Intermittent Vismodegib Regimen for Locally Advanced Basal Cell Carcinoma
Posted: Thursday, March 21, 2019
A transition from continuous to intermittent vismodegib therapy may improve health-related quality of life for patients with locally advanced basal cell carcinoma. The Hedgehog pathway inhibitor vismodegib is an effective but toxic agent approved for the treatment of patients with locally advanced and metastatic basal cell carcinomas who are ineligible for surgery and/or radiotherapy. In light of the reportedly high rate of vismodegib-emergent adverse effects (at least 95% of patients), the authors sought to ascertain whether an altered regimen could improve patients’ quality of life. Study findings were reported by Giulio Gualdi, MD, of the ASST Spedali Civili, Brescia, Italy, and colleagues in the British Journal of Dermatology.
In this study, 10 patients with locally advanced basal cell carcinoma completed the Pictorial Representation of Illness and Self Measure test to quantify perceived quality of life during vismodegib therapy. The test was administered prior to commencement of treatment as well as at 9 subsequent visits thereafter, in 28-day intervals. Health-related quality of life was expressed as a Self-Illness Separation (SIS) score, where a smaller distance signified a greater magnitude of suffering.
At day 0, the mean reported SIS score was 9.52 cm. This value rose sharply over the first two treatment cycles, then more gradually as adverse effects accumulated. In the fifth and sixth cycles, coinciding with clinical remission, SIS scores declined, reaching a nadir on day 168 of treatment. Vismodegib was not taken between days 168 and 196 or between days 224 and 252 (cycles 7 and 9), leading to maintenance of clinical remission as well as stabilization of adverse effects and mean SIS scores.
Further study is warranted to confirm the benefit of intermittent vismodegib therapy.
Disclosure: The study authors reported no conflicts of interest.