1
|
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; 25:779-794. [PMID: 38896403 PMCID: PMC11358199 DOI: 10.1007/s40257-024-00870-3] [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] [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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Ip KHK, McKerrow K. Itraconazole in the treatment of basal cell carcinoma: A case-based review of the literature. Australas J Dermatol 2021; 62:394-397. [PMID: 34160825 DOI: 10.1111/ajd.13655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/17/2021] [Accepted: 05/31/2021] [Indexed: 11/26/2022]
Abstract
Itraconazole is as an anti-fungal agent with the ability to inhibit the Hedgehog signalling pathway, which makes it a candidate drug that can be repurposed for the treatment of basal cell carcinomas (BCCs). We present a case of metastatic BCC, treated with oral itraconazole 100 mg twice daily, that resulted in sustained partial regression of metastatic pulmonary nodules. A systematic review on the clinical outcomes of BCCs treated with itraconazole highlights that current evidence for its clinical application remains limited and that this is the first case report where itraconazole monotherapy has achieved favourable response in metastatic BCC.
Collapse
Affiliation(s)
- Ken Hiu-Kan Ip
- Department of Dermatology, Auckland District Health Board, Auckland, New Zealand
| | | |
Collapse
|
4
|
Mehrotra K, Khullar G, Chanana C, Agrawal M. Erythematous Indurated Plaque on the Chin in an Elderly Man. Indian Dermatol Online J 2020; 11:667-669. [PMID: 32832474 PMCID: PMC7413469 DOI: 10.4103/idoj.idoj_549_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/14/2020] [Accepted: 04/08/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Krati Mehrotra
- Department of Dermatology and Sexually Transmitted Diseases, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Geeti Khullar
- Department of Dermatology and Sexually Transmitted Diseases, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Charvi Chanana
- Department of Dermatology and Sexually Transmitted Diseases, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Meetu Agrawal
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| |
Collapse
|
5
|
Plachouri KM, Balasis S, Mallioris AF, Koumoundourou D, Georgiou S. Successful treatment of multifocal pigmented basal cell carcinomas with the application of topical 5% imiquimod cream. Dermatol Ther 2018; 31:e12685. [DOI: 10.1111/dth.12685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/29/2018] [Accepted: 07/17/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Stauros Balasis
- Orthopaedics Department; University of Patras; Patras Greece
| | | | | | | |
Collapse
|
6
|
Marcasciano M, Mazzocchi M, Kaciulyte J, Spissu N, Casella D, Ribuffo D, Dessy LA. Skin cancers and dermal substitutes: Is it safe? Review of the literature and presentation of a 2-stage surgical protocol for the treatment of non-melanoma skin cancers of the head in fragile patients. Int Wound J 2018; 15:756-768. [PMID: 29863792 DOI: 10.1111/iwj.12924] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/27/2018] [Indexed: 11/29/2022] Open
Abstract
Non-melanoma skin cancers (NMSC) represent the most common skin tumours of the head region. We describe the use of dermal substitute in a 2-stage surgery protocol for selected fragile patients to remove NMSC of the head region. A review of the literature focusing on dermal substitutes' safety after skin tumours excision is provided. A total of 45 fragile patients with NMSC in the head region were selected and scheduled for the 2-stage surgical protocol. The first stage consisted of traditional surgical excision and immediate coverage with Hyalomatrix (Fidia Advanced Biopolymers, Abano Terme, Italy). After histology confirmed diagnosis and clearance of the margins, full-thickness skin autografts were performed. All of the patients reached complete tumour excision and wound healing. No local recurrences were registered during 24 months follow up. The 2-stage surgical therapeutic-diagnostic-reconstructive approach represents a less stressful and oncologically safe surgical protocol in selected fragile patients. When patients cannot tolerate invasive and long surgical procedures, general anaesthesia, and long hospitalisation, skin grafting following temporary skin substitute coverage can achieve oncological clearance and provide good functional and aesthetic results. The use of dermal substitutes represents a valid alternative surgical option in cases of ASA III, fragile patients non-eligible for complex reconstructive surgery. To our knowledge, this is the first paper reviewing literature focusing on dermal substitutes' applications and safety after skin tumour excision.
Collapse
Affiliation(s)
- Marco Marcasciano
- Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Policlinico Umberto I, Roma, Italy
| | - Marco Mazzocchi
- Unit of Plastic and Reconstructive Surgery, Department of Surgery, Ospedale Santa Maria Della Misericordia, Perugia (PG), Italy
| | - Juste Kaciulyte
- Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Policlinico Umberto I, Roma, Italy
| | - Noemi Spissu
- UOC di Chirurgia Generale, Ospedale San Francesco, di Nuoro, Italy
| | - Donato Casella
- Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Policlinico Umberto I, Roma, Italy
| | - Diego Ribuffo
- Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Policlinico Umberto I, Roma, Italy
| | | |
Collapse
|
7
|
Fahradyan A, Howell AC, Wolfswinkel EM, Tsuha M, Sheth P, Wong AK. Updates on the Management of Non-Melanoma Skin Cancer (NMSC). Healthcare (Basel) 2017; 5:healthcare5040082. [PMID: 29104226 PMCID: PMC5746716 DOI: 10.3390/healthcare5040082] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 12/21/2022] Open
Abstract
Non-melanoma skin cancers (NMSCs) are the most common malignancy worldwide, of which 99% are basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) of skin. NMSCs are generally considered a curable diseases, yet they currently pose an increasing global healthcare problem due to rising incidence. This has led to a shift in emphasis on prevention of NMSCs with development of various skin cancer prevention programs worldwide. This article aims to summarize the most recent changes and advances made in NMSC management with a focus on prevention, screening, diagnosis, and staging.
Collapse
Affiliation(s)
- Artur Fahradyan
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
- Division of Plastic and Maxillofacial Surgery, Children's Hospital of Los Angeles, Los Angeles, CA 90027, USA.
| | - Anna C Howell
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
| | - Erik M Wolfswinkel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
| | - Michaela Tsuha
- Division of Plastic and Maxillofacial Surgery, Children's Hospital of Los Angeles, Los Angeles, CA 90027, USA.
| | - Parthiv Sheth
- Keck School of Medicine of University of Southern California, Los Angeles, CA 91001, USA.
| | - Alex K Wong
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
| |
Collapse
|