Skin cancer drug shows periocular promise

By Lynda Williams, Senior medwireNews Reporter

Early research suggests that patients with periocular basal cell carcinoma (BCC) may benefit from treatment with a drug targeting the Hedgehog signaling pathway.

Results from seven patients with locally advanced, infiltrative BCC who were given the smoothened receptor antagonist vismodegib are reported in JAMA Ophthalmology.

All of the patients, who were aged an average of 71 years, had recurrent disease after excision and were unsuitable for further surgery or radiotherapy, say Harmeet Gill (University of Toronto, Ontario, Canada) and co-authors.

After an average of 11 weeks of oral treatment at 150 mg/day and 7.3 months of follow-up, two patients had achieved complete tumor regression. A further two patients achieved more than 80% tumor regression and two patients showed less than 35% regression, while one patient experienced progression.

Although the patient with progression had secondary orbital involvement, three of the four patients with orbital extension achieved partial regression, suggesting that orbital involvement may not predict tumor response to vismodegib, the researchers comment.

“In this new era of molecular medicine, vismodegib offers a promising alternative to destructive surgery or radiation for aggressive BCCs of the periocular region,” Gill et al write.

Following treatment, new squamous cell carcinomas were detected in two patients at the eyebrow and the forearm, areas that were unaffected by the original BCC. These tumors were well differentiated, keratocanthoma type tumors, and similar to the skin cancers reported with the use of other biologic anti-cancer agents, the researchers observe.

Six of the patients reported adverse events during treatment including muscle cramps (29%), alopecia (29%), a distorted sense of taste (29%), and anorexia (14%) but these were considered “tolerable.”

Gill et al therefore caution: “Patients receiving treatment should be counseled about common adverse reactions and monitored for new squamous cell carcinomas at uninvolved sites.”

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