Vismodegib: First-in-Class Hedgehog Pathway Inhibitor for Metastatic or Locally Advanced Basal Cell Carcinoma

© 2014 Harborside Press® Skin cancer is the most common cancer type in the United States, affecting more than 3 million people nationally (Cirrone & Harris, 2012). Basal cell carcinoma (BCC) and squamous cell carcinoma are the two main types of nonmelanoma skin cancer, while the more serious form, melanoma, is in its own category. An estimated 80% of nonmelanoma skin cancers are BCCs (Sekulic et al., 2012). Features such as stage, cancer history, and extent of disease determine BCC prognosis (Crowson, 2006). Basal cell carcinoma rarely metastasizes but is capable of local tissue destruction and commonly occurs in the geriatric patient population. The initial presentation of BCC is generally a pigmented nodule on the head or neck. Risk factors for BCC include chronic sun exposure; fair complexion; male gender; history of nonmelanoma skin cancer; family history of skin cancer; history of chronic arsenic exposure; or chronic immunosuppression, such as in lymphoma, transplant, or HIV-positive patients (Crowson, 2006). Topical agents such as imiquimod or fluorouracil (5-FU) can be used in low-risk superficial BCC (Fellner, 2012). However, surgery is the initial treatment for BCC. Complete excision of the tumor is preferred. Adjunctive radiation therapy is needed if the tumor margins were not adequately cleared during surgery. If surgery is impossible due to the location of the cancer or other complications, systemic chemotherapy agents such as 5-FU and cisplatin can be considered alternative options. With the approval of vismodegib (Erivedge), patients with metastatic or locally advanced BCC who are unable to undergo surgery now have a treatment alternative that may provide a beneficial outcome. Vismodegib is approved for metastatic BCC or locally advanced BCC that has recurred following surgery, or for those who are not candidates for surgery and who are not candidates for radiation therapy (Fellner, 2012).