Pharmacy and Wellness Review


The most prevalent nonmelanoma skin cancers are basal cell carcinoma (BCC) and locally advanced basal cell carcinoma (aBCC). Current, effective first-line treatments for BCC aim to remove and destroy cancerous skin cells through excision surgery, Mohs surgery, radiation therapy and cryotherapy, while treatment of aBCC remains limited. An emerging treatment option for aBCC that promotes tumor size reduction is vismodegib, a pharmaceutical product approved in 2012 by the U.S. Food and Drug Administration (FDA). Vismodegib was approved for the treatment of aBCC, metastasized HCC (mBCC) or recurrent BCC after surgery as well as for use in adults who are not candidates for surgery or radiation. Vismodegib is an inhibitor of the hedgehog (Hh) pathway which is essential for cell differentiation and organ formation in embryonic development. When the Hh pathway is inappropriately activated in tissues, Hh pathway cellular growth mechanisms promote the formation of several carcinomas. Two studies reported similar responses of tumor reduction to vismodegib in patients with aBCC and mBCC. One reported the assessed response rate of 30 percent tumor shrinkage in patients with mBCC and a response rate of 43 percent tumor shrinkage in patients with aBCC. Another reported objective responses in 46.4 percent of aBCC and 30.8 percent in mBCC. While vismodegib is an option for treatment, caution should be used. Pharmacists play a critical role by counseling on proper skin care, potential drug interactions and the different side effects of treatment. Vismodegib should be continuously studied as there is currently not enough information on long-term treatment options for patients.



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