Division of Dermatology, Department of Medicine, McGill University, Montreal, Canada.
Division of Dermatology, Department of Medicine, McGill University, Montreal, Canada.
J Am Acad Dermatol. 2018 Dec;79(6):1089-1100.e17. doi: 10.1016/j.jaad.2018.07.004. Epub 2018 Jul 10.
Sonic hedgehog inhibitors (SHHis) provide an additional treatment option for basal cell carcinomas (BCCs), especially for metastatic or locally advanced BCC. However, studies have been heterogeneous and lacked direct comparisons between molecules.
To determine the efficacy and safety of the class of molecules SHHi for treating BCC and to compare them individually.
We performed a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant systematic review of studies followed by a meta-analysis.
Eighteen articles were included in our meta-analysis; 16 articles were combined for efficacy and 16 for safety. In locally advanced BCC, overall response rates (ORRs) were similar for vismodegib and sonidegib (69% vs 57%, respectively) but not complete response rates (31% vs 3%, respectively). In metastatic disease, the ORR of vismodegib was 2.7-fold higher than the ORR of sonidegib (39% vs 15%, respectively). For side effects affecting a majority of patients, prevalences for muscle spasms (67.1%), dysgeusia (54.1%), and alopecia (57.7%) were in similar proportions for sonidegib and vismodegib. Patients receiving sonidegib experienced more upper gastrointestinal distress than patients receiving vismodegib.
SHHis induce a partial response to locally advanced BCC disease. Side effects are common, similar across molecules, associated with high discontinuation rates, and warrant discussion beforehand.
sonic hedgehog 抑制剂（SHHi）为基底细胞癌（BCC）提供了一种额外的治疗选择，尤其是对于转移性或局部晚期 BCC。然而，这些研究存在异质性，并且缺乏分子之间的直接比较。
确定 sonic hedgehog 抑制剂类药物治疗 BCC 的疗效和安全性，并对它们进行个体比较。
我们进行了一项符合 PRISMA（系统评价和荟萃分析的首选报告项目）标准的系统评价，并进行了荟萃分析。
我们的荟萃分析纳入了 18 篇文章；16 篇文章用于疗效合并，16 篇文章用于安全性合并。在局部晚期 BCC 中，维莫德吉和索尼德吉的总缓解率（ORR）相似（分别为 69%和 57%），但完全缓解率不同（分别为 31%和 3%）。在转移性疾病中，维莫德吉的 ORR 是索尼德吉的 2.7 倍（分别为 39%和 15%）。对于影响大多数患者的副作用，肌肉痉挛（67.1%）、味觉障碍（54.1%）和脱发（57.7%）在索尼德吉和维莫德吉中的发生率相似。接受索尼德吉治疗的患者比接受维莫德吉治疗的患者更易发生上消化道不适。
sonic hedgehog 抑制剂可诱导局部晚期 BCC 疾病部分缓解。副作用常见，各分子间相似，与高停药率相关，需要事先讨论。
