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Sol S, Boncimino F, Todorova K, Waszyn SE, Mandinova A. Therapeutic Approaches for Non-Melanoma Skin Cancer: Standard of Care and Emerging Modalities. Int J Mol Sci 2024; 25:7056. [PMID: 39000164 PMCID: PMC11241167 DOI: 10.3390/ijms25137056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 07/16/2024] Open
Abstract
Skin cancer encompasses a range of cutaneous malignancies, with non-melanoma skin cancers (NMSCs) being the most common neoplasm worldwide. Skin exposure is the leading risk factor for initiating NMSC. Ultraviolet (UV) light induces various genomic aberrations in both tumor-promoting and tumor-suppressing genes in epidermal cells. In conjunction with interactions with a changed stromal microenvironment and local immune suppression, these aberrations contribute to the occurrence and expansion of cancerous lesions. Surgical excision is still the most common treatment for these lesions; however, locally advanced or metastatic disease significantly increases the chances of morbidity or death. In recent years, numerous pharmacological targets were found through extensive research on the pathogenic mechanisms of NMSCs, leading to the development of novel treatments including Hedgehog pathway inhibitors for advanced and metastatic basal cell carcinoma (BCC) and PD-1/PD-L1 inhibitors for locally advanced cutaneous squamous cell carcinoma (cSCC) and Merkel cell carcinoma (MCC). Despite the efficacy of these new drugs, drug resistance and tolerability issues often arise with long-term treatment. Ongoing studies aim to identify alternative strategies with reduced adverse effects and increased tolerability. This review summarizes the current and emerging therapies used to treat NMSC.
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Affiliation(s)
- Stefano Sol
- Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Fabiana Boncimino
- Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Kristina Todorova
- Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | | | - Anna Mandinova
- Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
- Broad Institute of Harvard and MIT, 7 Cambridge Center, Cambridge, MA 02142, USA
- Harvard Stem Cell Institute, 7 Divinity Avenue, Cambridge, MA 02138, USA
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2
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Idriss MH, Stull CM, Migden MR. Treatments on the horizon for locally advanced basal cell carcinoma. Cancer Lett 2024; 589:216821. [PMID: 38521198 DOI: 10.1016/j.canlet.2024.216821] [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: 11/19/2023] [Revised: 02/16/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
Basal cell carcinoma (BCC) is one of the most common human cancers. Most cases of BCC are amenable to surgical and topical treatments with excellent prognosis if diagnosed timely and managed appropriately. However, in a small percentage of cases, it could be locally advanced BBC (laBCC) and not amenable to surgery or radiation, including recurrent, large tumors or tumors that invade deeper tissue. Hedgehog inhibitors (vismodegib and sonidegib) are approved as the first-line treatment of laBCC. PD-1 inhibitor immunotherapy (cemiplimab) is indicated for cases that progressed on or could not tolerate hedgehog inhibitors or when hedgehog inhibitors are contraindicated. Given the modest response and bothersome side effects of some of the agents above, there are reports of novel treatments, and clinical trials are currently evaluating multiple agents.
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Affiliation(s)
- Munir H Idriss
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Carolyn M Stull
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael R Migden
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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3
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Lavasidis G, Tzamalis A, Tsinopoulos I, Ziakas N. Exploring vismodegib: A non-surgical breakthrough in the management of advanced periocular basal cell carcinoma. Cancer Treat Res Commun 2024; 39:100796. [PMID: 38367414 DOI: 10.1016/j.ctarc.2024.100796] [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: 01/13/2024] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/19/2024]
Abstract
The management of periocular basal cell carcinoma (BCC) is challenging due to its proximity to the eyeball. Vismodegib, a Hedgehog pathway inhibitor, has emerged as a therapeutic option for locally advanced and metastatic BCC. To critically appraise the relevant evidence, we conducted a systematic review of observational and experimental studies assessing the efficacy and safety of vismodegib for periocular BCC. Thirty-seven trials, including 435 patients, were eligible. No randomized trials were retrieved. Complete and overall clinical response rates were 20-88 % and 68-100 %, respectively. Disease progression was observed at a maximum rate of 14 %. Recurrence rates varied between 0 % and 31 %. The most common side effects were muscle cramps, dysgeusia, weight loss and alopecia. Treatment with vismodegib improved health-related quality of life. In conclusion, vismodegib represents an important novel treatment for advanced periocular BCC, with good response rates and acceptable tolerability profile. Nevertheless, its full potential needs clarification through randomized controlled trials.
