1
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Farberg AS, Portela D, Sharma D, Kheterpal M. Evaluation of the Tolerability of Hedgehog Pathway Inhibitors in the Treatment of Advanced Basal Cell Carcinoma: A Narrative Review of Treatment Strategies. Am J Clin Dermatol 2024:10.1007/s40257-024-00870-3. [PMID: 38896403 DOI: 10.1007/s40257-024-00870-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/21/2024]
Abstract
Hedgehog pathway inhibitors (HHIs) have broadened the treatment options available for patients with advanced basal cell carcinoma (BCC) for whom traditional therapeutic approaches are not feasible or effective. Sonidegib and vismodegib are oral HHIs that were approved for treatment of patients with advanced BCC after demonstrating promising efficacy in the pivotal Phase II BOLT (NCT01327053) and ERIVANCE (NCT00833417) trials, respectively. However, the incidence and types of treatment-emergent adverse events (AEs) observed with these agents may limit continuous use of HHIs and ultimately impact clinical outcomes. In this review, we summarize the safety and tolerability profiles of sonidegib and vismodegib and discuss potential management strategies for HHI class-effect AEs, including muscle spasms, creatine phosphokinase increase, alopecia, and dysgeusia. These AEs primarily occur early in treatment and can lead to treatment discontinuation. Differences in the pharmacokinetic profiles of sonidegib and vismodegib may contribute to the variability noted in times to onset and resolution of these and other AEs. Evidence suggests that protocol modifications, such as treatment interruptions and dose reductions, are effective ways to manage AEs while maintaining disease control. Nonpharmacologic and pharmacologic interventions may also be considered as part of an AE management strategy. Overall, healthcare providers and patients with advanced BCC should be aware of the HHI class-effect AEs and plan effective management strategies to avoid treatment discontinuation and optimize therapeutic response.
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Affiliation(s)
- Aaron S Farberg
- Section of Dermatology, Baylor Scott & White Health System, Dallas, TX, USA.
- Bare Dermatology, 2110 Research Row, Dallas, TX, 75235, USA.
| | | | - Divya Sharma
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Meenal Kheterpal
- Department of Dermatology, Duke Health, Duke University, Durham, NC, USA
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2
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Sarin KY, Bradshaw M, O'Mara C, Shahryari J, Kincaid J, Kempers S, Tu JH, Dhawan S, DuBois J, Wilson D, Horwath P, de Souza MP, Powala C, Kochendoerfer GG, Plotkin SR, Webster GF, Le LQ. Effect of NFX-179 MEK inhibitor on cutaneous neurofibromas in persons with neurofibromatosis type 1. SCIENCE ADVANCES 2024; 10:eadk4946. [PMID: 38691597 PMCID: PMC11062565 DOI: 10.1126/sciadv.adk4946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/28/2024] [Indexed: 05/03/2024]
Abstract
This phase 2a trial investigated the efficacy of NFX-179 Topical Gel, a metabolically labile MEK inhibitor, in the treatment of cutaneous neurofibromas (cNFs) in neurofibromatosis type 1. Forty-eight participants were randomized to four treatment arms: NFX-179 Topical Gel 0.05%, 0.15%, and 0.5% or vehicle applied once daily to five target cNFs for 28 days. Treatment with NFX-179 Topical Gel resulted in a dose-dependent reduction in p-ERK levels in cNFs at day 28, with a 47% decrease in the 0.5% NFX-179 group compared to the vehicle (P = 0.0001). No local or systemic toxicities were observed during the treatment period, and systemic concentrations of NFX-179 remained below 1 ng/ml. In addition, 20% of cNFs treated with 0.5% NFX-179 Topical Gel showed a ≥50% reduction in volume compared to 6% in the vehicle group by ruler measurement with calculated volume (P = 0.021). Thus, NFX-179 Topical Gel demonstrated significant inhibition of MEK in cNF with excellent safety and potential therapeutic benefit.
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Affiliation(s)
- Kavita Y. Sarin
- Department of Dermatology, Stanford University Medical Center, Stanford, CA, USA
| | | | | | | | | | | | - John H. Tu
- Skin Search of Rochester, Inc., Rochester, NY, USA
| | - Sunil Dhawan
- Center for Dermatology Clinical Research Inc., Fremont, CA, USA
| | | | - David Wilson
- The Education and Research Foundation Inc., Lynchburg, VA, USA
| | | | | | | | | | | | | | - Lu Q. Le
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Dermatology, University of Virginia School of Medicine, Charlottesville, VA, USA
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3
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Groover M, Gupta N, Granger E, Forrester VJ, Anstadt EJ, Su W, Heusinkveld L, Chen A, Lukens JN, Silk AW, Vidimos AT, Schoenfeld JD, Koyfman SA, Ruiz ES. A multicenter real-world analysis of risk factors, therapeutics, and outcomes of patients with metastatic basal cell carcinoma. J Am Acad Dermatol 2024; 90:545-551. [PMID: 37949119 DOI: 10.1016/j.jaad.2023.10.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/12/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Metastatic basal cell carcinoma (mBCC) is rare and there are limited data regarding patient and tumor risk factors, optimal treatments, and disease prognosis. OBJECTIVE To assess patient and tumor characteristics, therapeutics, and outcomes of mBCC stratified by location of metastasis. METHODS Retrospective cohort study of 53 patients with mBCC treated at 4 large academic centers in Boston, Massachusetts; Philadelphia, Pennsylvania; and Cleveland, Ohio between January 1, 2005 and December 31, 2021. RESULTS A total of 53 patients with mBCC were identified across 4 centers, 22 (42%) of whom had mBCC with spread limited to lymph nodes and 31 (58%) patients with distant organ spread (with or without lymph node involvement). Overall, half (n = 11) of patients with nodal metastasis achieved complete remission of disease, compared with just 1 (3%) patient with distant metastasis. The 5-year survival for nodal and distant metastatic patients was 89.3% and 61.0%, respectively. LIMITATIONS Small sample size due to disease rarity. CONCLUSIONS AND RELEVANCE Patients with nodal disease are more likely to have disease remission whereas patients with distant metastasis are more likely to have persistent disease and die from their disease. However, 5-year survival rates exceed 50%, even for stage IV disease.
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Affiliation(s)
- Morgan Groover
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neha Gupta
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily Granger
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vernon J Forrester
- Department of Dermatology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Emily J Anstadt
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Su
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren Heusinkveld
- Department of Dermatology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Anna Chen
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John N Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ann W Silk
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Allison T Vidimos
- Department of Dermatology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Emily S Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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4
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Sen M, Demirci H, Honavar SG. Targeted therapy in ophthalmic oncology: The current status. Asia Pac J Ophthalmol (Phila) 2024; 13:100062. [PMID: 38642707 DOI: 10.1016/j.apjo.2024.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/22/2024] Open
Abstract
There have been rapid advancements in the field of ocular oncology for the diagnosis and management of intraocular, adnexal, and orbital tumors. Targeted therapy is in the forefront of medical research in all fields including ocular oncology. Targeted therapy include drugs that target specific genetic mutations, pathways or proteins involved in the development of cancer. In contrast to traditionally used chemotherapy, drugs used in targeted therapy are highly specific for tumor cells and preserve the function of normal cells. This review aims to familiarize ophthalmologists with the drugs that are currently approved or undergoing clinical trials for use in ocular oncology. Targeted therapy is particularly useful for locally advanced or metastatic tumors, including but not limited to eyelid and periocular basal cell carcinoma, periocular cutaneous and conjunctival squamous cell carcinoma, ocular adnexal lymphoma, conjunctival melanoma, and uveal melanoma. The results are promising with improved survival outcomes and better tolerability than chemotherapeutic drugs.
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Affiliation(s)
- Mrittika Sen
- Ocular Oncology Service, Raghunath Netralaya, Mumbai, India
| | - Hakan Demirci
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Santosh G Honavar
- Ocular Oncology Service, Centre for Sight Eye Hospital, Hyderabad, India.
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5
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Queirolo P, Cinquini M, Argenziano G, Bassetto F, Bossi P, Boutros A, Clemente C, de Giorgi V, Del Vecchio M, Patuzzo R, Peris K, Quaglino P, Reali A, Zalaudek I, Spagnolo F. Guidelines for the diagnosis and treatment of basal cell carcinoma: a GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology. ESMO Open 2023; 8:102037. [PMID: 37879235 PMCID: PMC10598491 DOI: 10.1016/j.esmoop.2023.102037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023] Open
Abstract
Basal cell carcinoma (BCC) is the most common form of cancer, with a high impact on the public health burden and social costs. Despite the overall prognosis for patients with BCC being excellent, if lesions are allowed to progress, or in a small subset of cases harboring an intrinsically aggressive biological behavior, it can result in local spread and significant morbidity, and conventional treatments (surgery and radiotherapy) may be challenging. When a BCC is not amenable to either surgery or radiotherapy with a reasonable curative intent, or when metastatic spread occurs, systemic treatments with Hedgehog inhibitors are available. These guidelines were developed, applying the GRADE approach, on behalf of the Italian Association of Medical Oncologists (AIOM) to assist clinicians in treating patients with BCC. They contain recommendations with regard to the diagnosis, treatment and follow-up, from primitive tumors to those locally advanced or metastatic, addressing the aspects of BCC management considered as priorities by a panel of experts selected by AIOM and other national scientific societies. The use of these guidelines in everyday clinical practice should improve patient care.
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Affiliation(s)
- P Queirolo
- Division of Melanoma, Sarcomas and Rare Tumors, European Institute of Oncology, Milan
| | - M Cinquini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - G Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples
| | - F Bassetto
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, Padua
| | - P Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia
| | - A Boutros
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa
| | - C Clemente
- UO SMEL-2, Surgical Pathology, Department of Pathology and Laboratory Medicine, IRCCS-Policlinico San Donato, Milan
| | - V de Giorgi
- Dermatology Unit, Azienda USL Toscana Centro, Florence; Section of Dermatology, Department of Health Sciences, University of Florence, Florence
| | - M Del Vecchio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - R Patuzzo
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Melanoma and Sarcoma Unit, Milan
| | - K Peris
- Dermatology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - P Quaglino
- Department of Medical Sciences, Clinic of Dermatology, University of Turin, Turin
| | - A Reali
- Radiation Oncology Department, Michele e Pietro Ferrero Hospital, Verduno
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste
| | - F Spagnolo
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa; Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy.
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6
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Berl A, Shir-az O, Genish I, Biran H, Mann D, Singh A, Wise J, Kravtsov V, Kidron D, Golberg A, Vitkin E, Yakhini Z, Shalom A. Exploring multisite heterogeneity of human basal cell carcinoma proteome and transcriptome. PLoS One 2023; 18:e0293744. [PMID: 37948379 PMCID: PMC10637653 DOI: 10.1371/journal.pone.0293744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/18/2023] [Indexed: 11/12/2023] Open
Abstract
Basal cell carcinoma (BCC) is the most common type of skin cancer. Due to multiple, potential underlying molecular tumor aberrations, clinical treatment protocols are not well-defined. This study presents multisite molecular heterogeneity profiles of human BCC based on RNA and proteome profiling. Three areas from lesions excised from 9 patients were analyzed. The focus was gene expression profiles based on proteome and RNA measurements of intra-tumor heterogeneity from the same patient and inter-tumor heterogeneity in nodular, infiltrative, and superficial BCC tumor subtypes from different patients. We observed significant overlap in intra- and inter-tumor variability of proteome and RNA expression profiles, showing significant multisite heterogeneity of protein expression in the BCC tumors. Inter-subtype analysis has also identified unique proteins for each BCC subtype. This profiling leads to a deeper understanding of BCC molecular heterogeneity and potentially contributes to developing new sampling tools for personalized diagnostics therapeutic approaches to BCC.
