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Danhof R, Lewis K, Brown M. Small Molecule Inhibitors of the Hedgehog Pathway in the Treatment of Basal Cell Carcinoma of the Skin. Am J Clin Dermatol 2018; 19:195-207. [PMID: 28887802 DOI: 10.1007/s40257-017-0319-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Basal cell carcinoma (BCC) is the most common type of skin cancer, with rising incidence rates primarily attributed to an aging population and ultraviolet radiation exposure. While the majority of BCCs are localized and respond to standard therapies, a very small minority of these tumors become locally destructive or metastasize. These advanced BCCs may not be amenable to localized treatment with surgery and/or radiation therapy. Most BCCs result from mutations in key receptors in the Hedgehog (HH) signaling pathway. As a result, identification of drugs that inhibit the receptor Smoothened (SMO) in the HH pathway has resulted in novel therapeutic approaches to treating patients with advanced BCC. These HH-pathway inhibiting medications have shown efficacy in clinical trials, and two medications, vismodegib and sonidegib, have received FDA approval. However, several limitations of these drugs have been identified, including treatment-limiting adverse events, drug resistance, and the formation of additional malignancies. This paper aims to summarize the clinical trials leading to the approval of SMO inhibitors, as well as reviewing potential mechanisms driving tumor resistance and the formation of cutaneous squamous cell carcinomas. Strategies to overcome some of these challenges, including the development of drugs that inhibit other downstream targets in the HH pathway, are the subject of ongoing clinical trials.
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Affiliation(s)
- Rebecca Danhof
- Department of Dermatology, Mayo Clinic College of Medicine and Science, Onalaska, WI, USA
| | - Karl Lewis
- Division of Hematology and Oncology, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mariah Brown
- Department of Dermatology, University of Colorado School of Medicine, Mail Stop F703, 1665, North Aurora Court, Aurora, CO, 80045, USA.
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Takebe N, Miele L, Harris PJ, Jeong W, Bando H, Kahn M, Yang SX, Ivy SP. Targeting Notch, Hedgehog, and Wnt pathways in cancer stem cells: clinical update. Nat Rev Clin Oncol 2015; 12:445-64. [PMID: 25850553 PMCID: PMC4520755 DOI: 10.1038/nrclinonc.2015.61] [Citation(s) in RCA: 924] [Impact Index Per Article: 102.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
During the past decade, cancer stem cells (CSCs) have been increasingly identified in many malignancies. Although the origin and plasticity of these cells remain controversial, tumour heterogeneity and the presence of small populations of cells with stem-like characteristics is established in most malignancies. CSCs display many features of embryonic or tissue stem cells, and typically demonstrate persistent activation of one or more highly conserved signal transduction pathways involved in development and tissue homeostasis, including the Notch, Hedgehog (HH), and Wnt pathways. CSCs generally have slow growth rates and are resistant to chemotherapy and/or radiotherapy. Thus, new treatment strategies targeting these pathways to control stem-cell replication, survival and differentiation are under development. Herein, we provide an update on the latest advances in the clinical development of such approaches, and discuss strategies for overcoming CSC-associated primary or acquired resistance to cancer treatment. Given the crosstalk between the different embryonic developmental signalling pathways, as well as other pathways, designing clinical trials that target CSCs with rational combinations of agents to inhibit possible compensatory escape mechanisms could be of particular importance. We also share our views on the future directions for targeting CSCs to advance the clinical development of these classes of agents.
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Affiliation(s)
- Naoko Takebe
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institute of Health, 9609 Medical Center Drive MSC9739, Bethesda, MD 20852, USA (N.T., P.J.H., S.P.I.). Stanley Scott Cancer Center, Louisiana State University Health Sciences Center and Louisiana Cancer Research Consortium, USA (L.M.). Cancer Therapy and Research Center, University of Texas, USA (W.J.). Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Japan (H.B.). Norris Comprehensive Cancer Research Center, University of Southern California, USA (M.K.). National Clinical Target Validation Laboratory, Division of Cancer Treatment and Diagnosis, National Cancer Institute, USA (S.X.Y.)
| | - Lucio Miele
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institute of Health, 9609 Medical Center Drive MSC9739, Bethesda, MD 20852, USA (N.T., P.J.H., S.P.I.). Stanley Scott Cancer Center, Louisiana State University Health Sciences Center and Louisiana Cancer Research Consortium, USA (L.M.). Cancer Therapy and Research Center, University of Texas, USA (W.J.). Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Japan (H.B.). Norris Comprehensive Cancer Research Center, University of Southern California, USA (M.K.). National Clinical Target Validation Laboratory, Division of Cancer Treatment and Diagnosis, National Cancer Institute, USA (S.X.Y.)
| | - Pamela Jo Harris
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institute of Health, 9609 Medical Center Drive MSC9739, Bethesda, MD 20852, USA (N.T., P.J.H., S.P.I.). Stanley Scott Cancer Center, Louisiana State University Health Sciences Center and Louisiana Cancer Research Consortium, USA (L.M.). Cancer Therapy and Research Center, University of Texas, USA (W.J.). Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Japan (H.B.). Norris Comprehensive Cancer Research Center, University of Southern California, USA (M.K.). National Clinical Target Validation Laboratory, Division of Cancer Treatment and Diagnosis, National Cancer Institute, USA (S.X.Y.)
