Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
Int J Oral Maxillofac Surg. 2020 Sep;49(9):1149-1152. doi: 10.1016/j.ijom.2020.03.006. Epub 2020 Mar 20.
We report the case of a 71-year-old woman who developed advanced basal cell carcinoma (BCC) affecting the right eyebrow, invading the orbit. Globe displacement resulted in visual disturbances. Following multidisciplinary assessment, the tumour was deemed technically resectable for excision and right orbital exenteration. The patient however refused ablative surgical treatment; in view of her multiple comorbidities, the tumour was considered unresectable for her. Targeted therapy with vismodegib (Erivedge; Roche Pharmaceuticals) was therefore initiated in accordance with the patient's desire to avoid disfiguring surgery. After nine 28-day cycles of treatment, the tumour showed dramatic regression both clinically and radiographically. Mapping biopsies taken after 9 months confirmed the absence of any residual tumour, negating the need for ablative surgery. Grade 1 adverse events including muscle cramps, loss of taste, and reduced appetite were reported. Treatment was discontinued at 15 months owing to cumulative toxicity. The patient remains in remission 14 months after cessation of vismodegib. The use of vismodegib for advanced BCC is emerging and a number of reports exist. However, its application is mainly reserved for patients with locally advanced or metastatic disease, patients who are medically unfit for surgery, and cases where primary surgical resection would cause unacceptable disfigurement.
我们报告了一例 71 岁女性，她患有晚期基底细胞癌（BCC），影响右侧眉毛，侵犯眼眶。眼球移位导致视力障碍。经过多学科评估，认为肿瘤可以通过切除和右眼窝切除术进行技术上的切除。然而，患者拒绝接受消融性手术治疗；鉴于她的多种合并症，肿瘤对她来说是不可切除的。根据患者避免毁容手术的愿望，开始使用维莫德吉（Erivedge；罗氏制药）进行靶向治疗。经过 9 个 28 天的治疗周期，肿瘤在临床和影像学上都有明显消退。9 个月后进行的活检证实没有任何残留肿瘤，无需进行消融性手术。报告了 1 级不良反应，包括肌肉痉挛、味觉丧失和食欲减退。由于累积毒性，治疗在 15 个月时停止。维莫德吉停药 14 个月后，患者仍处于缓解期。维莫德吉治疗晚期 BCC 正在出现，已有许多报告。然而，其应用主要保留给局部晚期或转移性疾病患者、不适合手术的患者，以及原发手术切除会导致不可接受的毁容的患者。