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Affiliation(s)
- Ariel Berl
- Department of Plastic Surgery, Meir Medical Center, Kfar Sava, Israel, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Shir-az
- Department of Plastic Surgery, Meir Medical Center, Kfar Sava, Israel, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilai Genish
- Efi Arazi School of Computer Science, Reichman University, Herzliya, Israel
| | - Hadas Biran
- Department of Computer Science, Technion - Israel Institute of Technology, Haifa, Israel
| | - Din Mann
- Department of Plastic Surgery, Meir Medical Center, Kfar Sava, Israel, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amrita Singh
- Department of Environmental Studies, Porter School of Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Julia Wise
- Department of Environmental Studies, Porter School of Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Vladimir Kravtsov
- Department of Pathology, Meir Medical Center, Kfar Sava, Israel, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Debora Kidron
- Department of Pathology, Meir Medical Center, Kfar Sava, Israel, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Golberg
- Department of Environmental Studies, Porter School of Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Edward Vitkin
- Efi Arazi School of Computer Science, Reichman University, Herzliya, Israel
| | - Zohar Yakhini
- Efi Arazi School of Computer Science, Reichman University, Herzliya, Israel
- Department of Computer Science, Technion - Israel Institute of Technology, Haifa, Israel
| | - Avshalom Shalom
- Department of Plastic Surgery, Meir Medical Center, Kfar Sava, Israel, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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7
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Albayati A, Özkan B, Tepeoğlu M, Uysal ÇA. Giant Basal Cell Carcinoma Causing Axillary Contracture: A Case Report of an Unusual Localization of an Advanced Case. Ann Dermatol 2023; 35:S211-S214. [PMID: 38061706 PMCID: PMC10727880 DOI: 10.5021/ad.21.044] [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: 04/28/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 12/20/2023] Open
Abstract
Basal cell carcinoma (BCC) is the most common type of non-melanoma skin cancer. Although BCC arises most commonly in sun-exposed areas of the body, such as the head and neck, it infrequently can be seen in sun-protected parts as well. Axilla is one of the least encountered areas of BCC. Delay in the diagnosis or management alongside negligence of the patient can lead to a tumor reaching a giant size. We report a case of giant axillary BCC in a 59-years old female patient with no known risk factors for skin cancers. The tumor was excised with wide margins, and the tissue defect was reconstructed with latissimus dorsi musculocutaneous flap. A 3-year follow-up did not show any sign of recurrence or metastasis.
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Affiliation(s)
- Abbas Albayati
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University Faculty of Medicine, Ankara, Turkey.
| | - Burak Özkan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Merih Tepeoğlu
- Department of Clinical Pathology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Çağrı A Uysal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University Faculty of Medicine, Ankara, Turkey
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8
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Dessinioti C, Stratigos AJ. Immunotherapy and Its Timing in Advanced Basal Cell Carcinoma Treatment. Dermatol Pract Concept 2023; 13:dpc.1304a252. [PMID: 37992360 PMCID: PMC10656142 DOI: 10.5826/dpc.1304a252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 11/24/2023] Open
Abstract
For patients with advanced basal cell carcinoma (BCC), including locally advanced or metastatic BCC not amenable to curative surgery or radiotherapy, hedgehog pathway inhibitors (HHI) vismodegib and sonidegib are approved as first-line systemic treatment. Results from clinical trials highlight that the overall discontinuation rate of HHI treatment varies from 88% to 92% with vismodegib and is approximately 92% with sonidegib, and half of patients will discontinue HHI after approximately 8 to 12 months. The main factors weighing in on the decision to discontinue HHI include efficacy (tumor response), adverse events and patient decision. In clinical practice, some of the patients that stop HHI may be re-evaluated if the tumor becomes amenable to surgery, or restart HHI at a later time, while others will need to switch to immunotherapy, depending on the reasons for HHI discontinuation. In this review, we revisit the therapeutic decisions considering a switch from HHI to immunotherapy with anti-PD-1 agent cemiplimab and we highlight the place of cemiplimab in the therapeutic ladder for patients with advanced BCC. We discuss the evidence on the efficacy and safety of anti-PD-1 agents as second-line systemic monotherapy, or in combination with other treatments, and the emergence of checkpoint immunotherapy as a neoadjuvant treatment.
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Affiliation(s)
- Clio Dessinioti
- Skin Cancer and Melanoma Unit, 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Alexander J Stratigos
- Skin Cancer and Melanoma Unit, 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
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9
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Ruiz-Salas V, Podlipnik S, Sandoval-Clavijo A, Sanmartin-Jiménez O, Bernia-Petit E, Bonfill-Ortí M, Bassas-Freixas P, Yebenes-Marsal M, Flórez-Menéndez Á, Solá-Ortigosa J, Just-Sarobé M, Aguayo-Ortiz R, Masferrer I Niubó E, Quintana-Codina M, Deza G, Jaka A, Fuentes MJ, Cañueto J, Toll A. Real-World Experience with Vismodegib on Advanced and Multiple BCCs: Data from the RELIVIS Study. Dermatology 2023; 239:685-693. [PMID: 37257423 DOI: 10.1159/000530813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 04/11/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND 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. OBJECTIVES 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. METHODS 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. RESULTS 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%. CONCLUSION 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.
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Affiliation(s)
- Verónica Ruiz-Salas
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Sebastian Podlipnik
- Hospital Clinic of Barcelona, Dermatology Department, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Alejandra Sandoval-Clavijo
- Hospital Clinic of Barcelona, Dermatology Department, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Eduardo Bernia-Petit
- Dermatology Department, Instituto Valenciano de Oncología (IVO), Valencia, Spain
| | - Montserrat Bonfill-Ortí
- Dermatology Department, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Patricia Bassas-Freixas
- Dermatology Department, Hospital Universitari Vall d´Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Mireia Yebenes-Marsal
- Dermatology Department, Hospital Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | - Ángeles Flórez-Menéndez
- Dermatology Department, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | - Miquel Just-Sarobé
- Dermatology Department, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Rafael Aguayo-Ortiz
- Dermatology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | | | - Gustavo Deza
- Dermatology Department, Hospital del Mar, Barcelona, Spain
| | - Ane Jaka
- Dermatology Department, Hospital Universitari Germans Trias I Pujol, Autonomous University of Barcelona, Barcelona, Spain
| | - Maria José Fuentes
- Dermatology Department, Hospital Universitari Germans Trias I Pujol, Autonomous University of Barcelona, Barcelona, Spain
| | - Javier Cañueto
- Dermatology Department, Hospital Universitario de Salamanca, Barcelona, Spain
| | - Agustí Toll
- Hospital Clinic of Barcelona, Dermatology Department, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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10
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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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11
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Di Brizzi EV, Argenziano G, Brancaccio G, Scharf C, Ronchi A, Moscarella E. The current clinical approach to difficult-to-treat basal cell carcinomas. Expert Rev Anticancer Ther 2023; 23:43-56. [PMID: 36579630 DOI: 10.1080/14737140.2023.2161517] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Basal cell carcinoma (BCC) is the most common malignant tumor in adult white populations. If BCCs are not treated for years, if they cause massive destruction of the surrounding tissues, if they are considered unresectable or not eligible for radiotherapy they become progressively 'locally advanced' (laBCC) or metastatic (mBCC). These tumors are defined as 'difficult-to-treat BCC.' AREAS COVERED A comprehensive search on PubMed was conducted to identify relevant literature about the several approved and recommended treatment options for the management of difficult-to-treat BCC published from January 2012 to July 2022. Surgical options, radiotherapy, hedgehog inhibitors, immunotherapy, and combined treatments are discussed. The keywords used were basal cell carcinoma; difficult-to-treat BCC; management of difficult-to-treat BCC; surgical therapy; radiotherapy; hedgehog inhibitors; immunotherapy. EXPERT OPINION Identifying the best approach to DTT BCCs is one of the main challenges for the dermato-oncologist. The introduction of HHI for the treatment of advanced BCCs has revolutionized the clinical management of DTT BCCs. The immune checkpoint inhibitor cemiplimab has been approved for the treatment of locally advanced or metastatic BCC refractory to HHI therapy or in patients intolerant to HHI therapy. Multidisciplinary teams (MDTs) play a key role in managing these complex patients.
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Affiliation(s)
| | | | | | - Camila Scharf
- Dermatology Unit, University of Campania, Naples, Italy
| | - Andrea Ronchi
- Pathology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
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12
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The role of Hedgehog and Notch signaling pathway in cancer. MOLECULAR BIOMEDICINE 2022; 3:44. [PMID: 36517618 PMCID: PMC9751255 DOI: 10.1186/s43556-022-00099-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/25/2022] [Indexed: 12/23/2022] Open
Abstract
Notch and Hedgehog signaling are involved in cancer biology and pathology, including the maintenance of tumor cell proliferation, cancer stem-like cells, and the tumor microenvironment. Given the complexity of Notch signaling in tumors, its role as both a tumor promoter and suppressor, and the crosstalk between pathways, the goal of developing clinically safe, effective, tumor-specific Notch-targeted drugs has remained intractable. Drugs developed against the Hedgehog signaling pathway have affirmed definitive therapeutic effects in basal cell carcinoma; however, in some contexts, the challenges of tumor resistance and recurrence leap to the forefront. The efficacy is very limited for other tumor types. In recent years, we have witnessed an exponential increase in the investigation and recognition of the critical roles of the Notch and Hedgehog signaling pathways in cancers, and the crosstalk between these pathways has vast space and value to explore. A series of clinical trials targeting signaling have been launched continually. In this review, we introduce current advances in the understanding of Notch and Hedgehog signaling and the crosstalk between pathways in specific tumor cell populations and microenvironments. Moreover, we also discuss the potential of targeting Notch and Hedgehog for cancer therapy, intending to promote the leap from bench to bedside.
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13
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Hooiveld-Noeken JS, Eggen AC, Rácz E, de Vries EG, Reyners AK, Jalving M. Towards less mutilating treatments in patients with advanced non-melanoma skin cancers by earlier use of immune checkpoint inhibitors. Crit Rev Oncol Hematol 2022; 180:103855. [DOI: 10.1016/j.critrevonc.2022.103855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/28/2022] [Accepted: 10/12/2022] [Indexed: 11/24/2022] Open
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14
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Heppt MV, Gebhardt C, Hassel JC, Alter M, Gutzmer R, Leiter U, Berking C. Long-Term Management of Advanced Basal Cell Carcinoma: Current Challenges and Future Perspectives. Cancers (Basel) 2022; 14:cancers14194547. [PMID: 36230474 PMCID: PMC9559463 DOI: 10.3390/cancers14194547] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/04/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Local therapies are no longer an option for locally advanced basal cell carcinoma. Abnormal activation of the hedgehog signaling pathway leads to uncontrolled tumor growth. Hedgehog pathway inhibitors are an effective treatment option for this kind of tumor. However, treatment-related toxicity under long-term treatment may lead to limitations in quality of life, and thus to therapy interruption or even discontinuation. This review summarizes pertinent treatment adjustments and novel therapeutic strategies for effective treatment of locally advanced basal cell carcinoma. Abstract The first-line therapy for locally advanced basal cell carcinoma (laBCC) is Hedgehog pathway inhibitors (HHIs), as they achieve good efficacy and duration of response. However, toxicity in the course of long-term treatment may lead to a decrease in the quality of life, and consequently to interruption or even discontinuation of therapy. As HHI therapy is a balancing act between effectiveness, adverse events, quality of life, and adherence, numerous successful treatment strategies have evolved, such as dose reduction and dose interruptions with on-off treatment schedules or interruptions with re-challenge after progression. As a small percentage of patients show primary or acquired resistance to HHIs, the inhibition of programmed cell death protein 1 (PD-1) has been approved as a second-line therapy, which may also be accompanied by immune-related toxicities and non-response. Thus, optimization of current treatment schedules, novel agents, and combination strategies are urgently needed for laBCC. Here, we narratively model the treatment sequence for patients with laBCC and summarize the current state of approved treatment regimens and therapeutic strategies to optimize the long-term management of laBCC.