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Affiliation(s)
- Georgios Lavasidis
- MSc Ocular Surgery, School of Medicine, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece; Evidence-based Medicine Unit, Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, University Campus, 45110 Ioannina, Greece; Department of Ophthalmology, Elpis General Hospital of Athens, Dimitsanas 7, 11522 Athens, Greece.
| | - Argyrios Tzamalis
- MSc Ocular Surgery, School of Medicine, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece; 2nd Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
| | - Ioannis Tsinopoulos
- MSc Ocular Surgery, School of Medicine, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece; 2nd Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
| | - Nikolaos Ziakas
- MSc Ocular Surgery, School of Medicine, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece; 2nd Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
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4
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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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Unsworth SP, Tingle CF, Heisel CJ, Eton EA, Andrews CA, Chan MP, Bresler SC, Kahana A. Analysis of residual disease in periocular basal cell carcinoma following hedgehog pathway inhibition: Follow up to the VISORB trial. PLoS One 2022; 17:e0265212. [PMID: 36455049 PMCID: PMC9714843 DOI: 10.1371/journal.pone.0265212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022] Open
Abstract
Basal cell carcinoma (BCC) is a common skin cancer caused by deregulated hedgehog signaling. BCC is often curable surgically; however, for orbital and periocular BCCs (opBCC), surgical excision may put visual function at risk. Our recent clinical trial highlighted the utility of vismodegib for preserving visual organs in opBCC patients: 67% of patients displayed a complete response histologically. However, further analysis of excision samples uncovered keratin positive, hedgehog active (Gli1 positive), proliferative micro-tumors. Sequencing of pre-treatment tumors revealed resistance conferring mutations present at low frequency. In addition, one patient with a low-frequency SMO W535L mutation recurred two years post study despite no clinical evidence of residual disease. Sequencing of this recurrent tumor revealed an enrichment for the SMO W535L mutation, revealing that vismodegib treatment enriched for resistant cells undetectable by traditional histology. In the age of targeted therapies, linking molecular genetic analysis to prospective clinical trials may be necessary to provide mechanistic understanding of clinical outcomes. Trial Registration: ClinicalTrials.gov Identifier: NCT02436408.
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Affiliation(s)
- Shelby P. Unsworth
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, United States of America
| | - Christina F. Tingle
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, United States of America
| | - Curtis J. Heisel
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, United States of America
| | - Emily A. Eton
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, United States of America
| | - Christopher A. Andrews
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, United States of America
| | - May P. Chan
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, United States of America
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States of America
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States of America
| | - Scott C. Bresler
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, United States of America
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States of America
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States of America
| | - Alon Kahana
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, United States of America
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, United States of America
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, MI, United States of America
- * E-mail:
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6
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Ramelyte E, Nägeli MC, Hunger R, Merat R, Gaide O, Navarini AA, Cozzio A, Wagner NB, Maul LV, Dummer R. Swiss Recommendations for Cutaneous Basal Cell Carcinoma. Dermatology 2022; 239:122-131. [PMID: 36137524 PMCID: PMC9808659 DOI: 10.1159/000526478] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/16/2022] [Indexed: 01/26/2023] Open
Abstract
Basal cell carcinoma (BCC) is the most common nonmelanoma skin cancer in Switzerland and worldwide. Most BCCs can be treated in a curative setting. However, patients can develop locally destructive and, rarely, metastatic tumors that require a different treatment approach. The clinical subtype of individual lesions provides prognostic information and influences management decisions. Surgical excision, topical therapies, and radiotherapy are highly effective in the majority of subtypes as well as in low- and high-risk diseases. For patients with low-risk diseases and superficial tumors not amenable to surgery, several nonsurgical alternatives are available. Systemic therapy is indicated for high-risk BCCs, which are not amenable to either surgery or radiotherapy. Hedgehog pathway inhibitors (HHI) are currently approved. Other therapeutic options such as immune checkpoint inhibitors show promising results in clinical trials. This first version of Swiss recommendations for diagnosis and management of BCC was prepared through extensive literature review and an advisory board consensus of expert dermatologists and oncologists in Switzerland. The present guidelines recommend therapies based on a multidisciplinary team approach and rate of recurrence for individual lesions. Based on the risk of recurrence, two distinct groups have been identified: low-risk (easy-to-treat) and high-risk (difficult-to-treat) tumors. Based on these classifications, evidence-based recommendations of available therapies are presented herein.
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Affiliation(s)
- Egle Ramelyte
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Mirjam C. Nägeli
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Robert Hunger
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Rastine Merat
- Division of Dermatology and Venereology, Geneva University Hospital, Geneva, Switzerland
| | - Olivier Gaide
- Department of Radiation Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Antonio Cozzio
- Clinic of Dermatology, Venereology and Allergology, St. Gallen Hospital, St. Gallen, Switzerland
| | - Nikolaus B. Wagner
- Clinic of Dermatology, Venereology and Allergology, St. Gallen Hospital, St. Gallen, Switzerland
| | - Lara Valeska Maul
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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7
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Wilson M, Johnson RP, Senft SC, Pan EY, Krakowski AC. Advanced basal cell carcinoma: What dermatologists need to know about treatment. J Am Acad Dermatol 2022; 86:S14-S24. [PMID: 35577406 DOI: 10.1016/j.jaad.2022.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
The treatment of advanced basal cell carcinoma (BCC) often requires therapies beyond local surgical excision or radiation due to the invasiveness of the tumor. Historically, cytotoxic chemotherapy was used to treat advanced BCC, but with limited data, no standard regimens were established. The discovery of cyclopamine, a natural inhibitor in the Hedgehog pathway, led to the development of the 2 currently approved Hedgehog inhibitors, vismodegib and sonidegib. Both agents are indicated for locally advanced BCC, while vismodegib is also indicated for metastatic BCC. In patients who progress on hedgehog inhibitors or cannot tolerate hedgehog inhibitors, the programmed cell death protein 1 inhibitor cemiplimab can be used to treat locally advanced or metastatic disease. Complex cases of locally advanced or metastatic BCC may be best discussed through a multidisciplinary approach in order to determine the optimal treatment approach for the individual patient.
