Dr Deek on Vismodegib Plus Radiation in Locally Advanced Unresectable Basal Cell Carcinoma

With regard to basal cell carcinoma, we're starting to have increasing evidence to support multidisciplinary care, integrating both systemic therapy and radiation therapy, especially for very large or unresectable tumors.”

Matthew P. Deek, MD, radiation oncologist, assistant professor, Division of Clinical Radiation Oncology, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, discusses the role of multidisciplinary approaches for the treatment of patients with locally advanced unresectable basal cell carcinoma (BCC).

Specifically, he highlights findings from a phase 2 single-arm trial (NCT01835626) evaluating the integration of vismodegib (Erivedge), a hedgehog pathway inhibitor, with curative-intent radiation therapy for this patient population. During the study, patients received 12 weeks of induction therapy consisting of vismodegib monotherapy, following by 7 weeks of concurrent vismodegib and radiotherapy.

Preliminary results demonstrated a locoregional control rate of 91% (95% CI, 68%-98%) at 1 year. The overall response rate was 63% (95% CI, 38%-84%) following induction therapy with vismodegib alone, which improved to 83% (95% CI, 59%-96%) after concurrent vismodegib and radiation therapy. At a median follow-up of 5.7 years, the 1-year progression-free survival (PFS) and overall survival (OS) rates were 100% and 96%, respectively; the respective 5-year PFS and OS rates were 78% and 83%.

For patients with unresectable BCC, a single-modality approach, such as radiotherapy alone, often yields suboptimal results due to the complexity and size of these tumors, Deek explains. This trial demonstrated the feasibility and effectiveness of combining vismodegib with definitive radiation therapy in this patient population, he adds.

This trial and other emerging data highlight the evolving role of systemic therapy and the need for a multidisciplinary approach for patients with locally advanced unresectable BCC, he continues. Tailoring treatment plans to individual patients is key in the management of locally advanced unresectable BCC, he concludes.