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Affiliation(s)
- Markus V. Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), 91054 Erlangen, Germany
- Correspondence:
| | - Christoffer Gebhardt
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - Jessica C. Hassel
- Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, 69120 Erlangen, Germany
| | - Mareike Alter
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, 32423 Minden, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, 32423 Minden, Germany
| | - Ulrike Leiter
- Department of Dermatology, Eberhard-Karls-University Tuebingen, 72076 Tuebingen, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), 91054 Erlangen, Germany
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15
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Canonical Hedgehog Pathway and Noncanonical GLI Transcription Factor Activation in Cancer. Cells 2022; 11:cells11162523. [PMID: 36010600 PMCID: PMC9406872 DOI: 10.3390/cells11162523] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 01/12/2023] Open
Abstract
The Hedgehog signaling pathway is one of the fundamental pathways required for development and regulation of postnatal regeneration in a variety of tissues. The pathway has also been associated with cancers since the identification of a mutation in one of its components, PTCH, as the cause of Basal Cell Nevus Syndrome, which is associated with several cancers. Our understanding of the pathway in tumorigenesis has expanded greatly since that initial discovery over two decades ago. The pathway has tumor-suppressive and oncogenic functions depending on the context of the cancer. Furthermore, noncanonical activation of GLI transcription factors has been reported in a number of tumor types. Here, we review the roles of canonical Hedgehog signaling pathway and noncanonical GLI activation in cancers, particularly epithelial cancers, and discuss an emerging concept of the distinct outcomes that these modes have on cancer initiation and progression.
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16
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Ge W, Chen CI, Wu N, Fury MG, Ruiz E, Jalbert JJ. Hedgehog pathway inhibitor real-world treatment patterns in patients with basal cell carcinoma: a claims-based analysis. Future Oncol 2022; 18:2561-2572. [PMID: 35735026 DOI: 10.2217/fon-2022-0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To examine real-world treatment patterns for Hedgehog pathway inhibitors (HHIs) for the treatment of advanced basal cell carcinoma. Patients & methods: HHI initiators between January 2013 and June 2019 were identified from IBM MarketScan® claims data. Time to treatment discontinuation and reinitiation were estimated using Kaplan-Meier methods using a 60-day grace period. Results: Among 526 patients with basal cell carcinoma who initiated an HHI, median time to first discontinuation was 144 days, and risk of discontinuation by 12 months was 88.0%. Probability of reinitiation within 12 months was 19.7%, and median time to second discontinuation was 118 days. Conclusion: HHI discontinuation was common and reinitiation uncommon in clinical practice. Future research should evaluate persistence with recently approved therapies.
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Affiliation(s)
- Wenzhen Ge
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Chieh-I Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Ning Wu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Matthew G Fury
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Emily Ruiz
- Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02130, USA
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17
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Verkouteren BJA, Sinx KAE, Reinders MGHC, Aarts MJB, Mosterd K. Update on Hedgehog Pathway Inhibitor Therapy for Patients with Basal Cell Naevus Syndrome or High-frequency Basal Cell Carcinoma. Acta Derm Venereol 2022; 102:980. [PMID: 35535645 PMCID: PMC9631257 DOI: 10.2340/actadv.v102.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Some patients with basal cell carcinoma develop a large number of basal cell carcinomas during their lives. The most common underlying genetic disease that causes multiple basal cell carcinomas is basal cell naevus syndrome. Basal cell naevus syndrome is caused by a germline mutation in patched-1 (PTCH1), a tumour suppressor gene of the hedgehog signalling pathway. However, in a significant portion of patients with multiple basal cell carcinomas, no underlying genetic cause is found. Nevertheless, these patients can experience a treatment burden comparable to that of patients with basal cell naevus syndrome. They are referred to as high-frequency basal cell carcinoma patients. Hedgehog pathway inhibitors were the first group of targeted therapy for basal cell carcinomas. This study reviews the literature on hedgehog pathway inhibitor therapy for patients with basal cell naevus syndrome and high-frequency basal cell carcinoma, to provide an overview on efficacy, safety, dosing regimens, tumour resistance and reoccurrence, and health-related quality of life.
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Affiliation(s)
- Babette J A Verkouteren
- Department of Dermatology, Maastricht University Medical Center+, P. Debyelaan 25, NL-6229 HX Maastricht, The Netherlands.
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18
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Cowey L, Chen CI, Aguilar KM, Davies K, LaFontaine PR, Fury MG, Bowler T, Golozar A, Jalbert JJ. Real-World Treatment Patterns and Outcomes Among Patients with Basal Cell Carcinoma Following First-Line Hedgehog Inhibitor Discontinuation. Dermatol Ther (Heidelb) 2022; 12:1211-1224. [PMID: 35507216 PMCID: PMC9110576 DOI: 10.1007/s13555-022-00724-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/02/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Until recently, patients discontinuing first-line (1L) hedgehog inhibitors (HHIs) for basal cell carcinoma (BCC) had few subsequent treatment options. The objective of this study was to describe the treatment journey and prognosis of patients discontinuing 1L HHI for BCC. METHODS This was a retrospective cohort study of patients with BCC who discontinued 1L HHI treatment in The US Oncology Network between 1 January 2012 and 1 January 2019 (with follow-up until 1 May 2020). Two cohorts were identified: patients who initiated a second-line (2L) treatment (2L initiators), and patients with 1L progression or toxicity without pathology-confirmed complete response who did not initiate 2L treatment (2L non-initiators). Patient demographics, treatment characteristics, and outcomes are reported for each cohort. RESULTS Among 115 patients with BCC who received 1L HHI treatment, 63.5% (n = 73/115) discontinued 1L HHIs. Of those, 50.7% (n = 37/73) discontinued because of documented toxicity or progression, without evidence of a complete response. We identified 4 patients who initiated 2L systemic treatment (median age 68.7 years, 100.0% female) and 15 patients who were eligible for the 2L non-initiator cohort (median age 80.2 years, 20.0% female). Median 1L HHI duration was 6.8 months (range 1.9-20.6 months) for the 2L non-initiator cohort and 8.6 months (range 6.8-42.2 months) for 2L initiators. At the end of follow-up, among 2L non-initiators (median follow-up duration 9.7 months), 40.0% were lost to follow-up, 33.3% had died, 20.0% continued observation, and 6.7% transitioned to an academic medical center or hospital; among 2L initiators (median follow-up duration 6.3 months), 50.0% were lost to follow-up, 25.0% had died, and 25.0% continued observation. CONCLUSIONS Following 1L HHI discontinuation, lack of standardized care and suboptimal outcomes were observed, including limited receipt of 2L treatment. Further studies are necessary to evaluate the impact of newer BCC treatment options.
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Affiliation(s)
- Lance Cowey
- Texas Oncology-Baylor Charles A. Sammons Cancer Center, Dallas, TX, USA
| | - Chieh-I Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA.
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19
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Elleson KM, DePalo DK, Zager JS. An update on local and systemic therapies for non-melanoma skin cancer. Expert Rev Anticancer Ther 2022; 22:479-489. [PMID: 35412413 DOI: 10.1080/14737140.2022.2065987] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Nonmelanoma skin cancers (NMSC) as a group exceed the incidence of all other malignancies combined. NMSC includes basal cell carcinoma, squamous cell carcinoma, and Merkel cell carcinoma. As the incidence continues to rise, it is important to appreciate the available treatment options. AREAS COVERED This article discusses the treatment of NMSC though surgical, topical, regional, and systemic modalities. EXPERT OPINION As there are many treatment options available for these diseases, selection of the appropriate method can be difficult. With time, we expect treatment decisions to become even more complex and personalized. The role of systemic immunotherapies and neoadjuvant therapies in the treatment of NMSC is still not well defined. Local treatment with intralesional injections and isolated limb infusion may prove to be promising alternative therapies.
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Affiliation(s)
- Kelly M Elleson
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
| | | | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
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20
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Yurchenko AA, Pop OT, Ighilahriz M, Padioleau I, Rajabi F, Sharpe HJ, Poulalhon N, Dreno B, Khammari A, Delord M, Alberti A, Soufir N, Battistella M, Mourah S, Bouquet F, Savina A, Besse A, Mendez-Lopez M, Grange F, Monestier S, Mortier L, Meyer N, Dutriaux C, Robert C, Saiag P, Herms F, Lambert J, de Sauvage FJ, Dumaz N, Flatz L, Basset-Seguin N, Nikolaev SI. Frequency and Genomic Aspects of Intrinsic Resistance to Vismodegib in Locally Advanced Basal Cell Carcinoma. Clin Cancer Res 2022; 28:1422-1432. [PMID: 35078858 PMCID: PMC9365352 DOI: 10.1158/1078-0432.ccr-21-3764] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/03/2021] [Accepted: 01/20/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE 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. EXPERIMENTAL DESIGN 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). RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Andrey A. Yurchenko
- INSERM U981, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Oltin T. Pop
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - Ismael Padioleau
- INSERM U981, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Fatemeh Rajabi
- INSERM U981, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | | | - Nicolas Poulalhon
- Service de dermatologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Brigitte Dreno
- Department of Dermato-Oncology, CHU Nantes, Nantes Université, CIC 1413, Inserm UMR 1302/EMR6001 INCIT, F-44000 Nantes, France
| | - Amir Khammari
- Department of Dermato-Oncology, CHU Nantes, Nantes Université, CIC 1413, Inserm UMR 1302/EMR6001 INCIT, F-44000 Nantes, France
| | - Marc Delord
- Université de Paris, Hôpital Saint-Louis, Paris, France.,Department of Population Health Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | | | - Maxime Battistella
- INSERM U976, Hôpital Saint-Louis, Paris, France.,Université de Paris, Hôpital Saint-Louis, Paris, France.,Service d'anatomie pathologique, Hôpital Saint-Louis, Claude Vellefaux, Paris, France
| | - Samia Mourah
- INSERM U976, Hôpital Saint-Louis, Paris, France.,Université de Paris, Hôpital Saint-Louis, Paris, France.,Département de Génomique des Tumeurs Solides, Hôpital Saint-Louis, Claude Vellefaux, Paris, France
| | | | | | - Andrej Besse
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Max Mendez-Lopez
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Florent Grange
- Service de dermatologie, CHU Reims, Rue du general Koenig, Reims, France.,Service de Dermatologie, centre hospitalier de Valence, Valence, France
| | | | - Laurent Mortier
- Service de dermatologie, CHU Lille, Clin Dermato Hop Huriez, Rue Michel Polonovski, Lille, France
| | - Nicolas Meyer
- Service de dermatologie, Institut Univeristaire du Cancer et CHU de Toulouse, Hôpital Larrey, Toulouse, France
| | | | - Caroline Robert
- INSERM U981, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France.,Department of Medical Oncology, Gustave Roussy and Paris-Saclay University, Villejuif, France
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré hospital, APHP, and EA 4340 “Biomarkers in Cancerology and Hemato-oncology,” UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Florian Herms
- Service de dermatologie, Hôpital Saint-Louis, Paris, France
