Systemic therapy for inoperable and metastatic basal cell cancer

Area of Science:

• Oncology
• Dermatology

Background:

• Cutaneous basal cell carcinoma (BCC) is the most common human cancer, with most cases treated by local therapies.
• Advanced BCC, including locally advanced (inoperable) and metastatic forms, can occur and has a poor prognosis with limited benefit from traditional chemotherapy.
• Aberrations in the sonic hedgehog (HH) signaling pathway are frequently observed in BCC, presenting a target for novel therapies.

Purpose of the Study:

• To review the current understanding of advanced basal cell carcinoma (BCC) treatment, focusing on novel molecular therapies targeting the sonic hedgehog (HH) pathway.
• To discuss the efficacy and limitations of systemic therapies, such as vismodegib, in managing advanced BCC.
• To emphasize the importance of multidisciplinary evaluation and patient monitoring for advanced BCC.

Main Methods:

• Review of existing literature on basal cell carcinoma (BCC) treatment modalities.
• Analysis of the role of sonic hedgehog (HH) pathway inhibitors in advanced BCC.
• Discussion of clinical considerations for systemic therapy, including resistance and side effect monitoring.

Main Results:

• Novel molecular therapies targeting the HH pathway, like vismodegib, demonstrate significant activity in advanced BCC.
• Systemic therapies are not curative and necessitate long-term treatment, regular monitoring for side effects and efficacy, and patient counseling.
• Multidisciplinary evaluation and consideration of patient-specific factors are crucial before initiating systemic treatment for advanced BCC.

Conclusions:

• Targeted therapies against the HH pathway offer a new avenue for treating advanced basal cell carcinoma (BCC).
• Systemic treatments require careful management, including monitoring for resistance and side effects, and should not replace potentially curative local therapies.
• A comprehensive approach involving experienced physicians, multidisciplinary tumor boards, and clinical trial enrollment is recommended for optimal patient care in advanced BCC.