la) BCC at our skin cancer center. METHODS A 3-year retrospective study was carried out enrolling patients with periocular laBCC treated with sonidegib. Therapeutic response was defined as complete remission (CR) in case of complete regression of the tumor, partial remission (PR) in case of tumor regression not achieving complete remission, and stable disease (SD). RESULTS A total 16 patients (11 men and 5 women; medium age 71.6 ± 11.5 years) with periocular laBCCs undergoing treatment with 200 mg/day of sonidegib were included in our study. Patients included in the study were treated for at least 6 months for a median duration of 9 months. Overall, CR was reported in 9/16 (56.2%) patients, PR was reported in 4/16 patients (25%), and tumor remained stable in 3 patients (18.8%). No cases of disease progression were collected. Fourteen out of 16 patients experienced multiple adverse events (AEs): dysgeusia was reported in 12 (75%) patients, muscle spasms in 13 (81%) patients, and 7 (43.7%) patients presented with alopecia. However, all of the AEs were mild and none required treatment discontinuation. CONCLUSION To the best of our knowledge, this is the first study investigating the effectiveness and safety of sonidegib in the management of BCC localized at the periocular region. Even if limited, our study suggests this drug as a valuable and safe option in periocular BCC management.
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Affiliation(s)
- Alessia Villani
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini, 5, 80131, Naples, Italy.
| | - Gabriella Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini, 5, 80131, Naples, Italy
| | | | - Luigi Fornaro
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini, 5, 80131, Naples, Italy
| | - Luca Potestio
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini, 5, 80131, Naples, Italy
| | - Massimiliano Scalvenzi
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini, 5, 80131, Naples, Italy
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Nazzaro G, Benzecry V, Mattioli MA, Denaro N, Beltramini GA, Marzano AV, Passoni E. Sonidegib in Locally Advanced Basal Cell Carcinoma: A Monocentric Retrospective Experience and a Review of Published Real-Life Data. Cancers (Basel) 2023; 15:3621. [PMID: 37509282 PMCID: PMC10377077 DOI: 10.3390/cancers15143621] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Basal cell carcinoma (BCC) represents the most common skin cancer and locally advanced BCC (laBCC) refers to an aggressive, large, infiltrative BCC that cannot be treated by surgery or radiotherapy. Sonidegib is a Hedghehog inhibitor (HHi) indicated for laBCC. This is a monocentric retrospective real-life study of laBCCs receiving Sonidegib treatment. Although Sonidegib is widely used, since its approval by Food and Drug Administration in 2015, only a limited number of real-life experiences have been reported. Eleven patients, including four patients diagnosed with Basal Cell Naevus syndrome, received treatment with Sonidegib for laBCCs. Seven (63.6%) patients experienced adverse events (AEs) but only three had to discontinue treatment and were therefore excluded from the following results. Four patients (50%) achieved complete clinical remission (CR); in all cases the remission was confirmed by biopsy. Partial response (PR) was found in three patients out of eight (37.5%). One patient out of eight (12.5%) showed a steady disease (SD). None of the patients showed signs of progression during treatment with HHi. Sonidegib showed the same efficacy in treating laBCCs as already seen in trials. All four patients suffering from Basal Cell Naevus syndrome achieved disease control by being treated with Sonidegib. Consequently, we strongly advise the joint management of laBCCs through a multidisciplinary team whenever feasible.
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Affiliation(s)
- Gianluca Nazzaro
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Valentina Benzecry
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maria A Mattioli
- Department of Physiopathology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Nerina Denaro
- Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giada A Beltramini
- Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Physiopathology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Emanuela Passoni
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Tiosano A, Ben-Ishai M, Fenig E, Ben Simon GJ, Yassur I. The initial rate of tumour response to vismodegib treatment, can predict a complete response outcome for periocular LA-BCC. Eye (Lond) 2023; 37:531-536. [PMID: 35210571 PMCID: PMC9905569 DOI: 10.1038/s41433-022-01982-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/09/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE 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 (ErivedgeTM), a sonic hedgehog inhibitor. DESIGN Subgroup analysis of data from the STEVIE study database. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Alon Tiosano
- Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Meydan Ben-Ishai
- Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Fenig
- Davidoff Center for Oncology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy J Ben Simon
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iftach Yassur
- Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kopecky A, Rokohl AC, Gaca PJ, Matos PAW, Nemcansky J, Heindl LM. Clinical Signs for Differential Diagnosis of Eyelid Tumours. Klin Monbl Augenheilkd 2023; 240:13-23. [PMID: 36706766 DOI: 10.1055/a-1996-0950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This article aims to present the differential diagnostics of benign and malignant eyelid tumours. The most common malignant eyelid tumour is basal cell carcinoma, followed by squamous cell carcinoma. The common signs of malignity are loss of lashes, ulceration, and infiltration of the lesion. Often the clinical appearance is various and therefore only a histological analysis gives the proper diagnosis. For most tumours, surgical resection is the gold standard of therapy. The reconstruction of the defects should be performed by an experienced oculoplastic surgeon. In malignant tumours that require large safety margins, the defect can be easily very large, and the reconstruction must then be performed with advanced ophthalmic plastic reconstruction techniques.