| | - Jerome Lambert
- Université de Paris, Hôpital Saint-Louis, Paris, France.,Service de Biostatistique et Information Médicale, Hôpital Saint-Louis, Paris, France
| | | | | | - Lukas Flatz
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Nicole Basset-Seguin
- INSERM U976, Hôpital Saint-Louis, Paris, France.,Université de Paris, Hôpital Saint-Louis, Paris, France.,Service de dermatologie, Hôpital Saint-Louis, Paris, France.,Corresponding Authors: Sergey I. Nikolaev, U981 INSERM, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94800 Villejuif, France. Phone: 33-142115775; E-mail: ; and Nicole Basset-Seguin, Service de dermatologie, unité d'oncodermatologie, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010 Paris. Phone: 33-153722066; Fax: 33-142355310; E-mail:
| | - Sergey I. Nikolaev
- INSERM U981, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France.,Corresponding Authors: Sergey I. Nikolaev, U981 INSERM, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94800 Villejuif, France. Phone: 33-142115775; E-mail: ; and Nicole Basset-Seguin, Service de dermatologie, unité d'oncodermatologie, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010 Paris. Phone: 33-153722066; Fax: 33-142355310; E-mail:
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21
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Słowińska M, Dudzisz – Śledź M, Sobczuk P, Łasińska I, Pieruszka A, Cybulska – Stopa B, Kowalczyk A, Świtaj T, Czarnecka I, Koseła‐Paterczyk H, Rogala P, Paluchowska E, Składowski K, Mackiewicz J, Rutkowski P, Owczarek W. Analysis of efficacy and safety of vismodegib therapy in patients with advanced basal cell carcinoma ‐ real world multicenter cohort study. J Eur Acad Dermatol Venereol 2022; 36:1219-1228. [PMID: 35279879 PMCID: PMC9541446 DOI: 10.1111/jdv.18070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Affiliation(s)
- M. Słowińska
- Department of Dermatology Military Institute of Medicine Warsaw Poland
| | - M. Dudzisz – Śledź
- Department of Soft Tissue/Bone Sarcoma and Melanoma Maria Skłodowska‐Curie National Research Institute of Oncology Warsaw Poland
| | - P. Sobczuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma Maria Skłodowska‐Curie National Research Institute of Oncology Warsaw Poland
- Department of Experimental and Clinical Physiology Laboratory of Centre for Preclinical Research Medical University of Warsaw Warsaw Poland
| | - I. Łasińska
- Department of Medical and Experimental Oncology Heliodor Święcicki Clinical Hospital Poznań University of Medical Sciences Poznań Poland
- Department of Nursing Faculty of Medicine and Health Sciences Collegium Medicum University of Zielona Góra Zielona Góra Poland
| | - A. Pieruszka
- 1st Radiation and Clinical Oncology Department Maria Skłodowska‐Curie National Research Institute of Oncology Gliwice Branch Gliwice Poland
| | - B. Cybulska – Stopa
- Clinical Oncology Department Maria Skłodowska‐Curie National Research Institute of Oncology Cracow Branch Cracow Poland
| | - A. Kowalczyk
- Department of Oncology and Radiotherapy Medical University of Gdańsk Gdańsk Poland
| | - T. Świtaj
- Department of Soft Tissue/Bone Sarcoma and Melanoma Maria Skłodowska‐Curie National Research Institute of Oncology Warsaw Poland
| | - I. Czarnecka
- Department of Dermatology Military Institute of Medicine Warsaw Poland
| | - H Koseła‐Paterczyk
- Department of Soft Tissue/Bone Sarcoma and Melanoma Maria Skłodowska‐Curie National Research Institute of Oncology Warsaw Poland
| | - P. Rogala
- Department of Soft Tissue/Bone Sarcoma and Melanoma Maria Skłodowska‐Curie National Research Institute of Oncology Warsaw Poland
| | - E. Paluchowska
- Department of Dermatology Military Institute of Medicine Warsaw Poland
| | - K. Składowski
- 1st Radiation and Clinical Oncology Department Maria Skłodowska‐Curie National Research Institute of Oncology Gliwice Branch Gliwice Poland
| | - J. Mackiewicz
- Department of Medical and Experimental Oncology Heliodor Święcicki Clinical Hospital Poznań University of Medical Sciences Poznań Poland
- Department of Diagnostics and Cancer Immunology Greater Poland Cancer Centre Poznań Poland
| | - P. Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma Maria Skłodowska‐Curie National Research Institute of Oncology Warsaw Poland
| | - W. Owczarek
- Department of Dermatology Military Institute of Medicine Warsaw Poland
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22
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Sekulic A, Yoo S, Kudchadkar R, Guillen J, Rogers G, Chang ALS, Guenthner S, Raskin B, Dawson K, Mun Y, Chu L, McKenna E, Lacouture M. Real-world assessment and treatment of locally advanced basal cell carcinoma: Findings from the RegiSONIC disease registry. PLoS One 2022; 17:e0262151. [PMID: 35030185 PMCID: PMC8759646 DOI: 10.1371/journal.pone.0262151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/16/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Limited information is available regarding real-world treatment patterns and their effectiveness and safety in patients with locally advanced basal cell carcinoma, including patients not typically represented in clinical trials. The purpose of the current study was to describe how clinicians diagnose and treat locally advanced basal cell carcinoma in the United States. METHODS This prospective, multicenter, observational registry study included patients with newly diagnosed, Hedgehog pathway inhibitor-naive locally advanced basal cell carcinoma without basal cell carcinoma nevus syndrome (n = 433) treated at 75 US academic and community practices, including dermatology, Mohs surgery, and medical oncology sites. The main outcomes of this study were treatment patterns and associated effectiveness and safety for patients with locally advanced basal cell carcinoma in real-world settings. RESULTS Determination of locally advanced basal cell carcinoma was mainly based on lesion size (79.6% of patients), histopathology (54.3%), extent of involvement (49.0%), and location (46.2%). Within 90 days of determination of locally advanced disease, 115 patients (26.6%) received vismodegib, 251 (58.0%) received surgery/other (non-vismodegib) treatment, and 67 (15.5%) had not yet received treatment (observation). Vismodegib-treated patients had a higher prevalence of high-risk clinical features predictive for locoregional recurrence than those with non-vismodegib treatment or observation. Clinical response rate was 85.1% with vismodegib and 94.9% with non-vismodegib treatment (primarily surgery). The most common adverse events with vismodegib were ageusia/dysgeusia, muscle spasms, alopecia, and weight loss. Rates of cutaneous squamous cell cancers were comparable between vismodegib and non-vismodegib treatment. CONCLUSIONS This prospective observational study offers insight on real-world practice, treatment selection, and outcomes for a nationally representative sample of US patients with locally advanced basal cell carcinoma. For patients with lesions that were not amenable to surgery, vismodegib treatment was associated with effectiveness and safety that was consistent with that observed in clinical trials.
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Affiliation(s)
- Aleksandar Sekulic
- Dermatology, Mayo Clinic, Scottsdale, Arizona, United States of America
- * E-mail:
| | - Simon Yoo
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Ragini Kudchadkar
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Julie Guillen
- UCSF Dermatology and Laser Surgery Center, University of California, San Francisco, California, United States of America
| | - Gary Rogers
- Surgical Dermatology, Tufts New England Medical Center, Boston, Massachusetts, United States of America
| | - Anne Lynn S. Chang
- Dermatology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Scott Guenthner
- Dermatology Center of Indiana/Indiana Clinical Trials Center, Plainfield, Indiana, United States of America
| | - Bernard Raskin
- Dermatology, UCLA School of Medicine, Los Angeles, California, United States of America
| | - Keith Dawson
- Medical Affairs, Genentech, South San Francisco, California, United States of America
| | - Yong Mun
- Biostatistics, Genentech, South San Francisco, California, United States of America
| | - Laura Chu
- Oncology, Genentech, South San Francisco, California, United States of America
| | - Edward McKenna
- Medical Affairs, Genentech, South San Francisco, California, United States of America
| | - Mario Lacouture
- Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
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Damsin T, Lebas E, Marchal N, Rorive A, Nikkels AF. Cemiplimab for locally advanced and metastatic basal cell carcinoma. Expert Rev Anticancer Ther 2022; 22:243-248. [PMID: 35175882 DOI: 10.1080/14737140.2022.2043748] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Locally advanced basal cell carcinoma (laBCC) represents approximatively 1% of all BCCs. Metastatic BCC (mBCC) is even more rare. Most cases are observed in immunocompromised patients, particularly solid organ transplant recipients (OTRs). When surgery and/or radiation therapy for laBCC or mBCC is not reasonable, oral hedgehog inhibitor (HHI) therapy may be initiated. LaBCC or mBCC patients with primary or secondary resistance, progression or intolerance to HHIs could benefit from programmed cell death protein-1 (PD-1) inhibitors as this has recently been published for cemiplimab, a recombinant IgG4 human monoclonal antibody anti-PD-1 for the intravenous treatment of laBCC and mBCC. AREAS COVERED Principal studies evaluating the efficacy and safety of cemiplimab for laBCC and mBCC are presented and discussed. EXPERT OPINION Cemiplimab is the first FDA (2021) approved anti-PD-1 antagonist for the systemic treatment of laBCC and mBCC which had previously shown disease progression on or intolerance to HHIs. Experts currently recommend cemiplimab as a first-line systemic alternative. As cemiplimab therapy is associated with a risk of organ graft rejection, advantages and disadvantages should be evaluated for every individual OTR patient with laBCC or mBCC, eligible for cemiplimab therapy.
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Affiliation(s)
- Thomas Damsin
- Department of Dermatology, Skin Cancer Center, University Hospital Centre, CHU du Sart Tilman, Liège, BELGIUM
| | - Eve Lebas
- Department of Dermatology, Skin Cancer Center, University Hospital Centre, CHU du Sart Tilman, Liège, BELGIUM
| | - Nathalie Marchal
- Department of Medical Oncology, Skin Cancer Center, University Hospital Centre, CHU du Sart Tilman, Liège, BELGIUM
| | - Andrée Rorive
- Department of Medical Oncology, Skin Cancer Center, University Hospital Centre, CHU du Sart Tilman, Liège, BELGIUM
| | - Arjen F Nikkels
- Department of Dermatology, Skin Cancer Center, University Hospital Centre, CHU du Sart Tilman, Liège, BELGIUM
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Vismodegib improves quality of life in patients with periocular locally advanced basal cell carcinoma: subgroup analysis, STEVIE trial. Eye (Lond) 2022; 36:407-413. [PMID: 33692538 PMCID: PMC8807711 DOI: 10.1038/s41433-021-01493-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/20/2021] [Accepted: 02/23/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES 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. METHODS 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). RESULTS 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. CONCLUSIONS 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.
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25
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Non-Surgical Treatments for Keratinocyte Carcinomas. Adv Ther 2021; 38:5635-5648. [PMID: 34652721 DOI: 10.1007/s12325-021-01916-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
Skin cancer is the most common malignancy worldwide, comprising approximately 30% of all human tumors. In recent decades, the incidence of keratinocyte carcinomas, which include basal cell carcinoma and cutaneous squamous cell carcinoma, has been steadily increasing globally (Rogers et al. in JAMA Dermatol 151(10):1081-1086. https://doi.org/10.1001/jamadermatol.2015.1187 , 2015; Nehal and Bichakjian in N Engl J Med 379(4):363-374. https://doi.org/10.1056/nejmra1708701 , 2018). Most tumors are cured with surgical excision; however, some tumors are best treated with non-surgical approaches. Superficial tumors can often be cured with non-surgical methods whereas more advanced stage tumors may not be amenable to surgery. Additionally, surgical treatment may not be available for all populations depending on geographic location and accessibility to care. This article reviews commonly utilized nonsurgical options such as cryotherapy, photodynamic therapy, topical treatments, and radiation as well as systemic treatments including immunotherapies and chemotherapies.
