16h30 Hedgehog pathway inhibitors, a new way of treating basal cell carcinoma?

Keywords: locally advanced basal cell carcinoma, Hedgehog pathway inhibitors, neoadjuvant treatment, complex local flap reconstruction

Objectives: basal cell carcinoma (BCC) is the most common cancer in Caucasians. These tumours are characterised by a slow progression and rarely metastasize. Standard of treatment comprises of surgical excision with negative margins. However, for locally advanced tumours (laBCC), different treatment modalities may be considered according to specific patient characteristics. The recent use of Hedgehog pathway inhibitors (HPIs), such as Vismodegib and Sonidegib, plays an important role in the treatment of locally advanced, metastasized and recurrent BCC.

Material and Methods: ongoing research is being conducted to explore the potential benefit of immune modulating drugs versus surgery. Questions arise concerning the morbidity of complex facial reconstruction, possible adverse effects of immune modulating drugs (dysgeusia, muscle spasms, arthralgia…) and duration of its treatment. We conducted a literature review and a case report.

Results: this case presents an 80-year-old female with multifocal basal cell carcinomas. A large erosive lesion is located in the right paranasal area and two smaller ones in the left periocular region. Treatment of choice was neoadjuvant Sonidegib. Large excision and complex reconstruction were avoided because of mediocre general health condition. After ten months of treatment, the erosive aspect had a good response to Sonidegib, but tumour foci were still present in the original margins of the extensive lesion. Sonidegib was discontinued because of troublesome muscle spasms and multidisciplinary oncological counsel decided upon surgical treatment.

Conclusion: laBCC treatment is complex and often requires a multidisciplinary approach. Neoadjuvant administration of HPIs can be helpful to reduce tumour size but cannot avoid reconstruction in patients eligible for surgery.