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Affiliation(s)
- Adam Kopecky
- Ophthalmology Clinic, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.,Department of Craniofacial Surgery, University of Ostrava Faculty of Medicine, Olomouc, Czech Republic
| | | | - Piotr Jakub Gaca
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | | | - Jan Nemcansky
- Ophthalmology Clinic, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Craniofacial Surgery, University of Ostrava Faculty of Medicine, Ostrava, Czech Republic
| | - Ludwig M Heindl
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.,Center for Integrated Oncology (CIO) - Aachen - Bonn - Cologne - Düsseldorf, Cologne, Germany
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Effective systemic treatment of advanced periocular basal cell carcinoma with sonidegib. Graefes Arch Clin Exp Ophthalmol 2021; 259:3821-3822. [PMID: 34338845 PMCID: PMC8589764 DOI: 10.1007/s00417-021-05311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022] Open
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Yuksel N. Letter to the editor: Effective treatment of locally advanced periocular basal cell carcinoma with oral hedgehog pathway inhibitor. Graefes Arch Clin Exp Ophthalmol 2021; 259:3819. [PMID: 34292393 DOI: 10.1007/s00417-021-05310-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 06/20/2021] [Accepted: 07/02/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Nilay Yuksel
- Ophthalmology Department, Ophthalmic Plastic Surgery Service, Ankara City Hospital, Ankara, Turkey.
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Tarantino V, Zavattaro E, Veronese F, Gironi LC, Savoia P. Rapid and exceptional response to Sonidegib in a patient with multiple locally advanced basal cell carcinomas. Anticancer Drugs 2021; 32:465-468. [PMID: 33534224 PMCID: PMC7952046 DOI: 10.1097/cad.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/11/2021] [Indexed: 12/03/2022]
Abstract
Locally advanced basal cell carcinoma (laBCC) represents a rare but possible occurrence in the vast scenario of dermatological diseases. It is well known that most BCC has a pathological activation of the hedgehog pathway, making them susceptible to targeted therapy with selective inhibitors. Sonidegib, approved for the treatment of laBCC on the basis of the results of the basal cell carcinoma outcomes with LDE225 treatment study, demonstrated rapid efficacy and a manageable safety profile. Here, we describe the case of a patient affected by multiple laBCC treated with Sonidegib. The patient experienced an important regression of tumors after only 2 months of therapy, with few side effects. This result confirms the role of Sonidegib as a valid and well-tolerated therapeutic option for laBCC.
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Affiliation(s)
| | - Elisa Zavattaro
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
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Abstract
Introduction: Basal cell carcinoma (BCC) is the most frequent skin malignancy, with incidence increasing worldwide. Most BCC can be cured with local treatments (surgery or topical therapies), but advanced or recurrent forms require specific therapies. Significant developments targeting the sonic hedgehog signalization pathway have been made in the past years, paving the way for new therapies.Areas covered: This review details emerging drugs for BCC treatment, focusing on topical, intra-tumoral, and systemic therapies, such as new targeted therapies and immune checkpoint inhibitors. A literature search was conducted to identify ongoing studies using PudMed database and clinicaltrials.gov website.Expert opinion: Although surgery is and will probably remain the gold-standard therapy for BCC, treatment of recurrent, advanced, and metastatic tumors is evolving. Emergence of tumors resistant to targeted therapies lead the way to new approaches. Topical and intra-tumoral treatments represent alternatives to surgical morbidity, and many studies are ongoing. The first results of immune checkpoint inhibitors are encouraging in advanced and metastatic forms of the disease. New targeted therapies are needed to overcome or prevent the resistance to standard hedgehog pathway inhibitors.
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Affiliation(s)
- Florian Herms
- Department of Dermatology, Université De Paris, Hôpital Saint-Louis, Paris, France
| | - Nicole Basset-Seguin
- Department of Dermatology, Université De Paris, Hôpital Saint-Louis, Paris, France
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Villani A, Cinelli E, Fabbrocini G, Lallas A, Scalvenzi M. Hedgehog inhibitors in the treatment of advanced basal cell carcinoma: risks and benefits. Expert Opin Drug Saf 2020; 19:1585-1594. [PMID: 33054455 DOI: 10.1080/14740338.2020.1837773] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION 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. AREAS COVERED 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. EXPERT OPINION 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.
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Affiliation(s)
- Alessia Villani
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy
| | - Eleonora Cinelli
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy
| | - Gabriella Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University , Thessaloniki, Greece
| | - Massimiliano Scalvenzi
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy
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