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26
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Bassompierre A, Dalac S, Dreno B, Neidhardt EM, Maubec E, Capelle C, Andre F, Behal H, Dziwniel V, Bens G, Leccia MT, Meyer N, Granel-Brocard F, Beylot-Barry M, Dereure O, Basset-Seguin N, Mortier L. Efficacy of sonic hedgehog inhibitors rechallenge, after initial complete response in recurrent advanced basal cell carcinoma: a retrospective study from the CARADERM database. ESMO Open 2021; 6:100284. [PMID: 34689002 PMCID: PMC8551849 DOI: 10.1016/j.esmoop.2021.100284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/12/2021] [Accepted: 09/22/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Smoothened (SMO) inhibitors, blocking the sonic hedgehog pathway, have been approved for advanced basal cell carcinoma (aBCC). Safety analyses reveal a high rate of adverse events (AEs) and, most of the time, vismodegib is most commonly stopped when the best overall response is reached. The long-term evolution of aBCC after vismodegib discontinuation is poorly described. The aim of this study is to evaluate the efficacy and safety of the SMO inhibitors (SMOis) available (vismodegib and sonidegib) following rechallenge after complete response (CR) following an initial treatment by vismodegib. MATERIALS AND METHODS This real-life, retrospective, multicenter and descriptive study is based on an extraction from the CARADERM accredited database, including 40 French regional hospitals, of patients requiring BCC systemic treatment. RESULTS Of 303 patients treated with vismodegib, 110 achieved an initial CR. The vast majority of these patients (98.2%) stopped vismodegib, notably due to poorly tolerated AEs. The CARADERM database provided a median follow-up of 21 months (13.5-36.0 months) after CR. Of the 110 patients, 48.1% relapsed after a median relapse-free survival of 24 months (13.0-38.0 months). Among them, 35 patients were retreated by an SMOi and the overall response rate was 65.7% (34.3% of CR and 31.4% of partial response). The median duration of retreatment was 6.0 months (4.0-9.5 months). CONCLUSION Our real-life study, carried out on patients with complex clinical pictures, shows that after treatment discontinuation, 48.1% of patients achieved CR relapse within an average of 24 months (13.0-38.0 months). It emphasized that even though rechallenge can be considered as a therapeutic option, efficacy seems to decrease, suggesting the development of resistance mechanisms.
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Affiliation(s)
- A Bassompierre
- Department of Dermatology, Lille University, CHU Lille, Lille, France.
| | - S Dalac
- Department of Dermatology, Dijon University Hospital, Dijon, France
| | - B Dreno
- Department of Dermatology, Dieu Hospital, Nantes, France
| | - E M Neidhardt
- Department of Dermatology, Léon Bérard Center, Lyon, France
| | - E Maubec
- Department of Dermatology, AP-HP, Avicenne University Hospital, Bobigny, France
| | - C Capelle
- Department of Dermatology, Lille University, CHU Lille, Lille, France
| | - F Andre
- Department of Dermatology, Lille University, CHU Lille, Lille, France
| | - H Behal
- Health Technology and Medical Practice Assessment, ULR 2694-METRICS, Lille University Hospital, University of Lille, Lille, France
| | - V Dziwniel
- Department of Dermatology, Lille University, CHU Lille, Lille, France; Languages Department, Centrale Lille Institut, Villeneuve d'Ascq, France
| | - G Bens
- Department of Dermatology, Orleans Regional Hospital, Orleans, France
| | - M T Leccia
- Department of Dermatology, Grenoble University Hospital, Grenoble, France
| | - N Meyer
- Department of Dermatology, IUC and CHU de Toulouse, Toulouse, France
| | - F Granel-Brocard
- Department of Dermatology, Nancy University Hospital, Nancy, France
| | - M Beylot-Barry
- Department of Dermatology, Bordeaux University Hospital, Bordeaux, France
| | - O Dereure
- Department of Dermatology, University of Montpellier, Montpellier, France
| | - N Basset-Seguin
- Department of Dermatology, Saint-Louis Hospital, AP-HP, Paris University Hospital, Paris, France
| | - L Mortier
- Department of Dermatology, Lille University, CHU Lille, Lille, France; INSERM U1189, CARADERM, CHU Lille, Lille, France
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27
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Tong J, Mitchell B, Roth K, Logan D, Ernst S. Real-World Experience of Vismodegib in Advanced Basal Cell Carcinoma at a Canadian Cancer Center. J Cutan Med Surg 2021; 26:143-148. [PMID: 34663118 DOI: 10.1177/12034754211051234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Vismodegib is a novel Hedgehog pathway inhibitor that has revolutionized the treatment of patients with advanced basal cell carcinoma (BCC) who are poor candidates for surgery or radiation. Few studies have explored the use of vismodegib to facilitate further surgery or radiotherapy, and the optimal treatment duration to balance outcomes with adverse effects. OBJECTIVES To characterize the disease response, progression, and recurrence outcomes of BCC patients, and to report the impact of subsequent therapies. METHODS We performed a retrospective study of 46 adult patients with advanced basal cell carcinoma (aBCC), including both locally advanced (laBCC) and metastatic (mBCC) disease, treated with vismodegib at a single center from 2012 to 2019. RESULTS Thirty-six had laBCC, and 10 had mBCC. Treatment was given over a mean of 21.9 months. Twenty-three (50%) had a complete response (CR), and 19 (41.3%) achieved partial response (PR). Median time to maximal response was 5.3 months. Eleven (23.9%) had resected disease at median 17.2 months, and 11 patients (23.9%) received radiotherapy. Thirty-two (69.6%) experienced progressive disease after achievement of CR or PR. Among 17 CR patients, who stopped treatment, 14 (82.3%) experienced subsequent relapse; 6 (85%) attained a repeat response. Twenty (43.5%) discontinued treatment at least once due to adverse effects. CONCLUSIONS With a response rate of 91%, London Regional Cancer Center's (LRCP)'s experience with vismodegib supports its effectiveness in treatment of aBCC. Moreover, a significant number of patients treated with vismodegib became amenable to surgery or radiotherapy. Toxicity remained an important factor that limited treatment duration.
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Affiliation(s)
- Justin Tong
- 70384 Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Brandon Mitchell
- 70384 Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Kathryn Roth
- 70384 Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, ON, Canada
| | - Diane Logan
- 70384 Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, ON, Canada
| | - Scott Ernst
- 70384 Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, ON, Canada
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Leiter-Stöppke U, Mohr P, Gutzmer R. Update - Systemtherapie beim Basalzellkarzinom. J Dtsch Dermatol Ges 2021; 19:1399-1400. [PMID: 34541806 DOI: 10.1111/ddg.14599_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Chai JY, Sugumar V, Alshawsh MA, Wong WF, Arya A, Chong PP, Looi CY. The Role of Smoothened-Dependent and -Independent Hedgehog Signaling Pathway in Tumorigenesis. Biomedicines 2021; 9:1188. [PMID: 34572373 PMCID: PMC8466551 DOI: 10.3390/biomedicines9091188] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 12/22/2022] Open
Abstract
The Hedgehog (Hh)-glioma-associated oncogene homolog (GLI) signaling pathway is highly conserved among mammals, with crucial roles in regulating embryonic development as well as in cancer initiation and progression. The GLI transcription factors (GLI1, GLI2, and GLI3) are effectors of the Hh pathway and are regulated via Smoothened (SMO)-dependent and SMO-independent mechanisms. The SMO-dependent route involves the common Hh-PTCH-SMO axis, and mutations or transcriptional and epigenetic dysregulation at these levels lead to the constitutive activation of GLI transcription factors. Conversely, the SMO-independent route involves the SMO bypass regulation of GLI transcription factors by external signaling pathways and their interacting proteins or by epigenetic and transcriptional regulation of GLI transcription factors expression. Both routes of GLI activation, when dysregulated, have been heavily implicated in tumorigenesis of many known cancers, making them important targets for cancer treatment. Hence, this review describes the various SMO-dependent and SMO-independent routes of GLI regulation in the tumorigenesis of multiple cancers in order to provide a holistic view of the paradigms of hedgehog signaling networks involving GLI regulation. An in-depth understanding of the complex interplay between GLI and various signaling elements could help inspire new therapeutic breakthroughs for the treatment of Hh-GLI-dependent cancers in the future. Lastly, we have presented an up-to-date summary of the latest findings concerning the use of Hh inhibitors in clinical developmental studies and discussed the challenges, perspectives, and possible directions regarding the use of SMO/GLI inhibitors in clinical settings.
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Affiliation(s)
- Jian Yi Chai
- School of Biosciences, Faculty of Health & Medical Sciences, Taylor’s University, 1 Jalan Taylors, Subang Jaya 47500, Malaysia; (J.Y.C.); (P.P.C.)
| | - Vaisnevee Sugumar
- School of Medicine, Faculty of Health & Medical Sciences, Taylor’s University, 1 Jalan Taylors, Subang Jaya 47500, Malaysia;
| | | | - Won Fen Wong
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | - Aditya Arya
- School of Biosciences, Faculty of Science, Building 184, The University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Pei Pei Chong
- School of Biosciences, Faculty of Health & Medical Sciences, Taylor’s University, 1 Jalan Taylors, Subang Jaya 47500, Malaysia; (J.Y.C.); (P.P.C.)
- Centre for Drug Discovery and Molecular Pharmacology (CDDMP), Faculty of Health & Medical Sciences, Taylor’s University, 1 Jalan Taylors, Subang Jaya 47500, Malaysia
| | - Chung Yeng Looi
- School of Biosciences, Faculty of Health & Medical Sciences, Taylor’s University, 1 Jalan Taylors, Subang Jaya 47500, Malaysia; (J.Y.C.); (P.P.C.)
- Centre for Drug Discovery and Molecular Pharmacology (CDDMP), Faculty of Health & Medical Sciences, Taylor’s University, 1 Jalan Taylors, Subang Jaya 47500, Malaysia
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Gürbüz M, Doğan İ, Akkuş E, Ermiş H, Utkan G, Vatansever S, Taş F. Efficacy and tolerability of vismodegib treatment in locally advanced and metastatic basal cell carcinoma: Retrospective real-life data. Dermatol Ther 2021; 34:e15122. [PMID: 34478210 DOI: 10.1111/dth.15122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Mustafa Gürbüz
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - İzzet Doğan
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Erman Akkuş
- Department of Internal Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hande Ermiş
- Department of Dermatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Güngör Utkan
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Sezai Vatansever
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Faruk Taş
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
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31
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Bossi P, Delrio P, Mascheroni A, Zanetti M. The Spectrum of Malnutrition/Cachexia/Sarcopenia in Oncology According to Different Cancer Types and Settings: A Narrative Review. Nutrients 2021; 13:1980. [PMID: 34207529 PMCID: PMC8226689 DOI: 10.3390/nu13061980] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 12/15/2022] Open
Abstract
Nutritional status in oncological patients may differ according to several modifiable and non-modifiable factors. Knowledge of the epidemiology of malnutrition/cachexia/sarcopenia may help to manage these complications early in the course of treatment, potentially impacting patient quality of life, treatment intensity, and disease outcome. Therefore, this narrative review aimed to critically evaluate the current evidence on the combined impact of tumor- and treatment-related factors on nutritional status and to draw some practical conclusions to support the multidisciplinary management of malnutrition in cancer patients. A comprehensive literature search was performed from January 2010 to December 2020 using different combinations of pertinent keywords and a critical evaluation of retrieved literature papers was conducted. The results show that the prevalence of weight loss and associated symptoms is quite heterogeneous and needs to be assessed with recognized criteria, thus allowing a clear classification and standardization of therapeutic interventions. There is a large range of variability influenced by age and social factors, comorbidities, and setting of cures (community-dwelling versus hospitalized patients). Tumor subsite is one of the major determinants of malnutrition, with pancreatic, esophageal, and other gastroenteric cancers, head and neck, and lung cancers having the highest prevalence. The advanced stage is also linked to a higher risk of developing malnutrition, as an expression of the relationship between tumor burden, inflammatory status, reduced caloric intake, and malabsorption. Finally, treatment type influences the risk of nutritional issues, both for locoregional approaches (surgery and radiotherapy) and for systemic treatment. Interestingly, personalized approaches based on the selection of the most predictive malnutrition definitions for postoperative complications according to cancer type and knowledge of specific nutritional problems associated with some new agents may positively impact disease course. Sharing common knowledge between oncologists and nutritionists may help to better address and treat malnutrition in this population.