| | - Woondong Jeong
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institute of Health, 9609 Medical Center Drive MSC9739, Bethesda, MD 20852, USA (N.T., P.J.H., S.P.I.). Stanley Scott Cancer Center, Louisiana State University Health Sciences Center and Louisiana Cancer Research Consortium, USA (L.M.). Cancer Therapy and Research Center, University of Texas, USA (W.J.). Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Japan (H.B.). Norris Comprehensive Cancer Research Center, University of Southern California, USA (M.K.). National Clinical Target Validation Laboratory, Division of Cancer Treatment and Diagnosis, National Cancer Institute, USA (S.X.Y.)
| | - Hideaki Bando
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institute of Health, 9609 Medical Center Drive MSC9739, Bethesda, MD 20852, USA (N.T., P.J.H., S.P.I.). Stanley Scott Cancer Center, Louisiana State University Health Sciences Center and Louisiana Cancer Research Consortium, USA (L.M.). Cancer Therapy and Research Center, University of Texas, USA (W.J.). Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Japan (H.B.). Norris Comprehensive Cancer Research Center, University of Southern California, USA (M.K.). National Clinical Target Validation Laboratory, Division of Cancer Treatment and Diagnosis, National Cancer Institute, USA (S.X.Y.)
| | - Michael Kahn
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institute of Health, 9609 Medical Center Drive MSC9739, Bethesda, MD 20852, USA (N.T., P.J.H., S.P.I.). Stanley Scott Cancer Center, Louisiana State University Health Sciences Center and Louisiana Cancer Research Consortium, USA (L.M.). Cancer Therapy and Research Center, University of Texas, USA (W.J.). Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Japan (H.B.). Norris Comprehensive Cancer Research Center, University of Southern California, USA (M.K.). National Clinical Target Validation Laboratory, Division of Cancer Treatment and Diagnosis, National Cancer Institute, USA (S.X.Y.)
| | - Sherry X. Yang
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institute of Health, 9609 Medical Center Drive MSC9739, Bethesda, MD 20852, USA (N.T., P.J.H., S.P.I.). Stanley Scott Cancer Center, Louisiana State University Health Sciences Center and Louisiana Cancer Research Consortium, USA (L.M.). Cancer Therapy and Research Center, University of Texas, USA (W.J.). Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Japan (H.B.). Norris Comprehensive Cancer Research Center, University of Southern California, USA (M.K.). National Clinical Target Validation Laboratory, Division of Cancer Treatment and Diagnosis, National Cancer Institute, USA (S.X.Y.)
| | - S. Percy Ivy
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institute of Health, 9609 Medical Center Drive MSC9739, Bethesda, MD 20852, USA (N.T., P.J.H., S.P.I.). Stanley Scott Cancer Center, Louisiana State University Health Sciences Center and Louisiana Cancer Research Consortium, USA (L.M.). Cancer Therapy and Research Center, University of Texas, USA (W.J.). Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Japan (H.B.). Norris Comprehensive Cancer Research Center, University of Southern California, USA (M.K.). National Clinical Target Validation Laboratory, Division of Cancer Treatment and Diagnosis, National Cancer Institute, USA (S.X.Y.)
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Basset-Seguin N, Sharpe HJ, de Sauvage FJ. Efficacy of Hedgehog pathway inhibitors in Basal cell carcinoma. Mol Cancer Ther 2015; 14:633-41. [PMID: 25585509 DOI: 10.1158/1535-7163.mct-14-0703] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 12/01/2014] [Indexed: 11/16/2022]
Abstract
Basal cell carcinoma (BCC) is the most commonly diagnosed cancer. While most BCCs are amenable to surgery, some tumors can reach a more advanced stage or metastasize, and become ineligible for surgical resection or radiotherapy. Abnormal activation of the Hedgehog (Hh) pathway is a key driver in BCC pathophysiology. Consequently, inhibitors of the Hh pathway have been developed. Molecules that inhibit the receptor protein Smoothened (SMO) are the most advanced in clinical development. Vismodegib is the first-in-class SMO inhibitor and has been approved in a number of countries for the treatment of metastatic or locally advanced BCC. Several molecules have demonstrated antitumoral activity, but treatment may be limited in duration by a number of side effects, and it is not yet established whether these agents are truly curative or whether continued treatment will be required. Resistance to SMO inhibition has been reported in the clinic for which incidence and mechanisms must be elucidated to inform future therapeutic strategies. Intermittent dosing regimens to improve tolerability, as well as neoadjuvant use of Hh pathway inhibitors, are currently under investigation. Here, we review the most recent outcomes obtained with Hh inhibitors under clinical investigation in BCC.
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Affiliation(s)
- Nicole Basset-Seguin
- Paris 7 Hôpital Saint-Louis, Paris, France. Department of Molecular Oncology, Genentech Inc., South San Francisco, California
| | - Hayley J Sharpe
- Department of Molecular Oncology, Genentech Inc., South San Francisco, California
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