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8
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Kurnia Wijaya J, Djawad K, Wahab S, Nurdin A, Irawan Anwar A. [Translated article] Vismodegib and Sonidegib in Locally Advanced and Metastatic Basal Cell Carcinoma: Update on Hedgehog Pathway Inhibitors. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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9
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Vismodegib y sonidegib en el carcinoma de células basales localmente avanzado y metastásico: actualización acerca de los inhibidores de la vía de Hedgehog. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:443-450. [DOI: 10.1016/j.ad.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022] Open
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10
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Mohseniabbasabadi T, Behboodyzad F, Abolhasani Zadeh F, Balali E. Vismodegib anticancer drug: Analyzing electronic and structural features and examining biological activities. MAIN GROUP CHEMISTRY 2021. [DOI: 10.3233/mgc-210160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vismodegib (Vis) is an anticancer drug, in which its electronic and structural features were examined in this work. To this aim, the chlorine atoms of original Vis model were substituted by other fluorine, bromine, and iodine halogen atoms yielding F-Vis, Br-Vis, and I-Vis in addition to the original Cl-Vis model. The models were optimized by performing quantum chemical calculations and their interactions with the smoothened (SMO) target were examined by performing molecular docking simulations. The results indicated that the stabilized structures of halogenated Vis models were achievable and their features indicated the dominant role of halogen atoms for their participation in interactions with other substances. Based on the obtained results, Br-Vis model was seen suitable for participating in interaction with the SMO target even better than the original Vis model. The hypothesis of this work was affirmed by employing the in silico approach for analyzing the features of singular ligands and for evaluating their biological functions.
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Affiliation(s)
- Tahereh Mohseniabbasabadi
- Department of Organic Chemistry, Faculty of Pharmaceutical Chemistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Farnoosh Behboodyzad
- Department of Organic Chemistry, Faculty of Pharmaceutical Chemistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | | | - Ebrahim Balali
- Department of Organic Chemistry, Faculty of Pharmaceutical Chemistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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11
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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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12
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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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13
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Passarelli A, Galdo G, Aieta M, Fabrizio T, Villonio A, Conca R. A Vismodegib Experience in Elderly Patients with Basal Cell Carcinoma: Case Reports and Review of the Literature. Int J Mol Sci 2020; 21:ijms21228596. [PMID: 33202689 PMCID: PMC7696523 DOI: 10.3390/ijms21228596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/31/2020] [Accepted: 11/12/2020] [Indexed: 01/09/2023] Open
Abstract
Cutaneous basal cell carcinoma (BCC) is the most common type of human tumor, and its incidence rate is increasing worldwide. Up until a few years ago, therapeutic options have been limited for patients with advanced BCC (including metastatic and locally-advanced BCC). Over the last few years, promising systemic therapies have been investigated for the treatment of advanced BCC. In particular, the Hedgehog signaling inhibition has shown remarkable results for this population. Hedgehog inhibitors, represented by vismodegib and sonidegib, have been approved by the Food and Drug Administration and the European Medicines Agency for the treatment of both locally advanced and metastatic BCC, with, generally, a good safety profile. Notwithstanding the late onset of BCC in the global population, associated with life expectancy increase, only a few clinical trials have evaluated the efficacy and safety profile of Hedgehog inhibitors in this complex and neglected population. Herein, we review the major mechanisms implicated in the pathogenesis of BCC focusing on the Hedgehog signaling pathway and its therapeutic role in the elderly population. Finally, we report two case reports of BCC elderly patients in order to demonstrate both efficacy and safety of the Hedgehog inhibitors.
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Affiliation(s)
- Anna Passarelli
- Department of Onco-Hematology, Unit of Medical Oncology, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero in Vulture, Italy; (M.A.); (R.C.)
- Correspondence: ; Tel.: +39-097-272-6111; Fax: +39-097-272-3509
| | - Giovanna Galdo
- Department of Onco-Hematology, Oncologic Dermatology Unit, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), IRCCS-CROB, 85028 Rionero in Vulture, Italy;
| | - Michele Aieta
- Department of Onco-Hematology, Unit of Medical Oncology, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero in Vulture, Italy; (M.A.); (R.C.)
| | - Tommaso Fabrizio
- Division of Plastic Surgery, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), IRCCS-CROB, 85028 Rionero in Vulture, Italy;
| | - Antonio Villonio
- Radiology Department, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), IRCCS-CROB, 85028 Rionero in Vulture, Italy;
| | - Raffaele Conca
- Department of Onco-Hematology, Unit of Medical Oncology, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero in Vulture, Italy; (M.A.); (R.C.)
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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: 18] [Impact Index Per Article: 4.5] [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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