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Affiliation(s)
- Paolo Bossi
- Medical Oncology Unit, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25123 Brescia, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Giovanni Pascale IRCCS-Italia, 80131 Naples, Italy;
| | - Annalisa Mascheroni
- Clinical Nutrition and Dietetics Unit, ASST Melegnano-Martesana, 20077 Melegnano, Italy;
| | - Michela Zanetti
- Department of Medical Sciences, University of Trieste, 34100 Trieste, Italy;
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32
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Nasr I, McGrath EJ, Harwood CA, Botting J, Buckley P, Budny PG, Fairbrother P, Fife K, Gupta G, Hashme M, Hoey S, Lear JT, Mallipeddi R, Mallon E, Motley RJ, Newlands C, Newman J, Pynn EV, Shroff N, Slater DN, Exton LS, Mohd Mustapa MF, Ezejimofor MC. British Association of Dermatologists guidelines for the management of adults with basal cell carcinoma 2021. Br J Dermatol 2021; 185:899-920. [PMID: 34050920 DOI: 10.1111/bjd.20524] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Affiliation(s)
- I Nasr
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - E J McGrath
- Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - C A Harwood
- Barts Health NHS Trust, London, E1 1BB, UK.,National Cancer Research Institute's Skin Cancer Clinical Studies Group and Non-Melanoma Skin Cancer Subgroup, London, UK
| | - J Botting
- Royal College of General Practitioners, London, UK
| | - P Buckley
- Independent Cancer Patients' Voice, London, UK
| | - P G Budny
- British Association of Plastic, Reconstructive & Aesthetic Surgeons, London, UK.,Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | | | - K Fife
- Royal College of Radiologists, London, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - G Gupta
- NHS Lothian, Lauriston Building, Edinburgh, EH3 9EN, UK
| | - M Hashme
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - S Hoey
- Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - J T Lear
- British Society for Skin Care in Immunosuppressed Individuals, London, UK.,Salford Royal NHS Foundation Hospital, Salford, M6 8HD, UK.,Manchester Academic Health Science Centre, Manchester, M20 2LR, UK
| | - R Mallipeddi
- British Society for Dermatological Surgery, London, UK.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - E Mallon
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - R J Motley
- University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - C Newlands
- British Association of Oral and Maxillofacial Surgeons, London, UK.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, GU2 7XX, UK
| | - J Newman
- British Dermatological Nursing Group, Belfast, Ireland.,King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - E V Pynn
- Nevill Hall Hospital, Abergavenny, NP7 7EG, UK
| | - N Shroff
- Primary Care Dermatology Society, Rickmansworth, UK
| | - D N Slater
- Royal College of Pathologists, London, UK
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M C Ezejimofor
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
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Alexandra D, Marie BB, Sandrine M, Jean-Philippe A, Jean-Jacques G, Hervé M, Philippe S, Nicolas P, Bernard C, Laurent M, Maxime B, Thomas J. Vismodegib efficacy in unresectable trichoblastic carcinoma: A multicenter study of 16 cases. J Am Acad Dermatol 2021; 86:1365-1366. [PMID: 34052337 DOI: 10.1016/j.jaad.2021.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 05/03/2021] [Accepted: 05/15/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Mansard Sandrine
- Service de Dermatologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | | | - Saiag Philippe
- Service de Dermatologie, APHP, CHU Ambroise Paré, Boulogne Billancourt, France
| | | | - Cribier Bernard
- Service de Dermatologie, Hospices civils de Strasbourg, Strasbourg, France
| | - Mortier Laurent
- Université de Lille, INSERM U1189, Service de Dermatologie, CHU Lille, Lille, France
| | - Battistella Maxime
- Service de Pathologie, APHP, Hôpital Saint Louis, Université de Paris, Paris, France
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Bertrand N, Guerreschi P, Basset-Seguin N, Saiag P, Dupuy A, Dalac-Rat S, Dziwniel V, Depoortère C, Duhamel A, Mortier L. Vismodegib in neoadjuvant treatment of locally advanced basal cell carcinoma: First results of a multicenter, open-label, phase 2 trial (VISMONEO study): Neoadjuvant Vismodegib in Locally Advanced Basal Cell Carcinoma. EClinicalMedicine 2021; 35:100844. [PMID: 33997740 PMCID: PMC8093898 DOI: 10.1016/j.eclinm.2021.100844] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Surgery is the primary treatment for basal cell carcinoma (BCC). In locally advanced basal cell carcinoma (laBCC), surgery may cause functional or aesthetic damage. In laBCC, neoadjuvant administration of vismodegib, an inhibitor of the Hedgehog signaling pathway, may reduce tumor size, facilitate resection, and reduce functional and aesthetic consequences of surgery. The VISMONEO study assessed efficacy and safety of vismodegib in neoadjuvant treatment of laBCC. METHODS VISMONEO (NCT02667574) is an open-label, noncomparative, multicenter, phase 2 study. Patients with ≥1 histologically confirmed facial BCC, inoperable or operable with functional or major aesthetic sequelae risk, were included. Oral vismodegib 150 mg was administered once daily for 4 to 10 months before planned surgery, which was performed once the best response under vismodegib was observed. Primary endpoint was percentage of patients with BCC with tumor downstaging following surgical resection after neoadjuvant vismodegib. Downstaging was defined according to a 6-stage surgical classification related to the aesthetic and functional consequences of surgery. FINDINGS 55 patients (median age: 73 years) with laBCC were included from November 2014 to June 2015. At inclusion, 4 patients were inoperable, 15 were operable with a major functional risk, and 36 were operable with a minor functional risk or a major aesthetic risk. Mean size of target lesion was 47.3 mm (SD: 27.2 mm). 44 patients presented with downstaging after vismodegib treatment (80%; 95% confidence interval [CI], 67 to 90). Of these 44 patients, 27 had a complete response (25 proved by biopsy). Mean treatment duration was 6.0 months. Overall Response Rate according to RECIST 1.1 criteria was 71% (95% CI, 59 to 88). At 3-years of follow-up, 16/44 patients had known recurrence (36%; 95%CI, 22 to 51). INTERPRETATION Neoadjuvant vismodegib allows for a downstaging of the surgical procedure for laBCCs in functionally sensitive locations. FUNDING VISMONEO was funded by F. Hoffmann-La Roche Ltd.
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Affiliation(s)
| | - Pierre Guerreschi
- Univ. Lille, CHU Lille, Plastic and Reconstructive Surgery Department, Lille, France
| | | | - Philippe Saiag
- Hôpital Ambroise Paré AP-HP, Dermatology Department, Boulogne‐Billancourt, France
| | - Alain Dupuy
- CHU Rennes, Dermatology Department, Rennes, France
| | | | | | - César Depoortère
- Univ. Lille, CHU Lille, Plastic and Reconstructive Surgery Department, Lille, France
| | | | - Laurent Mortier
- Univ. Lille, INSERM U1189, CHU Lille, Dermatology Department, Lille, France
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Zelin E, Zalaudek I, Agozzino M, Dianzani C, Dri A, Di Meo N, Giuffrida R, Marangi GF, Neagu N, Persichetti P, Toffoli L, Conforti C. Neoadjuvant Therapy for Non-melanoma Skin Cancer: Updated Therapeutic Approaches for Basal, Squamous, and Merkel Cell Carcinoma. Curr Treat Options Oncol 2021; 22:35. [PMID: 33725197 PMCID: PMC7966643 DOI: 10.1007/s11864-021-00826-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/17/2022]
Abstract
OPINION STATEMENT Recently introduced systemic therapies for locally advanced and metastatic non-melanoma skin cancers (NMSCs) are paving the way for neoadjuvant approach. Although none of the therapeutic options has currently gained indication in this setting, neoadjuvant approach for NMSCs is an open field and we are likely to see huge developments in the near future. Targeted therapy with sonic hedgehog pathway inhibitors is very effective in locally advanced or multiple basal cell carcinomas while immunotherapy with immune checkpoint inhibitors appears to be promising for advanced cutaneous squamous cell carcinoma and Merkel cell carcinoma. To date, targeted therapy and immunotherapy represent the frontiers in NMSC therapeutic management and, according to recent studies, good results can be achieved.
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Affiliation(s)
- Enrico Zelin
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy.
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Marina Agozzino
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Caterina Dianzani
- Plastic and Reconstructive Surgery Department, Campus Biomedico University, Rome, Italy
| | - Arianna Dri
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Nicola Di Meo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology Section, University of Messina, Messina, Italy
| | | | - Nicoleta Neagu
- Dermatology Clinic, Mures Country Hospital, Tirgu Mures, Romania
| | - Paolo Persichetti
- Plastic and Reconstructive Surgery Department, Campus Biomedico University, Rome, Italy
| | - Ludovica Toffoli
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Claudio Conforti
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
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Habashy S, Jafri A, Osman HO, Thomas NE, Udekwe S, Heindl SE. Hedgehog Pathway Inhibitors: Clinical Implications and Resistance in the Treatment of Basal Cell Carcinoma. Cureus 2021; 13:e13859. [PMID: 33754119 PMCID: PMC7971714 DOI: 10.7759/cureus.13859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer and is on the rise. Most BCCs are benign; however, a very small percentage are locally advanced and metastatic. The pathway that normally regulates cell growth and proliferation is directed by the hedgehog pathway (HP). In BCC, it becomes over-stimulated due to genetic abnormalities. Treatments for BCC include local treatment by cryotherapy (liquid nitrogen), topical immunosuppression, surgery, or radiotherapy. Systemic treatment may be required in locally advanced lesions, metastatic BCC, or individuals who are inoperable. The systemic treatments of BCC act to inhibit the HP and are called hedgehog pathway inhibitors. The first one being vismodegib and the second sonidegib. Although these treatments have shown promising results, they have prominent side effects in almost all patients, with few patients having to discontinue the treatment. About 50% of patients did not respond to treatment from the beginning, some had partial responses, others had recurrence after discontinuing the drugs, and few had worsening of the disease. In this paper, we will explore the most common side effects, resistance, and different methods to overcome resistance to ensure the highest rate of cure for BCC.
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Affiliation(s)
- Suzanne Habashy
- Family Medicine/Dermatology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aliya Jafri
- Biochemistry and Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Biochemistry, Jinnah Sindh Medical University, Karachi, PAK
| | - Hiba O Osman
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Neena E Thomas
- Psychiatry and Behavioral Sciences, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Somtochi Udekwe
- Internal Medicine, Endocrinology, Pediatrics, Gynecology, Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Stacey E Heindl
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Medicine, Avalon University School of Medicine, Willemstad, CUW
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Gaillard D, Barlow LA. A Mechanistic Overview of Taste Bud Maintenance and Impairment in Cancer Therapies. Chem Senses 2021; 46:6161548. [PMID: 33693542 DOI: 10.1093/chemse/bjab011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Since the early 20th century, progress in cancer therapies has significantly improved disease prognosis. Nonetheless, cancer treatments are often associated with side effects that can negatively affect patient well-being and disrupt the course of treatment. Among the main side effects, taste impairment is associated with depression, malnutrition, and morbid weight loss. Although relatively common, taste disruption associated with cancer therapies remains poorly understood. Here, we review the current knowledge related to the molecular mechanisms underlying taste maintenance and disruption in the context of cancer therapies.
