Diagnosis and Treatment of Locally Advanced Basal Cell Carcinoma: A Registry Study

By: Gavin Calabretta, BS
Posted: Wednesday, March 9, 2022

Advanced basal cell carcinoma follows a highly variable course, and historically, there is no standard chemotherapy regimen for the disease when it is locally advanced or metastatic. The effectiveness of radiation therapy and surgical resection changes drastically with patient characteristics, including lesion location, prior treatment, and presence of genetic syndromes. With these issues in mind, Mario Lacouture, MD, of Memorial Sloan Kettering Cancer Center, New York, and colleagues performed a registry study spanning 75 institutions to identify treatment patterns with associated safety and efficacy data. Their results were published in PLOS One.

The study enrolled 433 patients from the RegiSONIC study (an observational study of treatment patterns and effectiveness and safety outcomes in advanced basal cell carcinoma and basal cell carcinoma nevus syndrome patients). None of the patients selected from the study had nevus syndrome or a history of treatment with Hedgehog pathway inhibitors. Patient data including previous medical conditions and procedures, changes in medication, adverse events, disease status, and tumor response were collected.

The authors found that determination of locally advanced basal cell carcinoma was based most often on lesion size (79.6%), histopathology (54.3%), extent of tumor involvement (49.0%), location (46.2%), recurrence (26.7%), and likelihood of curative resection (25.3%). Within the first 3 months of diagnosis of locally advanced disease, 27% of patients received the Hedgehog pathway inhibitor vismodegib, 58% received surgery or other non-vismodegib treatment, and 16% had not yet started treatment.

Respectively, vismodegib and non-vismodegib treatment yielded clinical response rates of 85.1% and 94.9%. In addition, patients who received vismodegib, compared with those who received other treatment, had an increased frequency of high-risk characteristics predictive of locoregional recurrence; also, the recurrence rate itself was higher (23.8% vs. 2.0%). Common adverse events included ageusia/dysgeusia, muscle spasms, weight loss, and alopecia.

Disclosure: For full disclosures of the study authors, visit journals.plos.org.

PLOS One