Predicting Response to Vismodegib in Locally Advanced Basal Cell Carcinoma
Posted: Monday, September 27, 2021
In a recent letter to the editor, Maria Concetta Fargnoli, MD, of L’Aquila, L’Aquila, Italy, and colleagues shared their real-world, multicenter, retrospective study findings aimed at evaluating the clinical determinants of complete response to the Hedgehog pathway inhibitor vismodegib in patients with locally advanced basal cell carcinoma. Their work, published in the Journal of the European Academy of Dermatology and Venereology, showed that dosing changes compromised complete response rates.
“If complete response is the goal of treatment in clinical practice, we recommend maintaining the full dose of vismodegib for at least 5 months, while implementing supportive and proactive management of adverse events,” suggested the authors. In addition, “the high-risk histologic subtype was the only baseline clinicopathologic independent predictor of a noncomplete response.”
A total of 45 patients were included in the retrospective analysis. Complete response versus noncomplete response was determined by clinical disappearance of basal cell carcinoma. Complete response was determined based on the evaluation of treatment variables and treatment-related adverse events and dose adjustments.
The authors revealed that 21 patients (46.7%) achieved complete responses. The median time for best response was 5 months (1.0–11.0 months), and the median complete response was 4.9 months (2.9–10.6 months). The median time to patient follow-up was 11.7 months (95% confidence interval [CI] = 7.9–18.5 months). Patients reported treatment-related adverse events 82.2% of the time, and 55.6% were higher than category 2. Dose adjustments to vismodegib were made in 53.3% of patients. Noncomplete response (odds ratio [OR] = 8.1; 95% CI = 2.026–32.590) and dose adjustments (OR = 4.9; 95% CI = 1.372–17.2; P = .012) tended to be associated with high-risk histologic subtypes.
Disclosure: For full disclosures of the study, authors visit onlinelibrary.wiley.com.
Journal of the European Academy of Dermatology and Venereology