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Affiliation(s)
- Dany Gaillard
- Department of Cell & Developmental Biology, and the Rocky Mountain Taste & Smell Center, University of Colorado Anschutz Medical Campus, 12801 East 17th Avenue, Mail Stop 8108, Aurora, CO 80045, USA
| | - Linda A Barlow
- Department of Cell & Developmental Biology, and the Rocky Mountain Taste & Smell Center, University of Colorado Anschutz Medical Campus, 12801 East 17th Avenue, Mail Stop 8108, Aurora, CO 80045, USA
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38
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Zhang J, Fan J, Zeng X, Nie M, Luan J, Wang Y, Ju D, Yin K. Hedgehog signaling in gastrointestinal carcinogenesis and the gastrointestinal tumor microenvironment. Acta Pharm Sin B 2021; 11:609-620. [PMID: 33777671 PMCID: PMC7982428 DOI: 10.1016/j.apsb.2020.10.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/29/2020] [Accepted: 08/21/2020] [Indexed: 12/16/2022] Open
Abstract
The Hedgehog (HH) signaling pathway plays important roles in gastrointestinal carcinogenesis and the gastrointestinal tumor microenvironment (TME). Aberrant HH signaling activation may accelerate the growth of gastrointestinal tumors and lead to tumor immune tolerance and drug resistance. The interaction between HH signaling and the TME is intimately involved in these processes, for example, tumor growth, tumor immune tolerance, inflammation, and drug resistance. Evidence indicates that inflammatory factors in the TME, such as interleukin 6 (IL-6) and interferon-γ (IFN-γ), macrophages, and T cell-dependent immune responses, play a vital role in tumor growth by affecting the HH signaling pathway. Moreover, inhibition of proliferating cancer-associated fibroblasts (CAFs) and inflammatory factors can normalize the TME by suppressing HH signaling. Furthermore, aberrant HH signaling activation is favorable to both the proliferation of cancer stem cells (CSCs) and the drug resistance of gastrointestinal tumors. This review discusses the current understanding of the role and mechanism of aberrant HH signaling activation in gastrointestinal carcinogenesis, the gastrointestinal TME, tumor immune tolerance and drug resistance and highlights the underlying therapeutic opportunities.
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Key Words
- 5-Fu, 5-fluorouracil
- ALK5, TGF-β receptor I kinase
- ATO, arsenic trioxide
- BCC, basal cell carcinoma
- BCL-2, B cell lymphoma 2
- BMI-1, B cell-specific moloney murine leukemia virus insertion region-1
- CAFs, cancer-associated fibroblasts
- CSCs, cancer stem cells
- Cancer stem cells
- Carcinogenesis
- DHH, Desert Hedgehog
- Drug resistance
- EGF, epidermal growth factor
- FOLFOX, oxaliplatin
- G protein coupled receptor kinase 2, HH
- Gastrointestinal cancer
- Hedgehog
- Hedgehog, HIF-1α
- IHH, Indian Hedgehog
- IL-10/6, interleukin 10/6
- ITCH, itchy E3 ubiquitin ligase
- MDSCs, myeloid-derived suppressor cells
- NK, natural killer
- NOX4, NADPH Oxidase 4
- PD-1, programmed cell death-1
- PD-L1, programmed cell death ligand-1
- PKA, protein kinase A
- PTCH, Patched
- ROS, reactive oxygen species
- SHH, Sonic Hedgehog
- SMAD3, mothers against decapentaplegic homolog 3
- SMO, Smoothened
- SNF5, sucrose non-fermenting 5
- STAT3, signal transducer and activator of transcription 3
- SUFU, Suppressor of Fused
- TAMs, tumor-related macrophages
- TGF-β, transforming growth factor β
- TME, tumor microenvironment
- Tumor microenvironment
- VEGF, vascular endothelial growth factor
- WNT, Wingless/Integrated
- and leucovorin, GLI
- ch5E1, chimeric monoclonal antibody 5E1
- glioma-associated oncogene homologue, GRK2
- hypoxia-inducible factor 1α, IFN-γ: interferon-γ
- βArr2, β-arrestin2
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Affiliation(s)
- Jinghui Zhang
- Department of Gastrointestinal Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
- Department of Biological Medicines, Fudan University School of Pharmacy, Shanghai 201203, China
| | - Jiajun Fan
- Department of Biological Medicines, Fudan University School of Pharmacy, Shanghai 201203, China
- Shanghai Engineering Research Center of Immunotherapeutics, Shanghai 201203, China
| | - Xian Zeng
- Department of Biological Medicines, Fudan University School of Pharmacy, Shanghai 201203, China
- Shanghai Engineering Research Center of Immunotherapeutics, Shanghai 201203, China
| | - Mingming Nie
- Department of Gastrointestinal Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jingyun Luan
- Department of Biological Medicines, Fudan University School of Pharmacy, Shanghai 201203, China
- Shanghai Engineering Research Center of Immunotherapeutics, Shanghai 201203, China
| | - Yichen Wang
- Department of Biological Medicines, Fudan University School of Pharmacy, Shanghai 201203, China
- Shanghai Engineering Research Center of Immunotherapeutics, Shanghai 201203, China
| | - Dianwen Ju
- Department of Biological Medicines, Fudan University School of Pharmacy, Shanghai 201203, China
- Shanghai Engineering Research Center of Immunotherapeutics, Shanghai 201203, China
- Corresponding authors. Tel./fax: +86 21 65349106 (Kai Yin); Tel.: +86 21 5198 0037; Fax +86 21 5198 0036 (Dianwen Ju).
| | - Kai Yin
- Department of Gastrointestinal Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
- Corresponding authors. Tel./fax: +86 21 65349106 (Kai Yin); Tel.: +86 21 5198 0037; Fax +86 21 5198 0036 (Dianwen Ju).
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Marescassier H, Dousset L, Beylot-Barry M, Célérier P, Vaillant L, Bedane C, Leclère F, Wierzbicka-Hainaut E, Masson Regnault M. Predictive Factors of Non-Response to Vismodegib in Locally Advanced Basal-Cell Carcinoma. Dermatology 2021; 237:1023-1028. [PMID: 33472195 DOI: 10.1159/000512889] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
| | - Léa Dousset
- Department of Dermatology, CHU Bordeaux, Bordeaux, France
| | | | | | | | | | - Franck Leclère
- Department of Plastic Surgery, CHU Poitiers, Poitiers, France
| | - Ewa Wierzbicka-Hainaut
- Department of Dermatology, CHU Poitiers, Poitiers, France.,Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), EA4331, Université de Poitiers, Poitiers, France
| | - Marie Masson Regnault
- Department of Dermatology, CHU Poitiers, Poitiers, France, .,Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), EA4331, Université de Poitiers, Poitiers, France,
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40
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Verkouteren BJA, Wakkee M, Reyners AKL, Nelemans P, Aarts MJB, Rácz E, Terra JB, Devriese LA, Alers RJ, Kapiteijn E, van Doorn R, Bekkenk MW, Reinders MGHC, Mosterd K. Eight years of experience with vismodegib for advanced and multiple basal cell carcinoma patients in the Netherlands: a retrospective cohort study. Br J Cancer 2021; 124:1199-1206. [PMID: 33462360 PMCID: PMC8007568 DOI: 10.1038/s41416-020-01220-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Vismodegib has been used for the treatment of locally advanced basal cell carcinoma (laBCC) and metastatic BCC (mBCC) since 2011. Most efficacy and safety data are provided by clinical trials. This study evaluates the effectiveness of vismodegib for the treatment of laBCC, mBCC and basal cell nevus syndrome (BCNS) patients, and the tumour characteristics associated with a higher probability of achieving a complete response in the Netherlands. METHODS A retrospective cohort study that included all patients ≥18 years with histologically proven basal cell carcinoma that received ≥1 dose of vismodegib between July 2011 and September 2019 in the Netherlands. RESULTS In total, 48 laBCC, 11 mBCC and 19 BCNS patients were included. Median progression-free survival was 10.3 months (95% confidence interval (CI), 7.5-22.6) for laBCC, 11.7 (95% CI, 5.2-17.5) for mBCC and 19.1 (95% CI, 7.4-20.2) for BCNS. Larger laBCCs were associated with a lower probability of complete response (hazard ratio (HR) 0.77 per increase in cm, p = 0.02). Of all BCNS patients, 63% received ≥2 treatment sequences with vismodegib; all achieved partial responses. CONCLUSIONS Half of the aBCC patients progress within 1 year after the start of vismodegib treatment. More research is needed to investigate other treatment strategies after vismodegib progression and to evaluate long-term effects of repetitive vismodegib treatment.
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Affiliation(s)
- Babette J A Verkouteren
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands. .,GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Marlies Wakkee
- Department of Dermatology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - An K L Reyners
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Patty Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Emőke Rácz
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jorrit B Terra
- Department of Dermatology, Isala Dermatologic Center, Zwolle, The Netherlands
| | - Lot A Devriese
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert-Jan Alers
- Department of Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Remco van Doorn
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marie G H C Reinders
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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41
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Tronconi MC, Solferino A, Giordano L, Borroni R, Mancini L, Santoro A. Tailored Toxicity-Driven Administration of Vismodegib in Patients With Multiple or Locally Advanced Basal Cell Carcinoma: A Pilot Analysis. Front Oncol 2020; 10:563404. [PMID: 33282729 PMCID: PMC7691528 DOI: 10.3389/fonc.2020.563404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/19/2020] [Indexed: 12/18/2022] Open
Abstract
In this pilot study, we describe our experience with vismodegib in the treatment of basal cell carcinoma (BCC) and evaluate the feasibility of a tailored toxicity-driven administration of vismodegib in patients with multiple or locally advanced BCC. We retrospectively analyzed the clinical charts of 17 consecutive patients with BCC who were treated with vismodegib. Therapy was started at the usual dosage of 150 mg per day per person, continuously; a rescheduled dosage of 150 mg per day for 4 weeks with a subsequent stop of 2 weeks was allowed during the treatment according to the standard practice of our institution. During treatment, 14 patients with responsive disease presented an adverse event (100% cramps and 20% dysgeusia), therefore, requiring a change in the treatment plan. Overall, in eight out of 17 patients (47% of the overall population), it was possible to re-schedule the treatment by postponing therapy for 2 weeks every 4 weeks. These patients were all still alive at the time of the present analysis and were showing complete response. Adverse events resolved during the first interruption of therapy. The intermittent vismodegib schedule assessed in this pilot series could be beneficial in improving duration of treatment, allowing to maintain a long-term treatment response, even in an elderly and fragile population. Based on these preliminary findings, dedicated studies may be planned to further evaluate an intermittent schedule of vismodegib administration.
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Affiliation(s)
- Maria Chiara Tronconi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Alessandra Solferino
- Pharmacist Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Laura Giordano
- Biostatistics Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Riccardo Borroni
- Dermatology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Luca Mancini
- Dermatology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Armando Santoro
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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42
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Novel therapies for advanced skin carcinomas. Postepy Dermatol Alergol 2020; 37:660-670. [PMID: 33240003 PMCID: PMC7675086 DOI: 10.5114/ada.2020.100479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/02/2019] [Indexed: 12/11/2022] Open
Abstract
Advanced skin carcinomas are a serious therapeutic problem. The statistical analysis shows a continuous increase in the incidence of both melanoma and non-melanoma skin cancers. Traditional therapies are characterized by low effectiveness and patients overall survival is not affected by them. By understanding the molecular pathways that lead to the neoplastic transformation and thanks to the knowledge of the immune system, it is possible to use personalized medicine in novel therapies for advanced skin carcinomas.
