A small-molecule drug inhibitor called vismodegib successfully treated a dire case of infiltrative basal cell carcinoma. According to the authors, this case qualifies as a first to report a complete remission for this subset of skin cancer.
Basal cell carcinoma (BCC) is one of the most common types of skin cancer. For patients with locally advanced, recurrent or metastatic subsets of BCC who are not eligible for surgery or radiotherapy, small-molecule drug inhibitors provide a viable therapy option.
A case study published in Dermatologic Therapy (1) showed a complete recovery from a unique case of infiltrative basal cell carcinoma (BCC) in a patient taking vismodegib. A 48-year-old man developed an extensive tumour on the nose. The pathological explanation of a large, pigmented ulcerative plaque on the nose confirmed the diagnosis of infiltrative BCC. With no family history of cancer or signs of malignancy, the tumour was excised surgically. Unfortunately, a re-examination of the excised tumour revealed an incomplete excision warranting radiotherapy as a secondary course of treatment. The patient received local radiation therapy over a series of 24 treatments. Unfortunately, this course of action also failed, leading to the development of lesions, crusts, severe edema and inflammation in the nasal region. Administration of Imiquinoid cream and further surgical interventions failed to combat the cancer, which rapidly developed into an infiltrative subtype.
The patient underwent different treatments for more than a decade. Finally, vismodegib therapy was started in March 2016 and resulted in a marked improvement after three consecutive 28-day cycles. Along with a dramatic decrease in the tumour size and significant lesion healing. There were no reported side effects and after eight months of therapy, the skin biopsy showed no signs of residual BCC. To the authors’ knowledge, complete remission was achieved with three months of drug administration. Vismodegib, approved by the FDA in 2012, is a small molecule that inhibits a vital signalling pathway at the cellular level.
Even though there are cases of complete recovery, the occurrence of secondary malignancies remains high. Recent studies have shown that there is a significant risk of developing cutaneous squamous cell carcinoma (SCC) soon after initiation of vismodegib therapy. However, when all conventional treatment options are exhausted, vismodegib is a valuable tool.
Written by Akshita Wason, B. Tech, PhD
- Zargari, Omid, SeyyedeZeinabAzimi, and SiamakGeranmayeh. “Inoperable infiltrative basal cell carcinoma successfully treated with vismodegib.” Dermatologic Therapy(2017).