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Lospinoso Severini L, Ghirga F, Bufalieri F, Quaglio D, Infante P, Di Marcotullio L. The SHH/GLI signaling pathway: a therapeutic target for medulloblastoma. Expert Opin Ther Targets 2020; 24:1159-1181. [PMID: 32990091 DOI: 10.1080/14728222.2020.1823967] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Medulloblastoma (MB) is a heterogeneous tumor of the cerebellum that is divided into four main subgroups with distinct molecular and clinical features. Sonic Hedgehog MB (SHH-MB) is the most genetically understood and occurs predominantly in childhood. Current therapies consist of aggressive and non-targeted multimodal approaches that are often ineffective and cause long-term complications. These problems intensify the need to develop molecularly targeted therapies to improve outcome and reduce treatment-related morbidities. In this scenario, Hedgehog (HH) signaling, a developmental pathway whose deregulation is involved in the pathogenesis of several malignancies, has emerged as an attractive druggable pathway for SHH-MB therapy. AREAS COVERED This review provides an overview of the advancements in the HH antagonist research field. We place an emphasis on Smoothened (SMO) and glioma-associated oncogene homolog (GLI) inhibitors and immunotherapy approaches that are validated in preclinical SHH-MB models and that have therapeutic potential for MB patients. Literature from Pubmed and data reported on ClinicalTrial.gov up to August 2020 were considered. EXPERT OPINION Extensive-omics analysis has enhanced our knowledge and has transformed the way that MB is studied and managed. The clinical use of SMO antagonists has yet to be determined, however, future GLI inhibitors and multitargeting approaches are promising.
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Affiliation(s)
| | - Francesca Ghirga
- Center for Life NanoScience@Sapienza, Istituto Italiano di Tecnologia , 00161, Rome, Italy
| | - Francesca Bufalieri
- Department of Molecular Medicine, University of Rome La Sapienza , 00161, Rome, Italy
| | - Deborah Quaglio
- Department of Chemistry and Technology of Drugs, University of Rome La Sapienza, 00185 , Rome, Italy
| | - Paola Infante
- Center for Life NanoScience@Sapienza, Istituto Italiano di Tecnologia , 00161, Rome, Italy
| | - Lucia Di Marcotullio
- Department of Molecular Medicine, University of Rome La Sapienza , 00161, Rome, Italy.,Istituto Pasteur-Fondazione Cenci Bolognetti, University of Rome La Sapienza , 00161, Rome, Italy
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Metastatic Basal Cell Carcinoma of the Skin: A Comprehensive Literature Review, Including Advances in Molecular Therapeutics. Adv Anat Pathol 2020; 27:331-353. [PMID: 32618586 DOI: 10.1097/pap.0000000000000267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Basal cell carcinoma (BCC) of the skin is the most common type of malignant human tumor. In Europe, the incidence of BCC ranges from 44.6 to 128 cases per 100,000 inhabitants annually, whereas in the United States, the yearly incidence rate ranges between 500 and 1500. The global incidence has been calculated to be as high as 10 million cases of BCC per year. There are 2 main clinical patterns of BCC-the familial BCC in basal cell nevus syndrome and sporadic BCC. The etiology of cutaneous BCC is usually the result of the interaction between solar ultraviolet radiation and genetic factors. Somatic or germline mutations in the effector components of the hedgehog signaling pathway (ie, PTCH1, PTCH2, SMO or SUFU genes) are responsible for ∼90% of the cases of both sporadic and familial BCC, all causing a constitutive activation of the hedgehog pathway. Cutaneous BCC very rarely metastasizes, and diagnosis in metastatic sites can be very difficult. Metastatic BCC has weakly effective therapeutic options with a poor prognosis until few years ago. In 2012, small-molecule therapies, involving inactivation of the hedgehog signaling pathway, and capable of reducing tumor growth and progression have been introduced into clinical practice for advanced (locally advanced or metastatic) BCC. We performed a comprehensive literature review on metastatic BCC and found at least 915 cases reported to date. In addition, we extensively discussed the differential diagnosis of metastatic BCC, and outlined the advances in clinical therapeutics involving these small molecules.
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Ben Ishai M, Tiosano A, Fenig E, Ben Simon G, Yassur I. Outcomes of Vismodegib for Periocular Locally Advanced Basal Cell Carcinoma From an Open-label Trial. JAMA Ophthalmol 2020; 138:749-755. [PMID: 32407451 PMCID: PMC7226292 DOI: 10.1001/jamaophthalmol.2020.1539] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/15/2020] [Indexed: 12/16/2022]
Abstract
Importance 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. Objective To report the outcomes of vismodegib treatment in patients with POLA-BCC in the Safety Events in Vismodegib (STEVIE) study. Design, Setting, and Participants 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. Main Outcomes and Measures Response to treatment and adverse events. Results 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. Conclusions and Relevance 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.
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Affiliation(s)
- Meydan Ben Ishai
- Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Tiosano
- Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Fenig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Davidoff Center for Oncology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Guy Ben Simon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Goldscgleger Eye Institute, Sheba Medical Center, Tel Hashomer, 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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The Evolution of Care of Cancers of the Head and Neck Region: State of the Science in 2020. Cancers (Basel) 2020; 12:cancers12061543. [PMID: 32545409 PMCID: PMC7352543 DOI: 10.3390/cancers12061543] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/15/2022] Open
Abstract
Cancers that arise in the head and neck region are comprised of a heterogeneous group of malignancies that include carcinogen- and human papillomavirus (HPV)-driven mucosal squamous cell carcinoma as well as skin cancers such as cutaneous squamous cell carcinoma, basal cell carcinoma, melanoma, and Merkel cell carcinoma. These malignancies develop in critical areas for eating, talking, and breathing and are associated with substantial morbidity and mortality despite advances in treatment. Understanding of advances in the management of these various cancers is important for all multidisciplinary providers who care for patients across the cancer care continuum. Additionally, the recent Coronavirus Disease 2019 (COVID-19) pandemic has necessitated adaptations to head and neck cancer care to accommodate the mitigation of COVID-19 risk and ensure timely treatment. This review explores advances in diagnostic criteria, prognostic factors, and management for subsites including head and neck squamous cell carcinoma and the various forms of skin cancer (basal cell carcinoma, cutaneous squamous cell carcinoma, Merkel cell carcinoma, and melanoma). Then, this review summarizes emerging developments in immunotherapy, radiation therapy, cancer survivorship, and the delivery of care during the COVID-19 era.
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Su MG, Potts LB, Tsai JH. Treatment of periocular basal cell carcinoma with neoadjuvant vismodegib. Am J Ophthalmol Case Rep 2020; 19:100755. [PMID: 32490287 PMCID: PMC7262551 DOI: 10.1016/j.ajoc.2020.100755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose To report a case of a locally advanced periocular basal cell carcinoma treated with neoadjuvant Vismodegib therapy prior to surgery. Observations A 63-year-old female presented to the oculoplastics clinic with biopsy-proven basal cell carcinoma of the right periorbital region causing significant cicatricial ectropion of the right lower eyelid. The medial canthal lesion involved nearly the entire right lower eyelid with extension onto the cheek, the medial half of the right upper eyelid, the palpebral and bulbar conjunctiva, as well as the right lacrimal system. CT imaging was suggestive of involvement of the extraocular muscles and other post-septal tissues. Fortunately, the patient had no metastatic disease. The extent of the tumor would have necessitated aggressive resection to achieve surgical cure. However, the patient preferred to attempt globe-sparing therapy with a goal of preserving cosmesis as much as possible. Various treatment options were discussed with the patient, including the use of Vismodegib, and the patient elected to pursue this treatment strategy. The goal of Vismodegib treatment was to reduce the tumor size enough to permit surgical resection of all tumor without significantly affecting cosmesis. After 11 months of treatment with Vismodegib, the tumor size had reduced significantly to the point where surgical intervention with minimal disfigurement could be offered. The patient underwent multidisciplinary approach with Mohs micrographic excision of the tumor paired with oculoplastic reconstructive surgery resulting in negative margins and satisfactory cosmetic results. Conclusions and importance Although addition study is required regarding Vismodegib as a primary or adjuvant therapeutic approach to periorbital basal cell carcinoma, this case illustrates the potential usefulness of this drug as an option in this context. This case provides information that may help the comprehensive ophthalmologist or oculoplastic specialist in counseling patients with locally advanced periorbital basal cell carcinoma.
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Affiliation(s)
- Maxwell G Su
- Baylor Scott and White Department of Ophthalmology - Texas A&M University, 1815 S 31st Street, Temple, TX, 76508, USA
| | - Luke B Potts
- Baylor Scott and White Department of Ophthalmology - Texas A&M University, 1815 S 31st Street, Temple, TX, 76508, USA
| | - Jonathan H Tsai
- Baylor Scott and White Department of Ophthalmology - Texas A&M University, 1815 S 31st Street, Temple, TX, 76508, USA
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Vílchez-Márquez F, Borregón-Nofuentes P, Barchino-Ortiz L, Ruíz-de-Casas A, Palacios-Álvarez I, Soria-Rivas A, Descalzo-Gallego M, García-Doval I, Ríos-Buceta L, Redondo-Bellón P. Diagnosis and Treatment of Basal Cell Carcinoma in Specialized Dermatology Units: A Clinical Practice Guideline. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Vílchez-Márquez F, Borregón-Nofuentes P, Barchino-Ortiz L, Ruíz-de-Casas A, Palacios-Álvarez I, Soria-Rivas A, Descalzo-Gallego MA, García-Doval I, Ríos-Buceta L, Redondo-Bellón P. Diagnosis and Treatment of Basal Cell Carcinoma in Specialized Dermatology Units: A Clinical Practice Guideline. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:291-299. [PMID: 32241529 DOI: 10.1016/j.ad.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 07/10/2019] [Accepted: 07/13/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Basal cell carcinoma (BCC) is the most common skin cancer in the general population. BCC is managed in a variety of ways, and available international guidelines are difficult to put into practice in Spain. This guideline aims to improve the management of BCC based on current evidence and provide a point of reference for Spanish dermatologists. MATERIAL AND METHODS Members of the Spanish Oncologic Dermatology and Surgery Group (GEDOC) with experience treating BCC were invited to participate in drafting this guideline. The drafters used the ADAPTE collaboration process to develop the new guideline based on existing ones, first summarizing the care pathway and posing relevant clinical questions. They then searched for guidelines, assessed them with the AGREEII (Appraisal of Guidelines for Research and Evaluation) tool, and searched the selected guidelines for answers to the clinical questions. Finally, the recommendations were drafted and submitted for external review. RESULTS The highest-scoring guidelines were from the Association of Dermatologists, the National Comprehensive Cancer Network, the European Dermatology Forum, and the European Academy of Dermatology and Venereology. A total of 11 clinical questions were answered. CONCLUSIONS This new guideline answers the working group's clinical questions about the routine management of BCC in Spain. It provides dermatologists with a tool they can use for decision-making while taking into consideration the resources available and patient preferences.
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Affiliation(s)
- F Vílchez-Márquez
- Servicio de Dermatología, Hospital de Guadix, Guadix, Granada, España.
| | | | - L Barchino-Ortiz
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Ruíz-de-Casas
- Servicio de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - I Palacios-Álvarez
- Servicio de Dermatología, Clínica Universidad de Navarra, Pamplona, España
| | - A Soria-Rivas
- Servicio de Oncología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M A Descalzo-Gallego
- Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología, Madrid, España
| | - I García-Doval
- Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología, Madrid, España; Servicio de Dermatología, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
| | - L Ríos-Buceta
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - P Redondo-Bellón
- Servicio de Dermatología, Clínica Universidad de Navarra, Pamplona, España
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Úlcera vulvar en paciente menopáusica. Ampliando el diagnóstico diferencial. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2020. [DOI: 10.1016/j.gine.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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